Topical antibiotics for acute bacterial conjunctivitis: Cochrane systematic review and meta-analysis update

Background: Uncertainty remains about the extent to which findings from our previously published systematic review and meta-analysis of double-blind, randomised controlled trials of topical antibiotics compared with placebo in the management of patients with acute bacterial conjunctivitis treated in secondary care outpatient settings are generalisable to the management of the condition in primary care settings. We updated our review, undertaking searches, methodological assessment, data extraction and analysis according to a pre-defined protocol. In addition to the previous three included studies, we identified two additional double-blind primary care trials, one which compares fusidic acid gel with placebo gel and one which compares chloramphenicol eye drops with placebo eye drops in children. Meta-analyses of clinical and microbiological remission data reveal that topical antibiotics are of benefit in improving early (days 2-5) clinical (relative risk [RR] = 1.24, 95% confidence interval [CI] = 1.05 to 1.45) and microbiological (RR = 1.77, 95% CI = 1.23 to 2.54) remission rates; later (days 6-10) data reveal that these early advantages in clinical (RR = 1.11, 95% CI = 1.02 to 1.21) and microbiological cure rates are reduced (RR 1.56, 95% CI = 1.17 to 2.09), but persist. Most cases of acute bacterial conjunctivitis resolve spontaneously. While topical antibiotics are associated with significantly improved rates of early (days 2-5) clinical remission, this benefit is marginal for later remission (days 6-10).     

The efficacy of drug treatments for dysthymia: a systematic review and meta-analysis

BACKGROUND: Dysthymia is a common mental disorder, associated with considerable disability and high co-morbidity. This review assessed the role of pharmacological treatment. METHODS: All randomized-controlled trials that compared active drug versus placebo for dysthymic patients were included. Pooled relative risks (RR) and 95% confidence intervals (CI) were calculated with the Random Effect Model method. Where possible, number needed to treat and number needed to harm were estimated. RESULTS: Fifteen trials were included for the main comparisons. Similar results were obtained in terms of efficacy for different groups of drugs, such as tricyclic (TCA), selective serotonin reuptake inhibitors (SSRI), monoamine oxidase inhibitors (MAOI) and other drugs (sulpiride, amineptine, and ritanserin). The pooled RR treatment response was 0.68 (95% CI 0.59-0.78) for TCA, 0.64 (95% CI 0.55-0.74) for SSRIs, 0.59 (95% CI 0.48-0.71) for MAOIs. Other drugs (amisulpride, amineptine and ritanserin) showed similar results. Patients treated on TCA were more likely to report adverse events, compared with placebo. There were no differences in response to active treatment when dysthymia was compared to either dysthymia plus major depression or briefer non-major depressive states. CONCLUSIONS: Drug treatment appears to be effective in the short-term management of dysthymic disorder. The choice of drug should take into account specific side-effects profile of each drug.     

Topical antibiotics for acute bacterial conjunctivitis: a systematic review.

There has been uncertainty about whether antibiotic therapy confers significant benefit in the treatment of acute bacterial conjunctivitis. This study aimed to assess the efficacy of antibiotic therapy in the management of acute bacterial conjunctivitis. Using standard Cochrane search methods, we identified double-blind randomised controlled trials in which any form of antibiotic treatment (topical, systemic or combination) had been compared with placebo in the management of acute bacterial conjunctivitis. Data extraction and analysis followed a pre-defined protocol. Meta-analysis was performed to obtain summary measures of relative risk. Six published trials were identified, of which three fulfilled the eligibility criteria for inclusion in this review. The trials were heterogeneous in terms of their inclusion and exclusion criteria, the nature of the intervention, and the outcome measures assessed. Meta-analysis indicates that acute bacterial conjunctivitis is frequently a self-limiting condition, as clinical remission occurred by days 2 to 5 in 64% (95% confidence interval (CI) = 57-71) of those treated with placebo. Treatment with antibiotics was, however, associated with significantly better rates of clinical remission (days 2 to 5: relative risk (RR) = 1.31, 95% CI = 1.11-1.55), with a suggestion that this benefit was maintained for late clinical remission (days 6 to 10: RR = 1.27, 95% CI = 1.00-1.61). Acute bacterial conjunctivitis is frequently a self-limiting condition but the use of antibiotics is associated with significantly improved rates of early clinical remission, and early and late microbiological remission. Since trials to date have been conducted in selected specialist care patient populations, generalisation of these results to a primary care-based population should be undertaken with a degree of caution.     

