Evidence map›Paper›PMID 29504499›Full record

Trial reportThe New England journal of medicine2018

Quadrupling Inhaled Glucocorticoid Dose to Abort Asthma Exacerbations.

Tricia McKeever, Kevin Mortimer, Andrew Wilson, Samantha Walker, Christopher Brightling, Andrew Skeggs, Ian Pavord, David Price, Lelia Duley, Mike Thomas and 6 more

Open access · bronzeAbstract readComparative StudyPragmatic Clinical TrialRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in The New England journal of medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 42 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
42citing papers in PubMed, 4 pooled it
15.2field-weighted citation impact, top 1% 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

42 citing papers in PubMed, 4 syntheses or guidelines pooled it, 146 citations in OpenAlex.

  1. Pooled it
  2. InhaledEuropean respiratory review : an official journal of the European Respiratory Society · 2024
    Pooled it
  3. Pooled it
  4. Pooled it
  5. Trial
  6. Trial
  7. Article
  8. Article
  9. Article
  10. Article
  11. Article
  12. Review
  13. Audit of Asthma Exacerbation Management in a Swiss General Hospital.Respiration; international review of thoracic diseases · 2023
    Observational
  14. Article
  15. Global Initiative for Asthma Strategy 2021: Executive Summary and Rationale for Key Changes.American journal of respiratory and critical care medicine · 2022
    Article
  16. Article
  17. Review
  18. Review
  19. Review
  20. Inhaled corticosteroids for the prevention of asthma exacerbations.Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology · 2021
    Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

16 authors at 8 institutions in 3 countries.

