Travers Andrew H, Rowe Brian H, Barker Samantha, Jones Arthur, Camargo Carlos A
Division of Emergency Medicine, University of Alberta, 1G1.50 WMC, 8440-112th Street, Edmonton, AB, T6G 2B7 Canada.
Chest. 2002 Oct;122(4):1200-7. doi: 10.1378/chest.122.4.1200.
To determine the benefit of IV beta(2)-agonists for severe acute asthma treated in the emergency department (ED).
Randomized controlled trials were identified using EMBASE, MEDLINE, and CINAHL; the Cochrane Airways Review Group database; hand searching; bibliographies; pharmaceutical companies; and author contact. Studies where IV beta(2)-agonists were compared to placebo and/or existing standards of care were considered. Where appropriate, trials were combined using odds ratios (ORs) or weighted mean differences with 95% confidence intervals (CIs).
From 746 identified references, 55 potentially relevant articles were identified and 15 articles were included. All trials were performed outside North America and were published prior to 1997. Three main treatment strategies were reviewed: strategy 1 (three articles), IV beta(2)-agonists with inhaled beta(2)-agonists vs inhaled beta(2)-agonists; strategy 2 (six articles), IV beta(2)-agonists alone vs inhaled beta(2)-agonists; and strategy 3 (six articles), IV beta(2)-agonists vs IV methylxanthines. Compared to all treatments, IV beta(2)-agonist use did not lead to clinical or statistical significant differences in vital signs, pulmonary functions, laboratory measures, adverse effects, or clinical success. Although statistically nonsignificant, seven methodologically strong studies demonstrated that peak expiratory flows and heart rates were unchanged following beta(2)-agonist use compared to all other treatments at 60 min (8.3 L/min [95% CI, 17.6 to 34.2] and 3.65 beats/min [95% CI, 2.9 to 10.2], respectively), with an increased risk of adverse effects (OR, 1.98; 95% CI, 0.5 to 8.2).
Evidence is lacking to support the use of IV beta(2)-agonists in ED patients with severe acute asthma. Moreover, the clinical benefit appears questionable, while the potential clinical risks are obvious. The only recommendations for IV beta-(2)agonist use should be in those patients in whom inhaled therapy is not feasible, or in the context of a controlled clinical trial comparing IV beta(2)-agonists with standard care vs standard care alone.
确定静脉注射β₂激动剂对急诊科治疗的严重急性哮喘的益处。
通过EMBASE、MEDLINE和CINAHL、Cochrane气道综述组数据库、手工检索、参考文献、制药公司以及与作者联系来识别随机对照试验。纳入比较静脉注射β₂激动剂与安慰剂和/或现有护理标准的研究。在适当情况下，使用比值比（OR）或加权平均差及95%置信区间（CI）合并试验。
从746篇已识别的参考文献中，识别出55篇可能相关的文章，纳入15篇文章。所有试验均在北美以外进行，且发表于1997年之前。回顾了三种主要治疗策略：策略1（三篇文章），静脉注射β₂激动剂联合吸入β₂激动剂对比吸入β₂激动剂；策略2（六篇文章），单独静脉注射β₂激动剂对比吸入β₂激动剂；策略3（六篇文章），静脉注射β₂激动剂对比静脉注射甲基黄嘌呤。与所有治疗方法相比，使用静脉注射β₂激动剂在生命体征、肺功能、实验室指标、不良反应或临床成功率方面未导致临床或统计学上的显著差异。尽管在统计学上无显著意义，但七项方法学严谨的研究表明，与所有其他治疗方法相比，使用β₂激动剂后60分钟时呼气峰值流速和心率未发生变化（分别为8.3升/分钟[95%CI，17.6至34.2]和3.65次/分钟[95%CI，2.9至10.2]），且不良反应风险增加（OR，1.98；95%CI，0.5至8.2）。
缺乏支持在急诊科严重急性哮喘患者中使用静脉注射β₂激动剂的证据。此外，临床益处似乎存疑，而潜在临床风险明显。静脉注射β₂激动剂的唯一使用建议应限于吸入治疗不可行的患者，或在比较静脉注射β₂激动剂与标准护理加标准护理的对照临床试验背景下。