Sublingual immunotherapy for allergic rhinitis: systematic review and meta-analysis

Allergic rhinitis is a common condition which, at its most severe, can significantly impair quality of life despite optimal treatment with antihistamines and topical nasal corticosteroids. Allergen injection immunotherapy significantly reduces symptoms and medication requirements in allergic rhinitis but its use is limited by the possibility of severe systemic reactions. There has therefore been considerable interest in alternative routes for delivery of allergen immunotherapy, particularly the sublingual route. The objective was to evaluate the efficacy of sublingual immunotherapy (SLIT), compared with placebo, for reductions in symptoms and medication requirements. The Cochrane Controlled Clinical Trials Register, MEDLINE (1966-2002), EMBASE (1974-2002) and Scisearch were searched, up to September 2002, using the terms (Rhin* OR hay fever) AND (immunotherap* OR desensiti*ation) AND (sublingual). All studies identified by the searches were assessed by the reviewers to identify Randomized Controlled Trials involving participants with symptoms of allergic rhinitis and proven allergen sensitivity, treated with SLIT or corresponding placebo. Data from identified studies was abstracted onto a standard extraction sheet and subsequently entered into RevMan 4.1. Analysis was performed by the method of standardized mean differences (SMD) using a random effects model. P-values < 0.05 were considered statistically significant. Subgroup analyses were performed according to the type of allergen administered, the age of participants and the duration of treatment. Twenty-two trials involving 979 patients, were included. There were six trials of SLIT for house dust mite allergy, five for grass pollen, five for parietaria, two for olive and one each for, ragweed, cat, tree and cupressus. Five studies enrolled exclusively children. Seventeen studies administered the allergen by sublingual drops subsequently swallowed, three by drops subsequently spat out and two by sublingual tablets. Eight studies involved treatment for less than 6 months, 10 studies for 6-12 months and four studies for greater than 12 months. All included studies were double-blind placebo-controlled trials of parallell group design. Concealment of treatment allocation was considered adequate in all studies and the use of identical placebo preparations was almost universal. There was significant heterogeneity, most likely due to widely differing scoring systems between studies, for most comparisons. Overall there was a significant reduction in both symptoms (SMD -0.42, 95% confidence interval -0.69 to -0.15; P = 0.002) and medication requirements [SMD -0.43 (-0.63, -0.23); P = 0.00003] following immunotherapy. Subgroup analyses failed to identify a disproportionate benefit of treatment according to the allergen administered. There was no significant reduction in symptoms and medication scores in those studies involving only children but total numbers of participants was too small to make this a reliable conclusion. Increasing duration of treatment does not clearly increase efficacy. The total dose of allergen administered may be important but insufficient data was available to analyse this factor.     

Computer-based psychological treatments for depression: a systematic review and meta-analysis

The aim of the paper was to systematically review the literature on computer-based psychological treatments for depression and conduct a meta-analysis of the RCT studies, including examining variables which may effect outcomes. Database and hand searches were made using specific search terms and inclusion criteria. The review included a total of 40 studies (45 published papers), and 19 RCTs (23 published papers) were included in a standard meta-analysis. The review describes the different computer-based treatments for depression, their design, communication types employed: synchronous, asynchronous, and face-to-face (F:F); alongside various types and frequency of support delivered. The evidence supports their effectiveness and highlights participant satisfaction. However, pertinent limitations are noted. Across 19 studies the meta-analysis revealed a moderate post-treatment pooled effect size d=.56 (95% confidence interval [CI] -.71, -.41), Z=7.48, p<.001). Supported interventions yielded better outcomes, along with greater retention. The results reported statistically significant clinical improvement and recovery post-treatment. The review and meta-analysis support the efficacy and effectiveness of computer-based psychological treatments for depression, in diverse settings and with different populations. Further research is needed, in particular to investigate the influence of therapist factors in supported treatments, the reasons for dropout, and the maintenance of gains post-treatment.     

