Evidence map›Paper›PMID 40589124›Full record

ArticleRespirology (Carlton, Vic.)2025

The Risk-Benefit Balance of Oral Corticosteroid Treatment for Asthma Attacks: A Discrete Choice Experiment of Patients and Healthcare Professionals in the UK and New Zealand.

Imran Howell, Jonathan Noble, Aleksandra Howell, Caitlin Morgan, Jennifer Logan, Sarah Miller, Rekha Chaudhuri, Richard E K Russell, Mona Bafadhel, Richard Beasley and 2 more

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PubMed Full text at PMC Publisher
In one paragraph

Article in Respirology (Carlton, Vic.), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
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

4 citing papers in PubMed.

  1. Trial
  2. Observational
  3. Review
  4. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors.

Imran HowellRespiratory Medicine Unit and Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, University of Oxford, Oxford, UK.ORCID 0000-0002-6033-0488
Jonathan NobleMedical Research Institute of New Zealand, Wellington, New Zealand.
Aleksandra HowellRespiratory Medicine Unit and Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Caitlin MorganNorth Bristol NHS Trust, Bristol, UK.
Jennifer LoganGartnaval General Hospital, Glasgow, UK.
Sarah MillerPatient and Public Representative, Oxford, UK.
Rekha ChaudhuriGartnaval General Hospital, Glasgow, UK.
Richard E K RussellKing's Centre for Lung Health, School of Immunology and Microbial Sciences, King's College London, London, UK.
Mona BafadhelKing's Centre for Lung Health, School of Immunology and Microbial Sciences, King's College London, London, UK.
Richard BeasleyMedical Research Institute of New Zealand, Wellington, New Zealand.ORCID 0000-0003-0337-406X
Ian D PavordRespiratory Medicine Unit and Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, University of Oxford, Oxford, UK.ORCID 0000-0002-4288-5973
John BuckellHealth Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.

Funding

OXford Biomedical Research CentreOxford National Institute for Healthcare Research (NIHR)
6 · The paper itself

Abstract

BACKGROUND AND

objectiveOral corticosteroids (OCS) are the guideline recommended treatment for all asthma attacks, but benefits must be considered alongside the potential for cumulative side-effects. There is interest in trialling biomarker-directed management of attacks to rationalise OCS treatment in those with least benefit. Understanding stakeholder perspectives on the risks and benefits associated with OCS treatment can inform trial design and shared decision-making discussions in clinical practice. The aim was to examine patients' and healthcare professionals' preferences for the risks and benefits associated with OCS treatment for asthma attacks.

methodsDiscrete choice experiment (DCE) by patients with asthma and HCPs in the UK and New Zealand. Preferences were analysed using logit models.

resultsEight hundred and twenty-four patients and 171 HCPs completed the DCE. Avoiding the risks of permanent side effects had the greatest impact on treatment preference by patients and HCPs. Avoidance of side effects was weighted higher by patients than HCPs. Patients with uncontrolled asthma were more prepared to trade risk for benefit. Symptom recovery was the most valued clinical benefit to patients and HCPs. Patients preferred 'improving lung function' over 'avoiding additional GP treatment or hospitalisation', whereas HCPs preferred avoidance of further healthcare utilisation. Based on their responses we estimated the minimum clinically important difference for the treatment failure outcome at 20%.

conclusionPatients and HCPs will trade-off treatment benefits to avoid the side-effects associated with OCS. The risk-benefit balance of OCS should feature in shared decision-making discussions with patients experiencing outpatient asthma attacks. The findings support developing trials to personalise acute asthma treatment.

Indexed as

Adrenal Cortex HormonesAnti-Asthmatic AgentsAsthmaHealth PersonnelPatient PreferenceAdministration, OralAdultAgedChoice BehaviorFemaleHumansMaleMiddle AgedNew ZealandRisk AssessmentUnited KingdomAdrenal Cortex HormonesAnti-Asthmatic Agentsasthmaasthma attacksasthma exacerbationscorticosteroidsglucocorticoidspatient preferences

Identifiers

PMID40589124
PMCPMC12581093

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Registered trials

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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.