Kolbe J, Wells A, Ram F S
Department of Respiratory Medicine, Green Lane Hospital, Green Lane West, University of Auckland, Auckland 3, New Zealand.
Cochrane Database Syst Rev. 2000(2):CD000996. doi: 10.1002/14651858.CD000996.
Bronchiectasis is a progressive condition characterised by irreversible destruction and dilatation of airways, generally associated with chronic bacterial infection. The two distinct therapeutic goals are: symptom control and reduction in morbidity; and prevention of progression of the underlying disease.
To determine whether regular inhaled corticosteroids produce improvement in symptom control and whether they beneficially influence the natural history of the disease.
The Cochrane Airways Group RCT register and Cochrane Controlled Clinical Trials Register were searched using the following search terms; bronchiectasis AND [corticosteroid* OR beclomethasone OR budesonide OR fluticasone OR triamcinolone OR flunisolide]. Bibliographies of each included RCT was searched for additional trials. Pharmaceutical companies that manufacture inhaled corticosteroids were also contacted.
Only randomised double blind studies controlled trials were included. Patients with radiographic evidence of bronchiectasis were included, but patients with cystic fibrosis were excluded.
Data was extracted by one of the reviewers (FR). Continuous outcomes were analysed as effect sizes (weighted mean difference or as standardised mean difference with 95% confidence intervals).
Only two trials on a total of 54 patients could be included. The studies were of 4 and 6 weeks duration. Inhaled corticosteroids had no significant effect on any of the outcomes included in this review, however there was a trend towards improving: FEV1, FVC, PEFR, RV and DLco.
REVIEWER'S CONCLUSIONS: In bronchiectasis, regular use of inhaled corticosteroids may improve lung function. The available studies were too short and too small to provide any clear evidence to guide practice. Larger and longer studies should include rate of decline of lung function, exacerbation frequency, hospitalisations and healthy status as outcomes.
支气管扩张是一种进行性疾病，其特征为气道的不可逆破坏和扩张，通常与慢性细菌感染相关。两个不同的治疗目标是：控制症状并降低发病率；以及预防基础疾病的进展。
确定规律吸入糖皮质激素是否能改善症状控制，以及它们是否对疾病的自然病程产生有益影响。
使用以下检索词检索Cochrane气道组随机对照试验注册库和Cochrane对照临床试验注册库；支气管扩张 AND [糖皮质激素* 或倍氯米松或布地奈德或氟替卡松或曲安西龙或氟尼缩松]。检索每项纳入的随机对照试验的参考文献以查找其他试验。还联系了生产吸入性糖皮质激素的制药公司。
仅纳入随机双盲对照试验。纳入有支气管扩张影像学证据的患者，但排除囊性纤维化患者。
数据由一位审阅者（FR）提取。连续结局作为效应量进行分析（加权均数差或标准化均数差及95%置信区间）。
仅能纳入两项共54例患者的试验。研究为期4周和6周。吸入性糖皮质激素对本综述纳入的任何结局均无显著影响，然而在以下方面有改善趋势：第1秒用力呼气容积、用力肺活量、呼气峰流速、残气量和一氧化碳弥散量。
在支气管扩张中，规律使用吸入性糖皮质激素可能改善肺功能。现有研究规模太小且时间太短，无法提供指导实践的明确证据。更大规模和更长时间的研究应将肺功能下降速率、急性加重频率、住院率和健康状况作为结局指标。