Topical levocabastine is more effective than sodium cromoglycate for the prophylaxis and treatment of seasonal allergic conjunctivitis

The efficacy, tolerability, and adverse-effect profile of the recently developed, topical antihistamine levocabastine were compared with those of sodium cromoglycate in a 4-week double-blind, placebo-controlled trial in 95 patients with seasonal allergic conjunctivitis. At the end of the trial, global therapeutic efficacy was considered to be excellent or good in 87% of levocabastine-treated patients, as compared with 68% of sodium cromoglycate-treated patients ( P = 0.006) and 63% of those who received placebo ( P = 0.05). After 4 weeks of treatment, levocabastine patients had experienced significantly greater relief from their most severe ocular symptom than patients in the sodium cromoglycate group ( P < 0.05). Furthermore, 37% of levocabastine-treated patients were virtually symptom-free for at least 75% of the treatment period, as compared with only 6% of patients in the sodium cromoglycate group ( P < 0.01) and 4% of those who received placebo ( P < 0.01). Moreover, this trend was maintained on days when the pollen count was high, when the corresponding figures were 33%, 6% ( P = 0.02), and 4% ( P = 0.02), respectively. Levocabastine was well tolerated. Indeed, the incidence of adverse reactions was no greater in the levocabastine group than in the placebo group. Topical levocabastine is an effective and well-tolerated drug for the prophylaxis and treatment of seasonal allergic conjunctivitis.     

A systematic review and meta-analysis of treatments for impetigo.

BACKGROUND: Impetigo is a common clinical problem seen in general practice. Uncertainty exists as to the most effective treatment, or indeed if treatment is necessary. AIM: To determine the most effective treatment for impetigo in a systemically well patient. DESIGN OF STUDY: Systematic review and meta-analysis. METHOD: Databases were searched for relevant studies. The Cochrane highly sensitive randomised controlled trial (RCT) search string was employed and combined with the word 'impetigo' as the MeSH term and keyword. The bibliographies of relevant articles were searched for additional references. RCTs that were either double- or observer-blind, and involved systemically well patients of any age in either primary or secondary care settings, were included. Studies that selected patients on the basis of skin swab results were excluded, as were studies that were not in English. Cure or improvement of impetigo reported at seven to 14 days from start of treatment was the primary outcome measure. Meta-analysis was performed on homogeneous studies. RESULTS: Three hundred and fifty-nine studies were identified, of which 16 met the inclusion criteria. Meta-analysis demonstrated that topical antibiotics are more effective than placebo (odds ratio [OR] = 2.69, 95% confidence interval [CI] = 1.49 to 4.86). There is weak evidence for the superiority of topical antibiotics over some oral antibiotics, such as erythromycin (OR = 0.48, 95% CI = 0.23 to 1.00). There is no significant difference between the effects of mupirocin and fusidic acid (OR = 1.76, 95% CI = 0.77 to 4.03). CONCLUSION: This review found limited high-quality evidence to inform the treatment of impetigo. From that which is available, we would recommend the use of a topical antibiotic for a period of seven days in a systemically well patient with limited disease. Further research is needed on the role of flucloxacillin and non-antibiotic treatments for impetigo.     

