Evidence

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 moderate or low to moderate where GRADE has been performed and the intervention may be more effective/beneficial than the comparison for key outcomes.


Population: Adults with COPD ᵃ

Intervention: LAMA plus LABA

Comparison: LABA plus ICS

OutcomeEffectiveness (BMJ rating)?Confidence in evidence (GRADE)?

Exacerbations at 12 to 52 weeks

Favors intervention

Low

Serious adverse effects at 12 to 52 weeks

No statistically significant difference

Moderate

St. George's Respiratory Questionnaire (SGRQ) total score change from the baseline at 12 to 52 weeks

No statistically significant difference

Low

SGRQ total score improvement from the baseline (≥4 units) (follow‐up 24 to 52 weeks)

Favors intervention

Moderate

Trough forced expiratory volume in 1 second (FEV1) change from the baseline (follow‐up 12 to 52 weeks)

Favors intervention

Moderate

Pneumonia (follow‐up 12 to 52 weeks)

Favors intervention

Low

All‐cause mortality (follow‐up 12 to 52 weeks)

No statistically significant difference

Low

Hospitalizations for COPD exacerbations

-

No data reported on this outcome

Note

ᵃ Diagnosis was according to Chronic Obstructive Lung Disease (GOLD) guidelines. In most of the included studies, the population was people with moderate-to-severe COPD without recent exacerbations.

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 COPD

Intervention: IDM ᵃ

Comparison: Usual care (regular follow-up visits with healthcare providers)

OutcomeEffectiveness (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

OutcomeEffectiveness (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

  • What are the effects of integrated disease management (IDM) interventions for people with chronic obstructive pulmonary disease (COPD)?
    Show me the answer
  • How does umeclidinium bromide compare with placebo for people with chronic obstructive pulmonary disease (COPD)?
    Show me the answer
  • 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)?
    Show me the answer
  • How does tiotropium compare with ipratropium bromide for people with chronic obstructive pulmonary disease (COPD)?
    Show me the answer
  • 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)?
    Show me the answer
  • What are the longer-term (>6 months) effects of inhaled corticosteroids in people with stable chronic obstructive pulmonary disease?
    Show me the answer
  • What are the effects of long‐acting inhaled therapies for adults with chronic obstructive pulmonary disease (COPD)?
    Show me the answer
  • In people with chronic obstructive pulmonary disease (COPD), what are the effects of combined corticosteroid and long-acting beta-agonist (LABA) in one inhaler versus LABA alone?
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  • What are the effects of prophylactic antibiotics for people with chronic obstructive pulmonary disease (COPD)?
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  • What are the effects of influenza vaccine in people with chronic obstructive pulmonary disease (COPD)?
    Show me the answer
  • For people with chronic bronchitis or chronic obstructive pulmonary disease, how do mucolytic agents compare with placebo?
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  • What are the effects of pulmonary rehabilitation after exacerbation in people with chronic obstructive pulmonary disease?
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  • How does bronchoscopic lung volume reduction compare with medical therapy in people with chronic obstructive pulmonary disease?
    Show me the answer
  • How do statins compare with placebo for people with chronic obstructive pulmonary disease (COPD)?
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  • How does lung volume reduction surgery compare with usual medical care in people with diffuse emphysema?
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