Evidence map›Paper›PMID 25378918›Full record

ArticleInternational journal of chronic obstructive pulmonary disease2014

Comparing the effectiveness of small-particle versus large-particle inhaled corticosteroid in COPD.

Dirkje S Postma, Nicolas Roche, Gene Colice, Elliot Israel, Richard J Martin, Willem Mc van Aalderen, Jonathan Grigg, Anne Burden, Elizabeth V Hillyer, Julie von Ziegenweidt and 2 more

Open access · goldAbstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in International journal of chronic obstructive pulmonary disease, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.

0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed
2.7field-weighted citation impact, top 10% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

16 citing papers in PubMed, 31 citations in OpenAlex.

  1. Observational
  2. Observational
  3. Review
  4. Step-Up and Step-Down Treatment Approaches for COPD: A Holistic View of Progressive Therapies.International journal of chronic obstructive pulmonary disease · 2021
    Review
  5. Article
  6. Article
  7. COPD from an everyday primary care point of view.Journal of family medicine and primary care · 2019
    Article
  8. Observational
  9. Article
  10. Article
  11. Article
  12. Article
  13. Article
  14. Review
  15. Article
  16. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors at 9 institutions in 4 countries.

Dirkje S PostmaUniversity of Groningen, Department of Pulmonary Medicine and Tuberculosis, University Medical Center Groningen, Groningen, the Netherlands.
Nicolas RocheRespiratory and Intensive Care Medicine, Cochin Hospital Group, APHP, Paris-Descartes University (EA2511), Paris, France.
Gene ColicePulmonary, Critical Care and Respiratory Services, Washington Hospital Center and George Washington University School of Medicine, Washington DC, USA.
Elliot IsraelPulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Richard J MartinDepartment of Medicine, National Jewish Health, Denver, CO, USA.
Willem Mc van AalderenDept of Pediatric Respiratory Medicine and Allergy, Emma Children's Hospital AMC, Amsterdam, the Netherlands.
Jonathan GriggBlizard Institute, Queen Mary University London, London, UK.
Anne BurdenResearch in Real Life, Ltd, Cambridge, UK.
Elizabeth V HillyerResearch in Real Life, Ltd, Cambridge, UK.
Julie von ZiegenweidtResearch in Real Life, Ltd, Cambridge, UK.
Gokul GopalanRespiratory, Global Scientific Affairs, Teva Pharmaceuticals, Frazer, PA, USA.
David PriceResearch in Real Life, Ltd, Cambridge, UK ; Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
Emma Kinderziekenhuis · NLGeorge Washington University Hospital · USHarvard University · USQueen Mary University of London · GBTeva Pharmaceuticals (United States) · USUniversité Paris Cité · FRUniversity of Aberdeen · GBUniversity of Colorado Denver · USUniversity of Groningen · NL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeSmall airway changes and dysfunction contribute importantly to airway obstruction in chronic obstructive pulmonary disease (COPD), which is currently treated with inhaled corticosteroids (ICS) and long-acting bronchodilators at Global initiative for Obstructive Lung Disease (GOLD) grades 2-4. This retrospective matched cohort analysis compared effectiveness of a representative small-particle ICS (extrafine beclomethasone) and larger-particle ICS (fluticasone) in primary care patients with COPD. PATIENTS AND

methodsSmokers and ex-smokers with COPD ≥ 40 years old initiating or stepping-up their dose of extrafine beclomethasone or fluticasone were matched 1:1 for demographic characteristics, index prescription year, concomitant therapies, and disease severity during 1 baseline year. During 2 subsequent years, we evaluated treatment change and COPD exacerbations, defined as emergency care/hospitalization for COPD, acute oral corticosteroids, or antibiotics for lower respiratory tract infection.

resultsMean patient age was 67 years, 57%-60% being male. For both initiation (n=334:334) and step-up (n=189:189) patients, exacerbation rates were comparable between extrafine beclomethasone and fluticasone cohorts during the 2 year outcome period. Odds of treatment stability (no exacerbation or treatment change) were significantly greater for patients initiating extrafine beclomethasone compared with fluticasone (adjusted odds ratio 2.50; 95% confidence interval, 1.32-4.73). Median ICS dose exposure during 2 outcome years was significantly lower (P<0.001) for extrafine beclomethasone than fluticasone cohorts (315 μg/day versus 436 μg/day for initiation, 438 μg/day versus 534 μg/day for step-up patients).

conclusionWe observed that small-particle ICS at significantly lower doses had comparable effects on exacerbation rates as larger-particle ICS at higher doses, whereas initiation of small-particle ICS was associated with better odds of treatment stability during 2-years' follow-up.

Indexed as

Administration, InhalationAdrenal Cortex HormonesAgedAndrostadienesAnti-Bacterial AgentsBeclomethasoneDisease ProgressionEmergency Service, HospitalFemaleFluticasoneHospitalizationHumansLungMaleMiddle AgedParticle SizeAdrenal Cortex HormonesAndrostadienesAnti-Bacterial AgentsBeclomethasoneFluticasoneCOPD exacerbationextrafine particlematched cohort analysisreal lifesmall airways

Identifiers

PMID25378918
PMCPMC4207569
OpenAlexW2150498662

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.