Tricia McKeeverFrom the Department of Epidemiology and Public Health (T.M.) and the Nottingham Respiratory Research Unit (T.H.), National Institute for Health Research (NIHR) Biomedical Research Centre, and the Nottingham Clinical Trials Unit (A.S., L.D., L.B., R.H., E.M.), University of Nottingham, Nottingham, the Liverpool School of Tropical Medicine and Aintree University Hospital, Liverpool (K.M.), the University of Leicester (A.W.) and the Leicester NIHR Biomedical Research Centre, University of Leicester (C.B.), Leicester, Asthma UK, London (S.W.), the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.P.), the Centre of Academic Primary Care (D.P.) and the Institute of Medical Sciences (G.D.), University of Aberdeen, Aberdeen, the Primary Care and Population Science and NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton (M.T.), and the Department of Respiratory Medicine, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne (B.H.) - all in the United Kingdom.
Kevin MortimerFrom the Department of Epidemiology and Public Health (T.M.) and the Nottingham Respiratory Research Unit (T.H.), National Institute for Health Research (NIHR) Biomedical Research Centre, and the Nottingham Clinical Trials Unit (A.S., L.D., L.B., R.H., E.M.), University of Nottingham, Nottingham, the Liverpool School of Tropical Medicine and Aintree University Hospital, Liverpool (K.M.), the University of Leicester (A.W.) and the Leicester NIHR Biomedical Research Centre, University of Leicester (C.B.), Leicester, Asthma UK, London (S.W.), the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.P.), the Centre of Academic Primary Care (D.P.) and the Institute of Medical Sciences (G.D.), University of Aberdeen, Aberdeen, the Primary Care and Population Science and NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton (M.T.), and the Department of Respiratory Medicine, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne (B.H.) - all in the United Kingdom.
Andrew WilsonFrom the Department of Epidemiology and Public Health (T.M.) and the Nottingham Respiratory Research Unit (T.H.), National Institute for Health Research (NIHR) Biomedical Research Centre, and the Nottingham Clinical Trials Unit (A.S., L.D., L.B., R.H., E.M.), University of Nottingham, Nottingham, the Liverpool School of Tropical Medicine and Aintree University Hospital, Liverpool (K.M.), the University of Leicester (A.W.) and the Leicester NIHR Biomedical Research Centre, University of Leicester (C.B.), Leicester, Asthma UK, London (S.W.), the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.P.), the Centre of Academic Primary Care (D.P.) and the Institute of Medical Sciences (G.D.), University of Aberdeen, Aberdeen, the Primary Care and Population Science and NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton (M.T.), and the Department of Respiratory Medicine, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne (B.H.) - all in the United Kingdom.
Samantha WalkerFrom the Department of Epidemiology and Public Health (T.M.) and the Nottingham Respiratory Research Unit (T.H.), National Institute for Health Research (NIHR) Biomedical Research Centre, and the Nottingham Clinical Trials Unit (A.S., L.D., L.B., R.H., E.M.), University of Nottingham, Nottingham, the Liverpool School of Tropical Medicine and Aintree University Hospital, Liverpool (K.M.), the University of Leicester (A.W.) and the Leicester NIHR Biomedical Research Centre, University of Leicester (C.B.), Leicester, Asthma UK, London (S.W.), the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.P.), the Centre of Academic Primary Care (D.P.) and the Institute of Medical Sciences (G.D.), University of Aberdeen, Aberdeen, the Primary Care and Population Science and NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton (M.T.), and the Department of Respiratory Medicine, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne (B.H.) - all in the United Kingdom.
Christopher BrightlingFrom the Department of Epidemiology and Public Health (T.M.) and the Nottingham Respiratory Research Unit (T.H.), National Institute for Health Research (NIHR) Biomedical Research Centre, and the Nottingham Clinical Trials Unit (A.S., L.D., L.B., R.H., E.M.), University of Nottingham, Nottingham, the Liverpool School of Tropical Medicine and Aintree University Hospital, Liverpool (K.M.), the University of Leicester (A.W.) and the Leicester NIHR Biomedical Research Centre, University of Leicester (C.B.), Leicester, Asthma UK, London (S.W.), the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.P.), the Centre of Academic Primary Care (D.P.) and the Institute of Medical Sciences (G.D.), University of Aberdeen, Aberdeen, the Primary Care and Population Science and NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton (M.T.), and the Department of Respiratory Medicine, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne (B.H.) - all in the United Kingdom.
Andrew SkeggsFrom the Department of Epidemiology and Public Health (T.M.) and the Nottingham Respiratory Research Unit (T.H.), National Institute for Health Research (NIHR) Biomedical Research Centre, and the Nottingham Clinical Trials Unit (A.S., L.D., L.B., R.H., E.M.), University of Nottingham, Nottingham, the Liverpool School of Tropical Medicine and Aintree University Hospital, Liverpool (K.M.), the University of Leicester (A.W.) and the Leicester NIHR Biomedical Research Centre, University of Leicester (C.B.), Leicester, Asthma UK, London (S.W.), the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.P.), the Centre of Academic Primary Care (D.P.) and the Institute of Medical Sciences (G.D.), University of Aberdeen, Aberdeen, the Primary Care and Population Science and NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton (M.T.), and the Department of Respiratory Medicine, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne (B.H.) - all in the United Kingdom.
Ian PavordFrom the Department of Epidemiology and Public Health (T.M.) and the Nottingham Respiratory Research Unit (T.H.), National Institute for Health Research (NIHR) Biomedical Research Centre, and the Nottingham Clinical Trials Unit (A.S., L.D., L.B., R.H., E.M.), University of Nottingham, Nottingham, the Liverpool School of Tropical Medicine and Aintree University Hospital, Liverpool (K.M.), the University of Leicester (A.W.) and the Leicester NIHR Biomedical Research Centre, University of Leicester (C.B.), Leicester, Asthma UK, London (S.W.), the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.P.), the Centre of Academic Primary Care (D.P.) and the Institute of Medical Sciences (G.D.), University of Aberdeen, Aberdeen, the Primary Care and Population Science and NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton (M.T.), and the Department of Respiratory Medicine, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne (B.H.) - all in the United Kingdom.
David PriceFrom the Department of Epidemiology and Public Health (T.M.) and the Nottingham Respiratory Research Unit (T.H.), National Institute for Health Research (NIHR) Biomedical Research Centre, and the Nottingham Clinical Trials Unit (A.S., L.D., L.B., R.H., E.M.), University of Nottingham, Nottingham, the Liverpool School of Tropical Medicine and Aintree University Hospital, Liverpool (K.M.), the University of Leicester (A.W.) and the Leicester NIHR Biomedical Research Centre, University of Leicester (C.B.), Leicester, Asthma UK, London (S.W.), the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.P.), the Centre of Academic Primary Care (D.P.) and the Institute of Medical Sciences (G.D.), University of Aberdeen, Aberdeen, the Primary Care and Population Science and NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton (M.T.), and the Department of Respiratory Medicine, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne (B.H.) - all in the United Kingdom.ORCID 0000-0002-9728-9992
