Clinical efficacy of bronchodilators in equine asthma: Looking for minimal important difference
Summary Background Airway obstruction is the main trait of severe equine asthma that affects respiratory function and elicits detrimental effects on clinical presentation. Only few and underpowered clinical studies have investigated the impact of improvement in lung function induced by bronchodilato...
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| Veröffentlicht in: | Equine veterinary journal 2020-03, Vol.52 (2), p.305-313 |
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| container_title | Equine veterinary journal |
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| creator | Calzetta, L. Crupi, R. Roncada, P. Pistocchini, E. Cave, D. Rossi, I. Cito, G. Jacobson, G. A. Britti, D. |
| description | Summary
Background
Airway obstruction is the main trait of severe equine asthma that affects respiratory function and elicits detrimental effects on clinical presentation. Only few and underpowered clinical studies have investigated the impact of improvement in lung function induced by bronchodilators on the clinical signs of asthma‐affected horses.
Objectives
To identify the minimal important difference (MID) in lung function elicited by bronchodilator leading to a meaningful improvement in clinical signs.
Study design
Pairwise meta‐analysis and meta‐regression analysis.
Methods
Literature searches were performed for studies that investigated the effect of bronchodilator therapy on lung function and clinical condition of asthmatic horses. The relationship between the change in lung function variables and clinical score was analysed via random‐effect meta‐regression. One‐point change of the Improved clinically Detectable Equine Asthma Scoring System (IDEASS) score was used to identify the MID.
Results
A significant (P |
| doi_str_mv | 10.1111/evj.13137 |
| format | Article |
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Background
Airway obstruction is the main trait of severe equine asthma that affects respiratory function and elicits detrimental effects on clinical presentation. Only few and underpowered clinical studies have investigated the impact of improvement in lung function induced by bronchodilators on the clinical signs of asthma‐affected horses.
Objectives
To identify the minimal important difference (MID) in lung function elicited by bronchodilator leading to a meaningful improvement in clinical signs.
Study design
Pairwise meta‐analysis and meta‐regression analysis.
Methods
Literature searches were performed for studies that investigated the effect of bronchodilator therapy on lung function and clinical condition of asthmatic horses. The relationship between the change in lung function variables and clinical score was analysed via random‐effect meta‐regression. One‐point change of the Improved clinically Detectable Equine Asthma Scoring System (IDEASS) score was used to identify the MID.
Results
A significant (P<0.05) relationship was found between the changes in IDEASS score and maximum change in transpulmonary pressure (ΔPplmax) or pulmonary resistance (RL). Since only the model resulting for RL passed through the origin (Y‐intercept when X = 0: −0.31, 95% CI −0.75 to 0.14), this variable was used to identify the MID correlated with a meaningful improvement in clinical signs. The resulting MID value was a change in RL of 0.63 cm H2O/L/s (95% CI 0.33–0.94), representing the slope of meta‐regression model (high quality of evidence).
Main limitations
No long‐term studies investigated the effect of bronchodilator agents on both lung function and clinical signs in asthmatic horses.
Conclusions
In conclusion, bronchodilator pharmacotherapy in equine asthma elicits clinically meaningful effect when RL increases ≥1 cm H2O/L/s, a value indicating the MID. Assessing the MID based on change in RL may improve the quality of evidence and the scientific impact of future clinical trials as it extends beyond the simple, and limiting, evaluation of statistical significance.</description><identifier>ISSN: 0425-1644</identifier><identifier>EISSN: 2042-3306</identifier><identifier>DOI: 10.1111/evj.13137</identifier><identifier>PMID: 31132169</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Administration, Inhalation ; Airway management ; Animals ; Asthma ; Asthma - drug therapy ; Asthma - veterinary ; Bronchodilator Agents - therapeutic use ; bronchodilator pharmacotherapy ; Bronchodilators ; clinical efficacy ; equine asthma ; horse ; Horse Diseases - drug therapy ; Horses ; Treatment Outcome</subject><ispartof>Equine veterinary journal, 2020-03, Vol.52 (2), p.305-313</ispartof><rights>2019 EVJ Ltd</rights><rights>2019 EVJ Ltd.</rights><rights>Copyright © 2020 EVJ Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3537-4f90d86e4b1ac41fb30492d661a17c0744459e7f6bb0f7851747ee4c5dbf15a43</citedby><cites>FETCH-LOGICAL-c3537-4f90d86e4b1ac41fb30492d661a17c0744459e7f6bb0f7851747ee4c5dbf15a43</cites><orcidid>0000-0003-0456-069X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fevj.13137$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fevj.13137$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31132169$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Calzetta, L.</creatorcontrib><creatorcontrib>Crupi, R.</creatorcontrib><creatorcontrib>Roncada, P.</creatorcontrib><creatorcontrib>Pistocchini, E.</creatorcontrib><creatorcontrib>Cave, D.</creatorcontrib><creatorcontrib>Rossi, I.</creatorcontrib><creatorcontrib>Cito, G.</creatorcontrib><creatorcontrib>Jacobson, G. A.</creatorcontrib><creatorcontrib>Britti, D.</creatorcontrib><title>Clinical efficacy of bronchodilators in equine asthma: Looking for minimal important difference</title><title>Equine veterinary journal</title><addtitle>Equine Vet J</addtitle><description>Summary
Background
Airway obstruction is the main trait of severe equine asthma that affects respiratory function and elicits detrimental effects on clinical presentation. Only few and underpowered clinical studies have investigated the impact of improvement in lung function induced by bronchodilators on the clinical signs of asthma‐affected horses.
