Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is high or moderate to high where GRADE has been performed and the intervention is more effective/beneficial than the comparison for key outcomes.
Population: Adults with COPD
Intervention: IDM ᵃ
Comparison: Usual care (regular follow-up visits with healthcare providers)
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Quality of life (>6 to 15 months): St. George’s Respiratory Questionnaire (SGRQ) ᵇ | Favors intervention | Moderate |
Functional exercise capacity (>6 to 15 months) | Favors intervention | Moderate |
Respiratory‐related hospital admissions (12 months) | Favors intervention | High |
All hospital admissions | Favors intervention | Moderate |
Hospital days per patient (all causes) | Favors intervention | Moderate |
Emergency Department visits | Favors intervention | Moderate |
Number of patients experiencing ≥ 1 exacerbation | No statistically significant difference | GRADE assessment not performed for this outcome |
Mortality | No statistically significant difference | GRADE assessment not performed for this outcome |
Need for at least one course of oral steroids | No statistically significant difference | GRADE assessment not performed for this outcome |
Need for at least one course of antibiotics | No statistically significant difference | GRADE assessment not performed for this outcome |
Note The Cochrane review which underpins this Cochrane Clinical Answer (CCA) notes that the effects of IDM are better in the short and medium term, and that the effect size was different between included studies and interventions. IDM should be carefully designed and evaluated, consisting of different components which are linked to the personal goals of the patient. ᵃ Including organizational, professional, patient-directed, and financial interventions in primary, secondary, and tertiary healthcare settings. See CCA and the underlying Cochrane review for more information on specific interventions and the dominant components of the IDM programs. ᵇ Although statistically significant, this result did not quite reach the minimum clinically important difference. The CCA also reports a subgroup analysis for quality of life measured by the Chronic Respiratory Questionnaire. However, this was only reported in two studies and the analysis was underpowered.
This evidence table is related to the following section/s:
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is high or moderate to high where GRADE has been performed and the intervention is more effective/beneficial than the comparison for key outcomes.
Population: Adults with moderate-to-severe COPD
Intervention: Umeclidinium (once daily via a dry powder inhaler for 12-52 weeks)
Comparison: Placebo
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Number of participants with exacerbations requiring corticosteroids, antibiotics, or both at 52 weeks | Favors intervention | High |
Quality of life at 24-52 weeks (measured by the St George's Respiratory Questionnaire [SGRQ]) | Favors intervention | Moderate |
Number of participants with hospital admissions due to COPD exacerbation at 52 weeks (measured by the Transitional Dyspnea Index [TDI]) | No statistically significant difference | Low |
Improvement in symptoms at 24 weeks | Favors intervention | High |
Lung function at 4-52 weeks | Favors intervention | High |
Nonfatal serious adverse events | No statistically significant difference | Moderate |
Adverse events | No statistically significant difference | Moderate |
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- What are the effects of integrated disease management (IDM) interventions for people with chronic obstructive pulmonary disease (COPD)?
- How does tiotropium compare with ipratropium bromide for people with chronic obstructive pulmonary disease (COPD)?
- How does umeclidinium bromide compare with placebo for people with chronic obstructive pulmonary disease (COPD)?
- How does a combined inhaler with once‐daily long‐acting beta2‐agonist (LABA) plus a long‐acting muscarinic antagonist (LAMA) compare with placebo for adults with chronic obstructive pulmonary disease (COPD)?
- How does long‐acting muscarinic antagonist (LAMA) plus long‐acting beta‐agonist (LABA) compare with LABA plus inhaled corticosteroid (ICS) for people with stable chronic obstructive pulmonary disease (COPD)?
- What are the longer-term (>6 months) effects of inhaled corticosteroids in people with stable chronic obstructive pulmonary disease?
- What are the benefits and harms of inhaled corticosteroids (ICS) in people with stable chronic obstructive pulmonary disease (COPD)?
- What are the effects of long‐acting inhaled therapies for adults with chronic obstructive pulmonary disease (COPD)?
- How do phosphodiesterase‐4 inhibitors compare with placebo for people with chronic obstructive pulmonary disease?
- What are the effects of prophylactic antibiotics for people with chronic obstructive pulmonary disease (COPD)?
- Which interventions lead to increased regular physical activity for people with chronic obstructive pulmonary disease (COPD)?
- What are the effects of influenza vaccine in people with chronic obstructive pulmonary disease (COPD)?
- For people with chronic bronchitis or chronic obstructive pulmonary disease, how do mucolytic agents compare with placebo?
- What are the effects of pulmonary rehabilitation after exacerbation in people with chronic obstructive pulmonary disease?
- For people with chronic obstructive pulmonary disease (COPD), what are the effects of a supervised maintenance program after pulmonary rehabilitation?
- How does bronchoscopic lung volume reduction compare with medical therapy in people with chronic obstructive pulmonary disease?
- How do statins compare with placebo for people with chronic obstructive pulmonary disease (COPD)?
- How does lung volume reduction surgery compare with usual medical care in people with diffuse emphysema?
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