Summary of findings for the main comparison. Inhaled corticosteroids dose‐response effect.
| Inhaled corticosteroids dose‐response effect | ||||||
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Patient or population: children with persistent asthma
Settings: outpatients
Intervention: lower‐dose inhaled corticosteroids Control: higher‐dose ICS | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control group (higher‐dose ICS) | Intervention group (lower‐dose ICS) | |||||
| Growth velocity over 12 months (cm/y) (higher is better) | Mean growth velocity was 5.74 cm/y (range, 5.6 to 5.88) | Corresponding growth velocity on lower‐dose ICS was 0.2 cm/y higher: mean 5.94 cm/y (95% CI 5.76 to 6.13) | MD 0.20 (0.02 to 0.39) | 728 (4 studies) | ⊕⊕⊕⊕ high | Skoner 2011 data analysed using LRS model were used |
|
Change in height over 3 months (cm) (higher is better) |
Unadjusted mean change in height over 3 months was 1.34 cm (range, 0.9 to 1.8 cm) | Corresponding unadjusted change in height on lower‐dose ICS was 0.15 cm lower: mean 1.19 cm (95% CI 1.06 to 1.32) | MD ‐0.15 (‐0.28 to ‐0.02) | 944 (9 studies) | ⊕⊕⊝⊝ moderate1 | Data analysis was unadjusted for confounders |
| Change in height over 12 months (cm) (higher is better) | Unadjusted mean change in height over a year was 4.56 cm (range, 3.6 to 5.73 cm) | Corresponding unadjusted change in height on lower‐dose ICS was 0.25 cm higher; mean 4.81 cm (95% CI 4.52 to 5.1) | MD 0.25 (‐0.04 to 0.54) | 548 (4 studies) | ⊕⊕⊝⊝ moderate1 | Data analysis was unadjusted for confounders |
|
Change in SD scores over 12 months (height) (low change is better) |
Unadjusted mean change in SD score was ‐0.18 (range, ‐0.01 to ‐0.27) | Corresponding mean unadjusted change on lower‐dose ICS was 0.08 less; mean ‐0.10 (95% CI ‐0.21 to 0.02) | MD 0.08 (‐0.03 to 0.20) | 328 (3 studies) | ⊕⊕⊝⊝ moderate1 | Data analysis was unadjusted for confounders |
| Change in weight over 12 months (kg) (higher is better) | Mean change in weight was 3.4 kg | Corresponding mean change in weight on lower‐dose ICS was 0.3 kg lower: mean 3.1 (95% CI 2.58 to 3.62) | MD ‐0.30 (‐0.82 to 0.22) | 408 (1 study) | ⊕⊕⊝⊝ low2 | Based on only 1 trial |
| Change in BMI over 12 months (kg/m2) (higher is better) | Mean change in BMI was 0.7 kg/m2 | Corresponding mean change in BMI on lower‐dose ICS was 0.2 kg/m2 less: mean 0.5 (95% CI 0.21 to 0.79) | MD ‐0.20 (‐0.49 to 0.09) | 408 (1 study) | ⊕⊕⊝⊝ low2 | Based on only 1 trial |
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Change in skeletal maturation over 12 months (years) (higher is better) |
Mean change in skeletal maturation was 0.95 years | Corresponding mean change in skeletal maturation on lower‐dose ICS was 0.18 years more; mean 1.13 (95% CI 0.97 to 1.29) | MD 0.18 (0.02 to 0.34) | 181 (1 study) | ⊕⊕⊝⊝ low2 | Based on only 1 trial |
| *The basis for the assumed risk was the weighted mean control group risk across studies. The corresponding risk (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. | ||||||
| GRADE Working Group grades of evidence. High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1Data analysis was unadjusted for confounders.
2Based on only 1 trial.