Objectives
To identify the minimal important difference (MID) in lung function elicited by bronchodilator leading to a meaningful improvement in clinical signs.
Study design
Pairwise meta‐analysis and meta‐regression analysis.
Methods
Literature searches were performed for studies that investigated the effect of bronchodilator therapy on lung function and clinical condition of asthmatic horses. The relationship between the change in lung function variables and clinical score was analysed via random‐effect meta‐regression. One‐point change of the Improved clinically Detectable Equine Asthma Scoring System (IDEASS) score was used to identify the MID.
Results
A significant (P<0.05) relationship was found between the changes in IDEASS score and maximum change in transpulmonary pressure (ΔPplmax) or pulmonary resistance (RL). Since only the model resulting for RL passed through the origin (Y‐intercept when X = 0: −0.31, 95% CI −0.75 to 0.14), this variable was used to identify the MID correlated with a meaningful improvement in clinical signs. The resulting MID value was a change in RL of 0.63 cm H2O/L/s (95% CI 0.33–0.94), representing the slope of meta‐regression model (high quality of evidence).
Main limitations
No long‐term studies investigated the effect of bronchodilator agents on both lung function and clinical signs in asthmatic horses.
Conclusions
In conclusion, bronchodilator pharmacotherapy in equine asthma elicits clinically meaningful effect when RL increases ≥1 cm H2O/L/s, a value indicating the MID. Assessing the MID based on change in RL may improve the quality of evidence and the scientific impact of future clinical trials as it extends beyond the simple, and limiting, evaluation of statistical significance.</description><subject>Administration, Inhalation</subject><subject>Airway management</subject><subject>Animals</subject><subject>Asthma</subject><subject>Asthma - drug therapy</subject><subject>Asthma - veterinary</subject><subject>Bronchodilator Agents - therapeutic use</subject><subject>bronchodilator pharmacotherapy</subject><subject>Bronchodilators</subject><subject>clinical efficacy</subject><subject>equine asthma</subject><subject>horse</subject><subject>Horse Diseases - drug therapy</subject><subject>Horses</subject><subject>Treatment Outcome</subject><issn>0425-1644</issn><issn>2042-3306</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kD1PwzAURS0EoqUw8AeQJSaGtP5MWjZUlS9VYgFWy3Fs6pLYrZ2A-u8xpLDxlvuGo_OeLgDnGI1xmon-WI8xxbQ4AEOCGMkoRfkhGKaVZzhnbABOYlwjRClh5BgMKMaU4Hw2BGJeW2eVrKE2JqXaQW9gGbxTK1_ZWrY-RGgd1NvOOg1lbFeNvIZL79-te4PGB9gkQ5MMttn40ErXwsoao4N2Sp-CIyPrqM_2OQIvt4vn-X22fLp7mN8sM0U5LTJmZqia5pqVWCqGTUkRm5Eqz7HEhUIFY4zPdGHyskSmmHJcsEJrpnhVGswloyNw2Xs3wW87HVux9l1w6aQglBNKpojxRF31lAo-xqCN2IT0etgJjMR3lSJVKX6qTOzF3tiVja7-yN_uEjDpgU9b693_JrF4feyVX0hcfXI</recordid><startdate>202003</startdate><enddate>202003</enddate><creator>Calzetta, L.</creator><creator>Crupi, R.</creator><creator>Roncada, P.</creator><creator>Pistocchini, E.</creator><creator>Cave, D.</creator><creator>Rossi, I.</creator><creator>Cito, G.</creator><creator>Jacobson, G. A.</creator><creator>Britti, D.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><orcidid>https://orcid.org/0000-0003-0456-069X</orcidid></search><sort><creationdate>202003</creationdate><title>Clinical efficacy of bronchodilators in equine asthma: Looking for minimal important difference</title><author>Calzetta, L. ; Crupi, R. ; Roncada, P. ; Pistocchini, E. ; Cave, D. ; Rossi, I. ; Cito, G. ; Jacobson, G. A. ; Britti, D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3537-4f90d86e4b1ac41fb30492d661a17c0744459e7f6bb0f7851747ee4c5dbf15a43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Administration, Inhalation</topic><topic>Airway management</topic><topic>Animals</topic><topic>Asthma</topic><topic>Asthma - drug therapy</topic><topic>Asthma - veterinary</topic><topic>Bronchodilator Agents - therapeutic use</topic><topic>bronchodilator pharmacotherapy</topic><topic>Bronchodilators</topic><topic>clinical efficacy</topic><topic>equine asthma</topic><topic>horse</topic><topic>Horse Diseases - drug therapy</topic><topic>Horses</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Calzetta, L.