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Asthma is a common condition for which there are robust evidence-based guidelines.1 Such guidelines are by definition based on the gold standard of randomised controlled trials (RCTs) which often have restrictive, inclusion and exclusion criteria, such that patients enrolled are not representative of patients seen in real world settings. Pragmatic trial designs have been suggested as a method of overcoming some of these limitations.2
In two parallel, multicentre open-labelled pragmatic trials, Price and colleagues evaluated the effectiveness of inhaled corticosteroids (ICS) versus leukotriene receptor antagonists (LTRAs) as initial asthma therapy (in trial 1) and the addition of an LTRA or a long-acting β agonist (LABA), by random allocation, for participants who remained uncontrolled after 12 weeks of ICS (in trail 2). Participants with physician-diagnosed asthma were recruited from 53 primary care practices in the UK. The study was not funded by the …
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