ArticleERJ open research2026
Diversity and inclusivity in clinical trial populations for maintenance inhaler therapy in people with COPD: a systematic review.
Article in ERJ open research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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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.
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.
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Authors and funding
7 authors.
Funding
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Abstract
Background: Social determinants of health (SDH) influence COPD prevalence, progression and treatment, yet their inclusion in clinical trials is poorly understood. This study examined recruitment strategies for diverse populations in COPD trials of long-acting muscarinic antagonists (LAMA) and/or long-acting β-agonists (LABA), with or without additional therapy including inhaled corticosteroids (ICS), and assessed SDH reporting in primary trial documents and publications. Methods: Four clinical trials databases (CENTRAL, ClinicalTrials.gov, ISRCTN and ANZCTR) were searched to identify LAMA and/or LABA clinical trials with or without ICS in adults with COPD registered between 1 January 2000 and 8 May 2023. Extracted data included study locations, recruitment strategies, study outcomes, eligibility criteria, participant demographics and subgroup analyses. Results: 1822 records were identified, with 491 primary trials included. Of these, 407 trials (256 271 participants) had results available and 341 trials had associated publications. 439 trials (89.4%) were completed. Age (n=387 (95.1%)) and sex (n=386 (94.8%)) were well reported, with a male preponderance (n=176 285 (68.8%)). Inclusion of women improved from 22.6% (2006) to 46.5% (2020). Ethnicity was reported in 209 (51.4%)) trials, with over-representation of White individuals (n=130 086 (83.2%)) and no change over time. Only one trial reported socioeconomic status or occupation; none reported education or rurality. Most trials (97.5%) were conducted in high- or upper-middle-income countries. Conclusions: SDH, other than age and sex, were under-reported in LABA/LAMA COPD trials, and when reported, demonstrated a long-standing lack of diversity. Extrapolating efficacy from narrow populations may risk suboptimal care for diverse groups. Future trials must include and report on diverse populations to demonstrate safety and efficacy for all people in all contexts.
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Registered trials
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