"The Use of Long-Acting Beta-Agonists in the Treatment of Stable Asthma" is a wonderful example of a paper on drug therapy. In article number CD003901 in the Cochrane Database of Systematic Reviews, Walters, Walters, and Gibson conducted studies to clarify the controversy surrounding the regular use of long-acting beta-agonists in the treatment of stable asthma in both adults and children. The systematic research review (SRR) of the article aimed at comparing the effects of customary use of inhaled short-acting beta-agonists with long-acting beta-agonists in chronic asthma and assessing whether the effects are beneficial or harmful.
The randomized studies considered were both blinded and open and the participants involved had had clinical diagnoses of asthma for not less than six months. The SSR concluded that there are advantages associated with the use of long-acting inhaled beta-agonists over short-acting beta-agonists. This paper will describe the overall findings, the relevance of the research problem of the SSR to practice, and critique the levels of evidence in this study, the clarity in which it is presented, and its conclusions. For nurses caring for asthmatic patients, the relevance of this problem is that using long-acting beta-agonists actually has more beneficial effects yet it has been subjected to more controversy compared to the less beneficial short-acting beta-agonists.
Since it is more costly to use long-acting beta-agonists that short-acting beta-agonists, the question of whether there is an advantage associated with them becomes important. Therefore, it is imperative for nurses to understand which of the two interventions improves the control of asthma, pulmonary function, and quality of life for their patients while reducing asthma symptoms both during the day and night.
In practice, nurses are required to ensure that the intervention prescribed to their asthma patients has anti-inflammatory effects that also modify other diseases, which adds more significance and relevance to the problem of needing to know which is more beneficial. From the perspective of healthcare providers, nurses can use the findings of the SRR to design and discuss their intended plan of care with their patients as well as address the concerns of the patients with the healthcare team (Melnyk & Fineout-Overholt, 2011). However, the level of evidence and the study design in the SSR can be critiqued from several perspectives.
The Cochrane Collaboration suggests that a systematic review should be characterized by a set of clearly stated objectives and predefined eligibility study criteria as well as a methodology that is explicit and reproducible (Melnyk & Fineout-Overholt, 2011). In this SRR, the ideal situation would have been having all the studies blinded because blinded studies are given higher scores by the scoring system than open studies. However, the level of evidence could be lowered significantly by the designs of the studies that used both open and blinded studies as used in the SRR.
Further, studies that did not include the details of the severity level of the asthma of the participants were allowed as well as those that featured more than one intervention for treatment, which directly affects the level of evidence. On one hand, it is also appreciated that the SRR contains studies that are randomized controlled trials (RCTs) and the subjects were assigned randomly to both the control and experimental groups. However, on the other hand, the SRR did not seek to identify all the studies in the database that satisfy the eligibility criteria and does not describe the search strategy in detail so as to find all the relevant studies. The SRR attempts to critique and present the studies in detail but the discussion part gets too detailed and technical in discussing asthma as a chronic disease rather than the intervention proposed in the objective of the studies.
This compromises the clarity with which the SRR presents the studies. According to Melnyk and Fineout-Overholt (2011), an SRR should be a systematic presentation of the studies’ synthesis and include the findings and characteristics of the studies that the review covers.
However, the SRR also digressed with the studies used as it paid greater attention to asthma as a disease at the expense of the overall findings summarized in the reviewers’ conclusion. Hence, the clarity can be critiqued because it does not present a standardized evaluation of the validity of the results of the studies included, which increases the risk of bias. Although it is imperative to appreciate that the randomization and description of dropouts and descriptions were well addressed, the number of studies that had adult or adolescent participants largely outweighed that of children below 12 at 28 against three.
From this observation, the findings cannot confidently be said to a fair representation of the entire target population. The overall findings of the SSR indicate that long-acting inhaled beta-agonists do have several advantages on both clinical and physiological outcomes among patients for regular treatment. It was shown that although preventer medications are generally used in the treatment of chronic asthma to reduce underlying inflammation in the airways, bronchodilators are also required for their symptoms.
Specifically, that answered the question the studies were seeking to address because long-acting beta-agonists were shown to be more beneficial bronchodilator agents than the short-acting beta-agonists. Using long-acting bet agonist bronchodilator agents reduces asthma symptoms both at night and during the day and results in fewer medication requirements and better lung functions and quality of life. However, although the results were in comparison to using short-acting beta-agonists, they may be critiqued because no major adverse effects were seen as a result of using short-acting beta-agonists.
Further, the fact that no adverse effects were seen on patients who did not use any preventer medications questions the primary role of the preventer medications in practice, especially since there is a high cost associated with them. In terms of research, more studies and assessments need to be conducted to determine whether there would be similar effects if the preventer medicines are used in ways other than inhaling. Although the SRR includes studies that show the translocation of the CS-CS receptor complex is enhanced by beta-agonists, more work is needed in order to document the effects of the long-acting beta-agonists in their entirety.
ReferencesMelnyk, B.M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing &healthcare (2nd ed.). Philadelphia, PA: Wolters Kluwer/Lippincott, Williams & Wilkins.