Lelia DuleyFrom the Department of Epidemiology and Public Health (T.M.) and the Nottingham Respiratory Research Unit (T.H.), National Institute for Health Research (NIHR) Biomedical Research Centre, and the Nottingham Clinical Trials Unit (A.S., L.D., L.B., R.H., E.M.), University of Nottingham, Nottingham, the Liverpool School of Tropical Medicine and Aintree University Hospital, Liverpool (K.M.), the University of Leicester (A.W.) and the Leicester NIHR Biomedical Research Centre, University of Leicester (C.B.), Leicester, Asthma UK, London (S.W.), the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.P.), the Centre of Academic Primary Care (D.P.) and the Institute of Medical Sciences (G.D.), University of Aberdeen, Aberdeen, the Primary Care and Population Science and NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton (M.T.), and the Department of Respiratory Medicine, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne (B.H.) - all in the United Kingdom.ORCID 0000-0001-6721-5178
Mike ThomasFrom the Department of Epidemiology and Public Health (T.M.) and the Nottingham Respiratory Research Unit (T.H.), National Institute for Health Research (NIHR) Biomedical Research Centre, and the Nottingham Clinical Trials Unit (A.S., L.D., L.B., R.H., E.M.), University of Nottingham, Nottingham, the Liverpool School of Tropical Medicine and Aintree University Hospital, Liverpool (K.M.), the University of Leicester (A.W.) and the Leicester NIHR Biomedical Research Centre, University of Leicester (C.B.), Leicester, Asthma UK, London (S.W.), the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.P.), the Centre of Academic Primary Care (D.P.) and the Institute of Medical Sciences (G.D.), University of Aberdeen, Aberdeen, the Primary Care and Population Science and NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton (M.T.), and the Department of Respiratory Medicine, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne (B.H.) - all in the United Kingdom.ORCID 0000-0001-5939-1155
Lucy BradshawFrom the Department of Epidemiology and Public Health (T.M.) and the Nottingham Respiratory Research Unit (T.H.), National Institute for Health Research (NIHR) Biomedical Research Centre, and the Nottingham Clinical Trials Unit (A.S., L.D., L.B., R.H., E.M.), University of Nottingham, Nottingham, the Liverpool School of Tropical Medicine and Aintree University Hospital, Liverpool (K.M.), the University of Leicester (A.W.) and the Leicester NIHR Biomedical Research Centre, University of Leicester (C.B.), Leicester, Asthma UK, London (S.W.), the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.P.), the Centre of Academic Primary Care (D.P.) and the Institute of Medical Sciences (G.D.), University of Aberdeen, Aberdeen, the Primary Care and Population Science and NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton (M.T.), and the Department of Respiratory Medicine, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne (B.H.) - all in the United Kingdom.
Bernard HigginsFrom the Department of Epidemiology and Public Health (T.M.) and the Nottingham Respiratory Research Unit (T.H.), National Institute for Health Research (NIHR) Biomedical Research Centre, and the Nottingham Clinical Trials Unit (A.S., L.D., L.B., R.H., E.M.), University of Nottingham, Nottingham, the Liverpool School of Tropical Medicine and Aintree University Hospital, Liverpool (K.M.), the University of Leicester (A.W.) and the Leicester NIHR Biomedical Research Centre, University of Leicester (C.B.), Leicester, Asthma UK, London (S.W.), the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.P.), the Centre of Academic Primary Care (D.P.) and the Institute of Medical Sciences (G.D.), University of Aberdeen, Aberdeen, the Primary Care and Population Science and NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton (M.T.), and the Department of Respiratory Medicine, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne (B.H.) - all in the United Kingdom.
Rebecca HaydockFrom the Department of Epidemiology and Public Health (T.M.) and the Nottingham Respiratory Research Unit (T.H.), National Institute for Health Research (NIHR) Biomedical Research Centre, and the Nottingham Clinical Trials Unit (A.S., L.D., L.B., R.H., E.M.), University of Nottingham, Nottingham, the Liverpool School of Tropical Medicine and Aintree University Hospital, Liverpool (K.M.), the University of Leicester (A.W.) and the Leicester NIHR Biomedical Research Centre, University of Leicester (C.B.), Leicester, Asthma UK, London (S.W.), the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.P.), the Centre of Academic Primary Care (D.P.) and the Institute of Medical Sciences (G.D.), University of Aberdeen, Aberdeen, the Primary Care and Population Science and NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton (M.T.), and the Department of Respiratory Medicine, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne (B.H.) - all in the United Kingdom.
Eleanor MitchellFrom the Department of Epidemiology and Public Health (T.M.) and the Nottingham Respiratory Research Unit (T.H.), National Institute for Health Research (NIHR) Biomedical Research Centre, and the Nottingham Clinical Trials Unit (A.S., L.D., L.B., R.H., E.M.), University of Nottingham, Nottingham, the Liverpool School of Tropical Medicine and Aintree University Hospital, Liverpool (K.M.), the University of Leicester (A.W.) and the Leicester NIHR Biomedical Research Centre, University of Leicester (C.B.), Leicester, Asthma UK, London (S.W.), the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.P.), the Centre of Academic Primary Care (D.P.) and the Institute of Medical Sciences (G.D.), University of Aberdeen, Aberdeen, the Primary Care and Population Science and NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton (M.T.), and the Department of Respiratory Medicine, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne (B.H.) - all in the United Kingdom.
Graham DevereuxFrom the Department of Epidemiology and Public Health (T.M.) and the Nottingham Respiratory Research Unit (T.H.), National Institute for Health Research (NIHR) Biomedical Research Centre, and the Nottingham Clinical Trials Unit (A.S., L.D., L.B., R.H., E.M.), University of Nottingham, Nottingham, the Liverpool School of Tropical Medicine and Aintree University Hospital, Liverpool (K.M.), the University of Leicester (A.W.) and the Leicester NIHR Biomedical Research Centre, University of Leicester (C.B.), Leicester, Asthma UK, London (S.W.), the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.P.), the Centre of Academic Primary Care (D.P.) and the Institute of Medical Sciences (G.D.), University of Aberdeen, Aberdeen, the Primary Care and Population Science and NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton (M.T.), and the Department of Respiratory Medicine, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne (B.H.) - all in the United Kingdom.
Timothy HarrisonFrom the Department of Epidemiology and Public Health (T.M.) and the Nottingham Respiratory Research Unit (T.H.), National Institute for Health Research (NIHR) Biomedical Research Centre, and the Nottingham Clinical Trials Unit (A.S., L.D., L.B., R.H., E.M.), University of Nottingham, Nottingham, the Liverpool School of Tropical Medicine and Aintree University Hospital, Liverpool (K.M.), the University of Leicester (A.W.) and the Leicester NIHR Biomedical Research Centre, University of Leicester (C.B.), Leicester, Asthma UK, London (S.W.), the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.P.), the Centre of Academic Primary Care (D.P.) and the Institute of Medical Sciences (G.D.), University of Aberdeen, Aberdeen, the Primary Care and Population Science and NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton (M.T.), and the Department of Respiratory Medicine, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne (B.H.) - all in the United Kingdom.ORCID 0000-0002-3065-8247
Nottingham Biomedical Research Centre · GBUniversity of Leicester · GBAsthma UK · GBNewcastle upon Tyne Hospital · GBPrimary Health Care · QAUniversity of Aberdeen · GBUniversity of Nottingham · GBUniversity of Oxford · GB