Psychological treatments for irritable bowel syndrome: a systematic review and meta-analysis

This study conducted a systematic review to assess the quality of existing literature on psychological treatments for irritable bowel syndrome and to quantify the evidence for their efficacy. Three independent reviewers (2 from England, 1 from the United States) coded the quality of 32 studies, 17 of which provided data suitable for meta-analysis. Meta-analysis of efficacy data (50% reduction of symptoms) gave an odds ratio of 12 (95% confidence interval = 5.56-25.96) and a number needed to treat of 2. Psychological treatments are, as a class of interventions, effective in reducing symptoms compared with a pooled group of control conditions. Questions regarding the relative superiority of specific psychological treatments and influence of active versus nonspecific treatment effects remain unanswered.     

Topical tranexamic acid in total knee replacement: A systematic review and meta-analysis

BackgroundTo examine the safety and efficacy of topical use of tranexamic acid (TA) in total knee arthroplasty (TKA).MethodsAn electronic literature search of PubMed Medline; Ovid Medline; Embase; and the Cochrane Library was performed, identifying studies published in any language from 1966 to February 2013. The studies enrolled adults undergoing a primary TKA, where topical TA was used. Inverse variance statistical method and either a fixed or random effect model, depending on the absence or presence of statistical heterogeneity were used; subgroup analysis was performed when possible.ResultsWe identified a total of seven eligible reports for analysis. Our meta-analysis indicated that when compared with the control group, topical application of TA limited significantly postoperative drain output (mean difference: ? 268.36 ml), total blood loss (mean difference = ? 220.08 ml), Hb drop (mean difference = ? 0.94 g/dL) and lowered the risk of transfusion requirements (risk ratio = 0.47, 95CI = 0.26–0.84), without increased risk of thromboembolic events. Sub-group analysis indicated that a higher dose of topical TA (> 2 g) significantly reduced transfusion requirements.ConclusionsAlthough the present meta-analysis proved a statistically significant reduction of postoperative blood loss and transfusion requirements with topical use of TA in TKA, the clinical importance of the respective estimates of effect size should be interpreted with caution.Level of evidenceI, II.     

The effectiveness of computerized drug-lab alerts: A systematic review and meta-analysis

BackgroundInadequate lab monitoring of drugs is a potential cause of ADEs (adverse drug events) which is remediable.ObjectivesTo determine the effectiveness of computerized drug-lab alerts to improve medication-related outcomes.Data sourcesCitations from the Computerized Clinical Decision Support System Systematic Review (CCDSSR) and MMIT (Medications Management through Health Information Technology) databases, which had searched MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, International Pharmaceutical Abstracts from 1974 to March 27, 2013.Study selectionRandomized controlled trials (RCTs) of clinician-targeted computerized drug lab alerts conducted in any healthcare setting. Two reviewers performed full text review to determine study eligibility.Data abstractionA single reviewer abstracted data and evaluated validity of included studies using Cochrane handbook domains.Data synthesisThirty-six studies met the inclusion criteria (25 single drug studies with 22,504 participants, 14 targeting anticoagulation; 11 multi-drug studies with 56,769 participants). ADEs were reported as an outcome in only four trials, all targeting anticoagulants. Computerized drug-lab alerts did not reduce ADEs (OR 0.89, 95% CI 0.79–1.00, p = 0.05), length of hospital stay (SMD 0.00, 95%CI −0.93 to 0.93, p = 0.055, 1 study), likelihood of hypoglycemia (OR 1.29, 95% CI 0.31–5.37) or likelihood of bleeding, but were associated with increased likelihood of prescribing changes (OR 1.73, 95% CI 1.21–2.47) or lab monitoring (OR 1.47, 95% confidence interval 1.12–1.94) in accordance with the alert.ConclusionsThere is no evidence that computerized drug-lab alerts are associated with important clinical benefits, but there is evidence of improvement in selected clinical surrogate outcomes (time in therapeutic range for vitamin K antagonists), and changes in process outcomes (lab monitoring and prescribing decisions).     

Comparative effectiveness of tenofovir in HIV-infected treatment-experienced patients: systematic review and meta-analysis

Background: Antiretroviral therapy (ART) regimens for HIV infection are frequently changed. We conducted a systematic review of randomized trials (RCTs) on the benefits and harms of switching to tenofovir disoproxil fumarate (TDF)-based regimens in ART-experienced patients.

