Quality standards in respiratory real-life effectiveness research: the REal Life EVidence AssessmeNt Tool (RELEVANT): report from the Respiratory Effectiveness Group—European Academy of Allergy and Clinical Immunology Task Force

Table 3 Summary table of literature analysis, PICOT question 1: influence of adherence to ICS therapy on asthma outcomes

Reference	Statement	Type of data source	Final level of evidence (see Fig. 1)	Possible impact on clinical practice (TF opinion)	Similar evidence available from RCTs
Williams et al. [45]	Low adherence increases the risk of ED visits and oral steroid treatment	D-M	Moderate	Yes	No
Taegtmeyer et al. [46]	Lower ACQ improvement associated with low adherence	PC-A	Moderate	Yes	No
Laforest et al. [47]	Low adherence (MPR) associated with poorer control and more hospital contacts and oral steroid courses	PC-A	Moderate	Yes	No
Laforest et al. [48]	Low adherence (MPR) increases the risk of oral steroid treatment and hospitalization	D-A	Moderate	Yes	No
Sadatsafavi et al. [31]	Risk of asthma-related hospitalization lower with ICS-containing regimen than LABA alone	D-M	Moderate	Yes	No
	Risk of asthma-related hospitalization similar between ICS and ICS-LABA	D-M	Moderate	Yes	No^a
	Risk of asthma-related hospitalization increases when ICS treatment is irregular	D-M	Moderate	Yes	No
Friedman et al. [43]	Adherence and SABA use are better with MF than FP DPIs, with no difference in other clinical outcomes	D-M	Moderate	No	No
Campbell et al. [44]	Shifting drug costs to patients decreases adherence and impairs asthma outcomes	D	Moderate	Yes	No
Tan et al. [38]	In adherent patients, ICS > LTRA	D + S	Moderate (D), low (S)	Yes	In part (pragmatic RCT)
Tan et al. [38]	In non-adherent patients, ICS < LTRA	D + S	Moderate (D), low (S)	Yes	In part (pragmatic RCT)

SABA short-acting beta2 agonist, LABA long-acting beta2 agonist, ICS inhaled corticosteroid, LTRA leukotriene-receptor antagonist, MF mometasone furoate, FP fluticasone propionate, D database, PC prospective cohort, S survey, M matched, A adjusted, RCT randomized controlled trial, MPR medication possession ratio, ED emergency department, ACQ asthma control questionnaire, TF task force
^aOpposite finding regarding the risk of severe asthma exacerbation in several trials

ISSN: 2045-7022