Meta AnalysisID 7696
甘露醇支气管激发试验诊断哮喘的准确性
CRD42023438827
In people under investigation for asthma, what is the diagnostic test accuracy and cost-effectiveness of bronchial challenge testing with mannitol?
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Record Fields
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- Meta Analysis Id
- 7696
- Evidence Id
- 16254
- Core Evidence Id
- 16254
- Source Meta Analysis Id
- 7691
- Herb2 Meta Analysis Id
- HBMA007691
- Crd Id
- CRD42023438827
- Title
- Accuracy of bronchial challenge testing with mannitol for diagnosis of asthma
- Review Question
- In people under investigation for asthma, what is the diagnostic test accuracy and cost-effectiveness of bronchial challenge testing with mannitol?
- Study Type Included
- Clinical effectiveness (test and treat): • Systematic reviews of RCTs • Parallel RCTs Published NMAs and IPDs will be considered for inclusion. Diagnostic test accuracy: • Cross sectional studies • Cohort studies will be included
- Condition Being Studied
- Asthma
- Participant
- Inclusion: People with suspected asthma (presenting with respiratory symptoms). • Adolecents/ Adults (≥12 years old) Exclusion: • Children under 5 years old • Children aged 5-11 years as mannitol is not licenced in this population. • People on steroid medication (washout period minimum of 4 weeks for inclusion) • Stratification: smokers vs non-smokers vs mixed population
- Animal
- Human Disease Modelled
- Intervention
- • Mannitol (Positive test: usually PD15 <635mg)
- Comparator Control
- Clinical effectiveness (test-and-treat) • Compare to each other Diagnostic accuracy Reference standard: Physician diagnosis of asthma based on symptoms plus an objective test from any one of the following: • peak flow variability (cut-off value of more than 20% variability as indication of a positive test); • bronchodilator reversibility (cut-off value of an improvement in FEV1 of more than or equal to 12%, and an increase in volume of more than or equal to 200mls as indication of a positive test); • bronchial hyper-responsiveness (histamine or methacholine challenge test, cut-off value of PC20 less than or equal to 8mg/ml as indication of a positive test) • FeNO Where no evidence is available using the cut-off values specified above, evidence will be included from studies using a reference standard of physician diagnosis with an objective test using an alternative threshold. Where no evidence is available from studies using physician diagnosis and an objective test, evidence will be included from studies using physician diagnosis based on symptoms alone, or patient report of a previous physician diagnosis.
- Main Outcome
- Clinical effectiveness (test and treat): • Severe asthma exacerbations (defined as asthma exacerbations requiring oral corticosteroid use (dichotomous outcome at ≥6 months) • Mortality (dichotomous outcome at ≥6 months) • Quality of life (QOL; validated scale, including asthma specific questionnaires AQLQ; health-related) (continuous outcome at ≥3 months) • Asthma control assessed by a validated questionnaire (ACQ, ACT, St George’s respiratory) (continuous at ≥3 months) • Hospital admissions (dichotomous at ≥6 months) • Reliever/rescue medication use (continuous at ≥3 months) • Lung function (change in FEV1 or morning PEF – average over at least 7 days for morning PEF) (continuous at ≥3 months). Extract FEV1 %pred over litres if both reported. If only litres is reported, analyse separately (do not extract both). For children, only use FEV1 %pred. • Adverse events o Linear growth (continuous at ≥1 year), o Pneumonia frequency (continuous at ≥6 months) o Adrenal insufficiency as defined by study, including short synacthen test and morning cortisol (dichotomous at ≥3 months) o Bone mineral density (continuous at ≥6 months) • Inflammatory markers; exhaled nitric oxide (continuous at ≥8 weeks) Diagnostic accuracy: Asthma diagnosis Sensitivity (Threshold: upper 90%, lower 10% ) Specificity (Threshold: upper 80%, lower 50%) • Raw data to calculate 2x2 tables for sensitivity and specificity • Negative/positive predictive values Measures of effect Relative risk ratio, odds ratio, mean difference, risk difference, sensitivity, specificity
- Outcome Measure
- Additional Outcome
- Study Method
- Cost effectiveness, Diagnostic, Intervention, Systematic review
- Keyword
- Asthma; Bronchial Provocation Tests; Humans; Mannitol
- Contact
- Amy Crisp [email protected]
- Organisational Affiliation
- National Institute for Health and Care Excellence (NICE) and National Guideline Centre
- Funding Source
- This systematic review is being completed by the National Guideline Centre which receives funding from NICE
- Other Selection Criteria
- Final Publication
- Same Topic Review
- Published Protocol
- Review Type
- Language
- English
- Country
- England
- Review Stage
- Review Ongoing
- First Submission Date
- 2023-06-22
- Registration Date
- 2023-06-23
- Anticipated Start Date
- 2023-05-10
- Anticipated Completion Date
- 2024-07-31
- Title Cn
- 甘露醇支气管激发试验诊断哮喘的准确性
- Title En
- Accuracy of bronchial challenge testing with mannitol for diagnosis of asthma
- Bilingual Status
- complete