Methods: We included RCTs in HIV-infected adults comparing switching to a TDF-containing regimen with maintaining or switching to another regimen. We searched MEDLINE, EMBASE, CENTRAL, LILACS, SCI, and the WHO Global Health Library. We assessed bias with the Cochrane tool and synthesized data using random-effects meta-analyses and Peto’s approach. For further analyses, we added data from a previous systematic review in treatment-naïve patients.

Results: 17 RCTs with 2210 patients were included. All but one study had a high risk of bias. There was no significant association of switching to TDF-based regimens with mortality, fractures, CD4-cell count, body fat, virological failure, LDL-, and HDL-cholesterol. TDF-based regimens decreased total cholesterol (mean difference ?12.05 mg/dL; 95% CI ?20.76 to ?3.34), trigylcerides (?14.33 mg/dL; ?23.73 to ?4.93), and bone mineral density (BMD; hip: ?2.46%; ?3.9 to ?1.03; lumbar spine ?1.52%; ?2.69 to ?0.34). Effects on estimated glomerular filtration (eGFR) were inconsistent and depended on the measurement. Adding 22 RCTs from 8297 treatment-naïve patients gave consistent results with then significant reductions of LDL (?7.57 mg/dL; ?10.37 to ?4.78), HDL (?2.38 mg/dL; ?3.83 to ?0.93), and eGFR (?3.49 ml/min; ?5.56 to ?1.43).

Conclusions: Switching to TDF-based regimens is associated with reductions of BMD and lipid levels and possibly lowered kidney function. The evidence is limited by the high risk of bias.     

Omega 3 and 6 oils for primary prevention of allergic disease: systematic review and meta-analysis

Background:  There is conflicting evidence on the use of omega 3 and omega 6 supplementation for the prevention of allergic diseases. We conducted a systematic review evaluating the effectiveness of omega 3 and 6 oils for the primary prevention of sensitization and development of allergic disorders.
Methods:  We searched The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, LILACS, PsycInfo, AMED, ISI Web of Science and Google Scholar for double-blind randomized controlled trials. Two authors independently assessed articles for inclusion. Meta-analyses were undertaken using fixed effects modelling, or random effects modelling in the event of detecting significant heterogeneity.
Results:  Of the 3129 articles identified, 10 reports (representing six unique studies) satisfied the inclusion criteria. Four studies compared omega 3 supplements with placebo and two studies compared omega 6 supplements with placebo. There was no clear evidence of benefit in relation to reduced risk of allergic sensitization or a favourable immunological profile. Meta-analyses failed to identify any consistent or clear benefits associated with use of omega 3 [atopic eczema: RR = 1.10 (95% CI 0.78–1.54); asthma: RR = 0.81 (95% CI 0.53–1.25); allergic rhinitis: RR = 0.80 (95% CI 0.34–1.89) or food allergy RR = 0.51 (95% CI 0.10–2.55)] or omega 6 oils [atopic eczema: RR = 0.80 (95% CI 0.56–1.16)] for the prevention of clinical disease.
Conclusions:  Contrary to the evidence from basic science and epidemiological studies, our systematic review and meta-analysis suggests that supplementation with omega 3 and omega 6 oils is probably unlikely to play an important role as a strategy for the primary prevention of sensitization or allergic disease.     

Topical ocular administration of cromolyn sodium for treatment in seasonal ragweed conjunctivitis.

