Summary of findings 1. Single component intervention compared to control for chronic obstructive pulmonary disease (COPD).
| Single component intervention compared to control for chronic obstructive pulmonary disease (COPD) | |||||||
| Patient or population: COPD Setting: multi‐centre, outpatient pulmonary clinic, medical centre Intervention: single component intervention (change to pharmacotherapy, adherence aids) Comparison: control | |||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | ||
| Risk with control | Risk with single component intervention | ||||||
|
Adherence to pharmacotherapy: number of people completing treatment |
Change to pharmacotherapy 16 weeks' follow‐up |
429 people per 1000 | 334 people per 1000 (142 to 599) | OR 0.67 (0.22 to 1.99) | 55 (1 RCT) | ⊕⊕⊝⊝ Lowa,b | — |
|
Quality of life: SGRQ total or CCQ |
Change to pharmacotherapy SGRQ total score: 52 weeks' follow‐up Scale 0–100 lower scores represent better outcome |
The mean change in the SGRQ total score was –2.6 | MD 0.80 higher (3.12 lower to 4.72 higher) | — | 212 (1 RCT) | ⊕⊝⊝⊝ Very lowc,d | MID was 4 points change (Jones 2005; Welling 2015) |
|
Adherence aids CCQ total: 26 weeks' follow‐up Scale 0–7, lower scores represent better outcome |
The mean change in the CCQ total score was –0.2 | MD 0.4 higher (0.07 higher to 0.73 higher) | — | 137 (1 RCT) |
⊕⊝⊝⊝ Very lowe,f | MID was 0.4 (Kocks 2006) | |
|
Hospital service utilisation: number of people admitted to hospital (all cause) |
Change to pharmacotherapy 52 weeks' follow‐up |
171 people per 1000 | 233 people per 1000 (134 to 375) | OR 1.47 (0.75 to 2.90) | 212 (1 RCT) | ⊕⊝⊝⊝ Very lowb,c | — |
|
Exacerbations: number of people experiencing exacerbations |
Change to pharmacotherapy Mean 43.7 weeks' follow‐up** |
338 people per 1000 | 308 people per 1000 (207 to 434) | OR 0.87 (0.51 to 1.50) | 267 (2 RCTs) | ⊕⊝⊝⊝ Very lowb,c | — |
|
Adverse events: number of people experiencing adverse events (all cause or COPD‐related), serious adverse events, mortality |
Change to pharmacotherapy or adherence aids Adverse events (all‐cause) Mean 37.6 weeks' follow‐upg |
433 people per 1000 | 410 people per 1000 (311 to 517) | OR 0.92 (0.60 to 1.41) | 404 (3 RCTs) | ⊕⊝⊝⊝ Very lowc,h,i | — |
|
Change to pharmacotherapy Adverse events (COPD‐related) 52 weeks' follow‐up |
314 people per 1000 | 306 people per 1000 (198 to 441) | OR 0.96 (0.54 to 1.72) | 213 (1 RCT) | ⊕⊝⊝⊝ Very lowc,i | — | |
|
Change to pharmacotherapy or adherence aids Serious adverse events Mean 41.6 weeks follow‐upg |
120 people per 1000 | 176 people per 1000 (105 to 281) | OR 1.57 (0.86 to 2.87) | 350 (2 RCTs) | ⊕⊝⊝⊝ Very lowb,c | — | |
|
Change to pharmacotherapy Mortality 52 weeks' follow‐up |
19 people per 1000 | 9 people per 1000 (1 to 96) | OR 0.49 (0.04 to 5.44) | 212 (1 RCT) | ⊕⊝⊝⊝ Very lowc,i | — | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval;CCQ: Clinical COPD Questionnaire; COPD: chronic obstructive pulmonary disease; MD: mean difference; MID: minimal important difference; OR: odds ratio; RCT: randomised controlled trial; SGRQ: St George's Respiratory Questionnaire. | |||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | |||||||
aDowngraded one level for limitations in risk of bias performance, detection and selective reporting bias. bDowngraded one level for imprecision due to confidence interval crossing the line of no effect. cDowngraded two levels for limitations due to performance, detection, attrition and selective reporting bias. dDowngraded two levels for imprecision due to very wide confidence intervals. eDowngraded two levels for limitations in risk of bias due to performance and detection, selective reporting, and unclear risk for allocation concealment and attrition. fDowngraded one level for imprecision due to optimal information size less than 200 participants. gWeighted mean duration (weeks). hDowngraded one level for indirectness due to one trial that compared roflumilast at different dosages, whereas the other two trials compared different inhaler types. iDowngraded two levels for imprecision due to very wide confidence intervals.