Funding

Department of Health 10/143/01
6 · The paper itself

Abstract

backgroundAsthma exacerbations are frightening for patients and are occasionally fatal. We tested the concept that a plan for patients to manage their asthma (self-management plan), which included a temporary quadrupling of the dose of inhaled glucocorticoids when asthma control started to deteriorate, would reduce the incidence of severe asthma exacerbations among adults and adolescents with asthma.

methodsWe conducted a pragmatic, unblinded, randomized trial involving adults and adolescents with asthma who were receiving inhaled glucocorticoids, with or without add-on therapy, and who had had at least one exacerbation in the previous 12 months. We compared a self-management plan that included an increase in the dose of inhaled glucocorticoids by a factor of 4 (quadrupling group) with the same plan without such an increase (non-quadrupling group), over a period of 12 months. The primary outcome was the time to a first severe asthma exacerbation, defined as treatment with systemic glucocorticoids or an unscheduled health care consultation for asthma.

resultsA total of 1922 participants underwent randomization, of whom 1871 were included in the primary analysis. The number of participants who had a severe asthma exacerbation in the year after randomization was 420 (45%) in the quadrupling group as compared with 484 (52%) in the non-quadrupling group, with an adjusted hazard ratio for the time to a first severe exacerbation of 0.81 (95% confidence interval, 0.71 to 0.92; P=0.002). The rate of adverse effects, which were related primarily to local effects of inhaled glucocorticoids, was higher in the quadrupling group than in the non-quadrupling group.

conclusionsIn this trial involving adults and adolescents with asthma, a personalized self-management plan that included a temporary quadrupling of the dose of inhaled glucocorticoids when asthma control started to deteriorate resulted in fewer severe asthma exacerbations than a plan in which the dose was not increased. (Funded by the Health Technology Assessment Programme of the National Institute for Health Research; Current Controlled Trials number, ISRCTN15441965 .).

Indexed as

Self-ManagementAdministration, InhalationAdolescentAdultAnti-Asthmatic AgentsAsthmaDose-Response Relationship, DrugFemaleFluticasoneHumansKaplan-Meier EstimateMaleProportional Hazards ModelsAnti-Asthmatic AgentsFluticasone

Identifiers

PMID29504499
OpenAlexW2787246235

What OpenQuestion holds

Textmetadata
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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.