The purpose of this series is to help you to understand
research concepts by breaking them down into ‘bite-sized
TRIPLE THERAPY IMPROVES LUNG FUNCTION IN COPD
Research Project Manager, Module Leader for Evidenced Based Healthcare, Education
DOUBLE BLIND RANDOMISED CONTROLLED TRIAL
he phrase ‘double blind randomised controlled trial’ is common in
research journals but what does it mean?
In order for the effectiveness of new interventions (e.g. drugs, treatments
or diagnostic methods) to be evaluated they need to be tried out or
‘trialled’. Research designed to test an intervention is therefore called a
Trials evaluate whether the effects of new interventions on patients differ
from usual care or placebo (an inactive substance). The usual care or
placebo is the control; the standard against which the new intervention is
dding fluticasone/salmeterol to tiotropium therapy in patients with
moderate to severe COPD improved lung function, quality of life, and
• Why is the controlled trial ‘randomised’?
hospitalisation rates but did not statistically influence exacerbation rates,
Imagine you wish to run a controlled trial to test the effectiveness of a
new drug treatment. The intervention and control groups should be as
A total of 449 patients with moderate or severe COPD were randomised to
one year’s treatment with tiotropium plus placebo, tiotropium plus salmeterol, or
similar as possible at the start so that any differences at the end of the
tiotropium plus fluticasone/salmeterol.
trial can be attributed to the new treatment. The best way of doing
Results showed that nearly two-thirds (62.8%) of patients treated with
this is to randomly allocate patients to receive either the new drug or
tiotropium plus placebo experienced an exacerbation, which was similar to the
rate in patients given tiotropium plus salmeterol (64.8%) or tiotropium plus
Further results demonstrated that tiotropium plus fluticasone/salmeterol
improved lung function (p=<0.049) and disease-specific quality of life (p =<0.01)
and reduced the number of hospital admissions for COPD exacerbation (incidence
rate ratio, 0.53 [CI, 0.33 to 0.86]) and all-cause hospitalisations (incidence rate
ratio, 0.67 [CI, 0.45 to 0.99]) compared with tiotropium plus placebo.
In contrast, tiotropium plus salmeterol did not statistically improve lung
function or hospitalization rates compared with tiotropium plus placebo.
Addition of fluticasone/salmeterol to tiotropium therapy may improve lung
function, quality of life, and hospitalisation rates in patients with moderate
to severe COPD but will not influence rates of COPD exacerbation.
• Why is it the randomised controlled trial ‘double blind’?
This means that the patients included in the trial and the researchers
handling the data do not know (are blind to) which group patients are in.
You might like to ponder why this might be, and whether it is always
possible to achieve in clinical trials. These questions will be addressed in
Education for Health runs training in Reading and Understanding
Research Papers and Evidenced Based Healthcare
LA CUESTIÓN DEL EXTRANJERO EN “LOS RÍOS PROFUNDOS” DE JOSÉ MARÍA ARGUEDAS Leticia Alle Este artículo analiza Los Ríos Profundos de José María Arguedas a partir de la figura del extranjero. Se propone una hipótesis de lectura basada en la idea según la cual Ernesto, el protagonista de la novela, se encuentra atravesado por una doble condición de extranjería. De un l
Statement of Frederick K. Goodwin M. D. regarding the 11-21-08 New York Times article by Gardiner Harris and the follow up editorial of Nov 29 Mr. Harris’ article is filled with misstatements of fact, and incorrect implications; which also characterize the brief mention of me in the Nov 29 editorial. Let me first note that I spent nearly an hour on the phone with Mr. Harris, and followed this