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Clinical efficacy of bronchodilators in equine asthma: Looking for minimal important difference

Calzetta, L, Crupi, R, Roncada, P, Pistocchini, E, di Cave, D, Rossi, I, Cito, G, Jacobson, GA ORCID: 0000-0002-3409-8769 and Britti, D 2019 , 'Clinical efficacy of bronchodilators in equine asthma: Looking for minimal important difference' , Equine Veterinary Journal , pp. 1-9 , doi: 10.1111/evj.13137.

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Background: Airway obstruction is the main trait of severe equine asthma that affects respiratory function and elicits detrimental effects on clinicalpresentation. Only few and underpowered clinical studies have investigated the impact of improvement in lung function induced by bronchodilators onthe 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 inclinical 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 conditionof 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 (Pmax) 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 to0.14), this variable was used to identify the MID correlated with a meaningful improvement in clinical signs. The resulting MID value was a change in RLof 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, avalue indicating the MID. Assessing the MID based on change in RL may improve the quality of evidence and the scientific impact of future clinical trialsas it extends beyond the simple, and limiting, evaluation of statistical significance.

Item Type: Article
Authors/Creators:Calzetta, L and Crupi, R and Roncada, P and Pistocchini, E and di Cave, D and Rossi, I and Cito, G and Jacobson, GA and Britti, D
Keywords: horse, bronchodilator pharmacotherapy, equine asthma, clinical efficacy
Journal or Publication Title: Equine Veterinary Journal
Publisher: Equine Veterinary Journal Ltd
ISSN: 0425-1644
DOI / ID Number: 10.1111/evj.13137
Copyright Information:

Copyright 2019 EVJ Ltd.

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