Title: Evidence to guide care in adults and children with asthma
Funder: Department of Health (England)

Abstract: BackgroundThe Cochrane Airways Group has published over 260 Cochrane systematic reviews on asthma COPD and other lung diseases. These reviews evaluate evidence from clinical trials using a pre-specified plan or protocol. The intended audience for Cochrane reviews are people making decisions about healthcare such as patients or carers doctors and guideline writers.Cochrane reviews are necessary because individual trials are frequently underpowered to assess the safety of treatments well enough to inform clinical practice and policy. By combining the results from multiple trials there is increased power to estimate the impact of treatments and management strategies on key outcomes including hospital admissions. Systematic reviews improve healthcare in the UK (and worldwide) by underpinning guidelines.The healthcare landscape is constantly evolving and therefore so must our collection of Cochrane reviews. For instance new trials are published new treatments become available and clinical practice changes. Therefore we periodically update the Cochrane reviews and sometimes change the emphasis to make them more useful. It is important that our Cochrane reviews tackle the most relevant questions for people making decisions about healthcare. This programme grant allows us to target important questions relevant to decision makers. We have identified three key areas from our prioritisation work and our knowledge of asthma guidelines in the UK: asthma management; asthma monitoring; and asthma therapies. We selected new reviews and updates where new research is likely to impact on the conclusions of the review and treatment practice.Importance and relevance of the projectDespite effective treatments people with asthma suffer unnecessary symptoms reflected in exacerbations and 70000 hospitalisations per year. The UK ranks 8th worst of 27 European countries for asthma deaths with direct NHS costs exceeding £1 billion/year and further indirect costs to individuals families and society. Asthma management is important to clinical commissioning groups as it constitutes a significant proportion of service demand and cost. Rationalisation of service use and policy planning should be informed by the most robust evidence base including the impact of asthma treatments on quality of life and resource use. A key issue for asthma management is appropriate use of available therapies as we know that there is both overuse and underuse of asthma medications. Regular use of preventer inhalers has been shown to reduce hospital admission rates but adherence to treatment is a particular problem in asthma because people who are feeling well tend be less medication adherent.Theme and ScopeAsthma monitoring: The crucial question is what difference does asthma monitoring make on important clinical outcomes (such as prevention of asthma exacerbations and hospital admissions)? Asthma management: We have several reviews on asthma management and education but the trials are heterogeneous and conclusions difficult to implement. We have shown in existing reviews that inhaled steroids work to control the underlying inflammation in asthma. The main challenge for the NHS is promoting adherence to these therapies particularly in those adults and children who are subject to exacerbations leading to visits to hospital. Adolescents are a group that can be hard to reach – our PPI input has suggested that text messages and tweets are the best way to reach teenagers because they are discreet and fit into their lifestyle. We plan to explore clinician education lay-led interventions and interventions to improve inhaler technique. Care pathways are increasingly being used in our hospitals and clinics – but do they work?We aim to take a user-centred approach to defining the most important clinical questions in asthma management and to employ rapid review methods to produce reviews more efficiently. The results of the suite of management reviews will inform the updating of BTS/SIGN guidelines and their subsequent application could reduce avoidable out-of-hours GP calls ED visits and hospital admissions. Asthma therapies: the number of trials for asthma therapies is rapidly increasing – both for existing treatments and for new ones. We propose to update a number of important reviews where we have identified new trials and a write number of new reviews to cover gaps in our existing review. We intend to produce reviews on sublingual immunotherapy tiotropium and treatment for gastro-oesophageal reflux disease.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;7.3 MANAGEMENT AND DECISION MAKING
Health categories: RESPIRATORY