Walters E H, Walters J
Department of Respiratory Medicine, Alfred Hospital, Commercial Road, Prahan, Victoria, Australia.
Cochrane Database Syst Rev. 2000;2003(4):CD001285. doi: 10.1002/14651858.CD001285.
Inhaled beta2-adrenergic agonists delivered by inhalation are very widely used in asthma. There has been much controversy of the use and possible consequences of the use of these agents for regular, as opposed as-needed use in asthma.
This review to assessed the clinical trial evidence to test whether using regular use of short-acting beta2-agonists reduced asthma control and pulmonary function; worsened symptoms, airway reactivity and quality of life; and increased the rate of exacerbations.
A search was carried out of the Cochrane Airways Group "Asthma and Wheez* RCT" register using the terms: regular AND [beta agonist OR bronchodilator OR salbutamol OR albuterol Or terbutaline OR isoproterenol OR reproterol OR fenoterol]. Bibliographies of existing trials were searched and primary trial authors and pharmaceutical companies were approached for additional trials.
Randomised controlled trials in which the short-acting beta2-agonist was given regularly in the experimental group, together with an inhaled bronchodilator for relief of symptoms ('rescue use'). The control group consisted of matching placebo inhaled regularly, with an inhaled bronchodilator for as-needed 'rescue use'.
Data were extracted and quality assessments were made by both reviewers. Parallel group and cross-over trials were analysed separately. Where possible data were pooled using a fixed effects model.
Over 800 abstracts were identified, following a review, 60 papers were requested for full assessment by both reviewers. 34 trials from 30 papers met the entry criteria. Data from 31 outcomes were analyzable. There was little difference between the treatments for nearly all outcomes. In cross-over studies, evening peak flow was better with regular treatment, weighted mean difference (WMD) 13.1 l/min (95% confidence interval 24.3, 1.9). In contrast, the FEV1 was better with as-needed treatment (WMD 157 ml (95% CI: 123, 192). Bronchial hyper reactivity was slightly better in the as-needed group, standardised mean difference 0.23, 95% CI: 0.52, 1.12.
REVIEWER'S CONCLUSIONS: These results support current guidelines. There is little advantage in using short-acting beta2-agonists regularly, and potentially some small clinical disadvantage.
吸入性β2肾上腺素能激动剂在哮喘治疗中应用广泛。对于这些药物在哮喘中常规使用（与按需使用相对）的应用及可能产生的后果一直存在诸多争议。
本综述旨在评估临床试验证据，以检验常规使用短效β2激动剂是否会降低哮喘控制水平和肺功能；是否会使症状、气道反应性和生活质量恶化；以及是否会增加急性加重发生率。
使用以下检索词在Cochrane气道组“哮喘与喘息*随机对照试验”登记库中进行检索：常规且[β激动剂或支气管扩张剂或沙丁胺醇或阿替洛尔或特布他林或异丙肾上腺素或瑞普特罗或非诺特罗]。检索了现有试验的参考文献，并与主要试验作者和制药公司联系以获取更多试验。
随机对照试验，其中试验组常规给予短效β2激动剂，并联合吸入支气管扩张剂以缓解症状（“急救使用”）。对照组为定期吸入匹配的安慰剂，并按需使用吸入支气管扩张剂进行“急救”。
两位综述作者均进行了数据提取和质量评估。平行组试验和交叉试验分别进行分析。尽可能使用固定效应模型合并数据。
共识别出800多篇摘要，经综述后，两位综述作者要求对60篇论文进行全面评估。30篇论文中的34项试验符合纳入标准。31项结局的数据可进行分析。几乎所有结局的治疗组间差异不大。在交叉研究中，常规治疗组的夜间峰值呼气流速较好，加权平均差（WMD）为13.1升/分钟（95%置信区间24.3，1.9）。相比之下，按需治疗组的第一秒用力呼气容积（FEV1）较好（WMD 157毫升（95%CI：123，192）。按需治疗组的支气管高反应性略好，标准化平均差0.23，95%CI：0.52，1.12。
这些结果支持当前指南。常规使用短效β2激动剂几乎没有优势，且可能存在一些小的临床劣势。
