Evidence map›Paper›PMID 37945034›Full record

SynthesisThe European respiratory journal2023

Best step-up treatments for children with uncontrolled asthma: a systematic review and network meta-analysis of individual participant data.

Sofia Cividini, Ian Sinha, Sarah Donegan, Michelle Maden, Katie Rose, Olivia Fulton, Giovanna Culeddu, Dyfrig A Hughes, Stephen Turner, Catrin Tudur Smith and 1 more

Open access · hybridAbstract readSystematic ReviewNetwork Meta-Analysis
In one paragraph

Synthesis in The European respiratory journal, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
1.2field-weighted citation impact, top 20% 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

3 citing papers in PubMed, 1 synthesis or guideline pooled it, 7 citations in OpenAlex.

  1. Pooled it
  2. Pediatric spontaneous-reporting patterns for biologics approved or used for asthma: Analysis of the FDA adverse event reporting system.Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology · 2026
    Article
  3. Article
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

11 authors at 4 institutions in 1 country.

Sofia CividiniDepartment of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK.ORCID 0000-0003-2705-9224
Ian SinhaAlder Hey Children's Foundation NHS Trust, Liverpool, UK.ORCID 0000-0002-7342-5523
Sarah DoneganDepartment of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK.ORCID 0000-0003-1709-2290
Michelle MadenLiverpool Reviews and Implementation Group, Institute of Population Health, University of Liverpool, Liverpool, UK.ORCID 0000-0003-4419-6343
Katie RoseAlder Hey Children's Foundation NHS Trust, Liverpool, UK.ORCID 0000-0002-2348-2036
Olivia FultonPatient Representative, Liverpool, UK.ORCID 0000-0001-7358-0219
Giovanna CuledduCentre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK.ORCID 0000-0001-5032-4255
Dyfrig A HughesCentre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK.ORCID 0000-0001-8247-7459
Stephen TurnerWomen and Children Division, NHS Grampian, Aberdeen, UK.ORCID 0000-0001-8393-5060
Catrin Tudur SmithDepartment of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK cat1@liverpool.ac.uk.ORCID 0000-0003-3051-1445
EINSTEIN Collaborative Group
University of Liverpool · GBAlder Hey Children's NHS Foundation Trust · GBBangor University · GBUniversity of Aberdeen · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThere is uncertainty about the best treatment option for children/adolescents with uncontrolled asthma despite inhaled corticosteroids (ICS) and international guidelines make different recommendations. We evaluated the pharmacological treatments to reduce asthma exacerbations and symptoms in uncontrolled patients age <18 years on ICS.

methodsWe searched MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Embase, Web of Science, National Institute for Health and Care Excellence Technology Appraisals, National Institute for Health and Care Research Health Technology Assessment series, World Health Organization International Clinical Trials Registry, conference abstracts and internal clinical trial registers (1 July 2014 to 5 May 2023) for randomised controlled trials of participants age <18 years with uncontrolled asthma on any ICS dose alone at screening. Studies before July 2014 were retrieved from previous systematic reviews/contact with authors. Patients had to be randomised to any dose of ICS alone or combined with long-acting β

resultsOf the 4708 publications identified, 144 trials were eligible. Individual participant data were obtained from 29 trials and aggregate data were obtained from 19 trials. Compared with ICS Low, ICS Medium+LABA was associated with the lowest odds of exacerbation (OR 0.44, 95% credibility interval (95% CrI) 0.19-0.90) and with an increased forced expiratory volume in 1 s (mean difference 0.71, 95% CrI 0.35-1.06). Treatment with LTRA was the least preferred. No apparent differences were found for asthma control.

conclusionsUncontrolled children/adolescents on low-dose ICS should be recommended a change to medium-dose ICS+LABA to reduce the risk for exacerbation and improve lung function.

Indexed as

Anti-Asthmatic AgentsAsthmaAdministration, InhalationAdolescentAdrenal Cortex HormonesChildDrug Therapy, CombinationHumansLeukotriene AntagonistsSystematic Reviews as TopicTheophyllineAdrenal Cortex HormonesAnti-Asthmatic AgentsLeukotriene AntagonistsTheophylline

Identifiers

PMID37945034
PMCPMC10752294
OpenAlexW4388524182

What OpenQuestion holds

Textmetadata
LicenceCC BY
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.