Results Although highlighting a general lack of high- quality real-life effectiveness observational research on these clinical ly important topics , the analysis provided insights into how identified observational studies might inform asthma guidelines developers and clinicians .
Overall , RELEVANT appeared reliable and easy to use by expert review ers .
Conclusions Using such quality appraisal tools is m and atory to assess whether specific observational real-life effectiveness studies can be used to inform guideline development and /or decision-making in clinical practice
Abstract Introduction A Task Force was commissioned jointly by the European Academy of Allergy and Clinical Immunology ( EAACI ) and the Respiratory Effectiveness Group ( REG ) to develop a  quality assessment tool for real-life observational research to identify high- quality real-life asthma studies that could be considered within future guideline development .
Regional lung deposition and bronchodilator response as a function of beta2-agonist particle size.
RATIONALE Aerosol particle size influences the extent , distribution , and site of inhaled drug deposition within the airways . OBJECTIVES We hypothesized that targeting albuterol to regional airways by altering aerosol particle size could optimize inhaled bronchodilator delivery . METHODS In a r and omized , double-blind , placebo-controlled study , 12 subjects with asthma ( FEV1 , 76.8 + /- 11.4 % predicted ) inhaled technetium-99m-labeled monodisperse albuterol aerosols ( 30-microg dose ) of 1.5- , 3- , and 6-microm mass median aerodynamic diameter , at slow ( 30 - 60 L/min ) and fast ( > 60 L/min ) inspiratory flows . Lung and extrathoracic radioaerosol deposition were quantified using planar gamma-scintigraphy . Pulmonary function and tolerability measurements were simultaneously assessed . Clinical efficacy was also compared with unlabeled monodisperse albuterol ( 15-microg dose ) and 200 microg metered-dose inhaler ( MDI ) albuterol . RESULTS Smaller particles achieved greater total lung deposition ( 1.5 microm [ 56 % ] , 3 microm [ 50 % ] , and 6 microm [ 46 % ] ) , farther distal airways penetration ( 0.79 , 0.60 , and 0.36 , respective penetration index ) , and more peripheral lung deposition ( 25 , 17 , and 10 % , respectively ) . However , larger particles ( 30-microg dose ) were more efficacious and achieved greater bronchodilation than 200 microg MDI albuterol ( deltaFEV1 [ ml ] : 6 microm [ 551 ] , 3 microm [ 457 ] , 1.5 microm [ 347 ] , MDI [ 494 ] ) . Small particles were exhaled more ( 1.5 microm [ 22 % ] , 3 microm [ 8 % ] , 6 microm [ 2 % ] ) , whereas greater oropharyngeal deposition occurred with large particles ( 15 , 31 , and 43 % , respectively ) . Faster inspiratory flows decreased total lung deposition and increased oropharyngeal deposition for the larger particles , with less bronchodilation . A shift in aerosol distribution to the proximal airways was observed for all particles . CONCLUSIONS Regional targeting of inhaled beta2-agonist to the proximal airways is more important than distal alveolar deposition for bronchodilation . Altering intrapulmonary deposition through aerosol particle size can appreciably enhance inhaled drug therapy and may have implication s for developing future inhaled treatments
Results Although highlighting a general lack of high- quality real-life effectiveness observational research on these clinical ly important topics , the analysis provided insights into how identified observational studies might inform asthma guidelines developers and clinicians .
Overall , RELEVANT appeared reliable and easy to use by expert review ers .
Conclusions Using such quality appraisal tools is m and atory to assess whether specific observational real-life effectiveness studies can be used to inform guideline development and /or decision-making in clinical practice
Abstract Introduction A Task Force was commissioned jointly by the European Academy of Allergy and Clinical Immunology ( EAACI ) and the Respiratory Effectiveness Group ( REG ) to develop a  quality assessment tool for real-life observational research to identify high- quality real-life asthma studies that could be considered within future guideline development .