We studied topical ocular administration of a 4% solution of cromolyn sodium (CS)for treatment of 112 patients with ragweed conjunctivitis in two 8-wk, double-blind, matched-pair studies. During the 1977 and 1978 ragweed seasons, patients instilled a daily total of 12.8 or 19.2 mg CS into each eye, control patients received placebo drops. Treatment efficacy was assessed by daily symptom score diaries, ophthalmic examinations, and a subjective report by the patient at the end of the trials. In the 1977 trial, CS pair members whose preseasonal immunoglobulin E antibody level was <99 ng/ml showed a significant reduction in eye itching (p < 0.01), eye irritation (p < 0.02), visual blurring (p < 0.025), and nasal congestion (p < 0.025) and required less supplemental medication (p < 0.02) during the peak pollen period. In the 1978 trial all patients had IgE antibody levels >100 ng/ml. CS pair members showed a significant reduction in rhinorrhea (p < 0.004) and nasal congestion (p < 0.007) only; no significant reduction in eye symptoms was noted. Transient eye burning was noted by a total of 38 CS and 39 placebo patients from both studies; ophthalmic examinations were unremarkable; and no other side effects were noted. The 4% CS ophthalmic solution provided significant relief of nasal symptoms in both the 1977 and 1978 trials, but significant relief of ocular symptoms was noted only in the 1977 trial and only in those patients with lower preseasonal IgE ragweed antibody levels.     

Pharmacological treatments for psychotic symptoms in dementia: A systematic review with pairwise and network meta-analysis

Psychotic symptoms of dementia are highly prevalent and lead to poor medical outcomes and substantial dysfunction. To date, which drug to use remains controversial without a summary of all direct or indirect comparisons of pharmacotherapy. Therefore, we conducted a systematic review with pairwise and network meta-analysis to examine efficacy and tolerability outcomes of pharmacological treatments in dementia patients. MEDLINE, Cochrane Library, EMBASE, and PubMed were searched systematically up to August 31, 2020. We included trials of cholinesterase inhibitors (ChEIs), memantine, antipsychotics, antidepressants, and mood stabilizers, with final approval from the U.S. Food and Drug Administration. We ranked the comparative effects of all drugs against placebo with surface under the cumulative ranking (SUCRA) probabilities. This analysis is based on 34 trials, which included 10,415 patients randomly assigned to 15 commonly used drug regimens. Donepezil (standardized mean difference [SMD] −0.30, 95% credible interval [CrI] −0.50 to −0.12; SUCRA, 0.85), memantine (SMD −0.20, 95%CrI −0.34 to −0.07; SUCRA, 0.68) and aripiprazole (SMD −0.17, 95% CrI −0.32 to −0.02; SUCRA, 0.62) showed greater benefit than placebo, and with relatively good tolerability in network meta-analyses. Risperidone was also found to be more efficacious than placebo (SMD −0.16, 95% CrI −0.28 to −0.05; SUCRA, 0.60), but with poor tolerability (odds ratios [OR] 1.50, 95% CrI 1.06–2.26). Donepezil, memantine, haloperidol, aripiprazole and risperidone were more efficacious than quetiapine (SMDs ranged from −0.36 to −0.22). Besides, donepezil, memantine and mirtazapine were more efficacious than sertraline (SMDs ranged from −0.47 to −0.36). Most of the results were rated as “low” to “very low”. Several effective treatment choices for psychotic symptoms are available across drug classes. Donepezil, memantine and aripiprazole are probably the appropriate options to consider when a pharmacological treatment is indicated. Given the limitations of the meta-analytic approach and the low methodological quality of the majority of studies, our results should be cautiously interpreted.     

The clinical effectiveness of counselling in primary care: a systematic review and meta-analysis

BACKGROUND: Counselling is frequently used in the management of common mental disorders (such as anxiety and depression) in primary care. However, there are concerns over the clinical effectiveness of counselling, both in comparison with usual general practitioner care, and with other treatments such as alternative psychological therapies and antidepressant treatment. This study used systematic review methodology to assess the current evidence-base. METHOD: A systematic literature review located seven trials of relevance, comparing counselling with usual general practitioner care, cognitive-behaviour therapy and antidepressant medication. Data on internal and external validity were examined using a standardized quality rating scheme. Data concerning the impact of counselling on symptoms of anxiety and depression were pooled using meta-analytical procedures. RESULTS: The main analyses showed significantly greater clinical effectiveness of counselling compared with usual general practitioner care in the short-term (standardized mean difference -0.28, 95% CI -0.43 to -0.13, N=741, six trials) but not the long-term (standardized mean difference -0.07, 95% CI -0.26 to 0.12, N=447, four trials). Sensitivity analyses were undertaken to test the robustness of the results. CONCLUSION: Counselling is associated with modest improvement in short-term outcome compared with usual general practitioner care, and thus may be a useful addition to mental health services in primary care.     