</creatorcontrib><creatorcontrib>Crupi, R.</creatorcontrib><creatorcontrib>Roncada, P.</creatorcontrib><creatorcontrib>Pistocchini, E.</creatorcontrib><creatorcontrib>Cave, D.</creatorcontrib><creatorcontrib>Rossi, I.</creatorcontrib><creatorcontrib>Cito, G.</creatorcontrib><creatorcontrib>Jacobson, G. A.</creatorcontrib><creatorcontrib>Britti, D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><jtitle>Equine veterinary journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Calzetta, L.</au><au>Crupi, R.</au><au>Roncada, P.</au><au>Pistocchini, E.</au><au>Cave, D.</au><au>Rossi, I.</au><au>Cito, G.</au><au>Jacobson, G. A.</au><au>Britti, D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical efficacy of bronchodilators in equine asthma: Looking for minimal important difference</atitle><jtitle>Equine veterinary journal</jtitle><addtitle>Equine Vet J</addtitle><date>2020-03</date><risdate>2020</risdate><volume>52</volume><issue>2</issue><spage>305</spage><epage>313</epage><pages>305-313</pages><issn>0425-1644</issn><eissn>2042-3306</eissn><abstract>Summary
Background
Airway obstruction is the main trait of severe equine asthma that affects respiratory function and elicits detrimental effects on clinical presentation. Only few and underpowered clinical studies have investigated the impact of improvement in lung function induced by bronchodilators on the clinical signs of asthma‐affected horses.
Objectives
To identify the minimal important difference (MID) in lung function elicited by bronchodilator leading to a meaningful improvement in clinical signs.
Study design
Pairwise meta‐analysis and meta‐regression analysis.
Methods
Literature searches were performed for studies that investigated the effect of bronchodilator therapy on lung function and clinical condition of asthmatic horses. The relationship between the change in lung function variables and clinical score was analysed via random‐effect meta‐regression. One‐point change of the Improved clinically Detectable Equine Asthma Scoring System (IDEASS) score was used to identify the MID.
Results
A significant (P<0.05) relationship was found between the changes in IDEASS score and maximum change in transpulmonary pressure (ΔPplmax) or pulmonary resistance (RL). Since only the model resulting for RL passed through the origin (Y‐intercept when X = 0: −0.31, 95% CI −0.75 to 0.14), this variable was used to identify the MID correlated with a meaningful improvement in clinical signs. The resulting MID value was a change in RL of 0.63 cm H2O/L/s (95% CI 0.33–0.94), representing the slope of meta‐regression model (high quality of evidence).
Main limitations
No long‐term studies investigated the effect of bronchodilator agents on both lung function and clinical signs in asthmatic horses.
Conclusions
In conclusion, bronchodilator pharmacotherapy in equine asthma elicits clinically meaningful effect when RL increases ≥1 cm H2O/L/s, a value indicating the MID. Assessing the MID based on change in RL may improve the quality of evidence and the scientific impact of future clinical trials as it extends beyond the simple, and limiting, evaluation of statistical significance.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>31132169</pmid><doi>10.1111/evj.13137</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-0456-069X</orcidid></addata></record> |
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| subjects | Administration, Inhalation Airway management Animals Asthma Asthma - drug therapy Asthma - veterinary Bronchodilator Agents - therapeutic use bronchodilator pharmacotherapy Bronchodilators clinical efficacy equine asthma horse Horse Diseases - drug therapy Horses Treatment Outcome |
| title | Clinical efficacy of bronchodilators in equine asthma: Looking for minimal important difference |
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