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1、EducationalAimsToimproveunderstandingof:•Therelativebenefitsandlimitationsofevidencederivedfromdifferentstudydesignsandtherolethatreal-lifeasthmastudiescanplayinaddressinglimitationsintheclassicalrandomisedcontrolledtrial(cRCT)evidencebase.•Theimportanceof
2、guidelinerecommendationsbeingmodifiedtofitthepopulationsstudiedandthemodelofcareprovidedintheirreferencestudies.Keypoints•Classicalrandomisedcontrolledtrials(cRCTs)showresultsfromanarrowpatientgroupwithaconstrainedecologyofcare.•Patientswith“real-life”co-m
3、orbiditiesandlifestylefactorsreceivingusualcareoftenhavedifferentresponsestomedicationwhichwillnotbecapturedbycRCTsiftheyareexcludedbystrictselectioncriteria.•Meta-analyses,usedtodirectguidelines,containaninherentmeta-biasbasedonpatientselectionandartifici
4、alpatientcare.•GuidelinerecommendationsshouldclarifywheretheyrelatedtocRCTideals(intermsofpatientpopulations,medicalresourcesandcarereceived)andcouldbeenhancedthroughinclusionofevidencefromstudiesdesignedtobettermodelthepopulationsandcareapproachespresenti
5、nroutinecare.Image:TonyAlter,Flickr,underCCBY-SA2.0DavidPrice1,2,1RespiratoryEffectivenessGroup,5RespiratoryandIntensiveCareDavidPrice,AcademicCentreCambridge,UKMedicine,GHCochin,SiteValdeofPrimaryCare,UniversityofGuyBrusselle1,3,4,2UniversityofAberdeen,Ab
6、erdeen,UKGrace,Paris,FranceAberdeen,PolwarthBuilding,NicolasRoche1,5,6,3DepartmentofRespiratory6UniversitéParis-Descartes(EA2511),Foresterhill,Aberdeen,AB25DarylFreeman1,7,Diseases,GhentUniversitySorbonneParisCité,Paris,France2ZD,UKHospital,Ghent,Belgium7E
7、astofEnglandStrategicClinicalAlisonChisholm14DepartmentsofEpidemiologyandNetwork,Norfolk,UKRespiratoryMedicine,ErasmusMC,david@rirl.orgRotterdam,TheNetherlandsReal-worldresearchanditsimportanceinrespiratorymedicineConflictofinterestSummaryConflictsaredecla
8、redattheendoftheClinicalpracticerequiresacomplexinterplaybetweenexperienceandtraining,research,article.guidelinesandjudgement,andmustnotonlydrawondatafromtraditionalorclassicalrandomisedcontrolledtrials(cRCTs