The effectiveness of psychological interventions for anxiety in the perinatal period: A systematic review and meta-analysis

Purpose

Anxiety disorders are relatively common during pregnancy and the postnatal period. Despite their potential acceptability to users, psychological interventions research for this population is still in its infancy. The meta-analysis aimed to comprehensively evaluate the evidence of the effectiveness of psychological interventions for reducing perinatal anxiety.

Method

The review followed PRISMA guidelines. A total of 26 studies published between 2004 and 2022 fulfilled inclusion criteria of which 22 were included in the meta-analysis.

Results

Results indicated that psychological interventions were more effective than control conditions in reducing symptoms of perinatal anxiety (equivalent to a medium post treatment effect size). Effect sizes were robust for cognitive, behavioural and mindfulness-based interventions. Targeting anxiety also appeared to impact on depression symptoms. There was substantial evidence of methodological heterogeneity.

Conclusions

This review demonstrates that psychological interventions are effective in reducing symptoms of both anxiety and comorbid anxiety and depression in both the antenatal and postnatal periods. Further research on longer-term effects, infant outcomes, treatment approach and modality are required.     

The effectiveness of exercise-based interventions for preventing or treating postpartum depression: a systematic review and meta-analysis

Archives of Women's Mental Health - Postpartum depression can have detrimental effects on both a mother’s physical and mental health and on her child’s growth and emotional...     

Yoga for asthma: a systematic review and meta-analysis

BackgroundAlthough yoga is frequently used by patients with asthma, its efficacy in alleviating asthma remains unclear.ObjectiveTo systematically assess and meta-analyze the available data on efficacy and safety of yoga in alleviating asthma.MethodsMEDLINE/PubMed, Scopus, the Cochrane Central Register of Controlled Trials, PsycINFO, CAM-Quest, CAMbase, and IndMED were searched through January 2014. Randomized controlled trials of yoga for patients with asthma were included if they assessed asthma control, symptoms, quality of life, and/or pulmonary function. For each outcome, standardized mean differences (SMDs) or risk ratios (RRs) and 95% confidence intervals (CIs) were calculated. Risk of bias was assessed using the Cochrane tool.ResultsFourteen randomized controlled trials with 824 patients were included. Evidence for effects of yoga compared with usual care was found for asthma control (RR, 10.64; 95% CI, 1.98 to 57.19; P = .006), asthma symptoms (SMD, −0.37; 95% CI, −0.55 to −0.19; P < .001), quality of life (SMD, 0.86; 95% CI, 0.39 to 1.33; P < .001), peak expiratory flow rate (SMD, 0.49; 95% CI, 0.32 to 0.67; P < .001), and ratio of forced expiratory volume in 1 second to forced vital capacity (SMD, 0.50; 95% CI, 0.24 to 0.75; P < .001); evidence for effects of yoga compared with psychological interventions was found for quality of life (SMD, 0.61; 95% CI, 0.22 to 0.99; P = .002) and peak expiratory flow rate (SMD, 2.87; 95% CI, 0.14 to 5.60; P = .04). No evidence for effects of yoga compared with sham yoga or breathing exercises was revealed. No effect was robust against all potential sources of bias. Yoga was not associated with serious adverse events.ConclusionYoga cannot be considered a routine intervention for asthmatic patients at this point. It can be considered an ancillary intervention or an alternative to breathing exercises for asthma patients interested in complementary interventions.