Walters E H, Walters J
Clinical School, University of Tasmania, Collins Street, Hobart, Tasmania, Australia.
Cochrane Database Syst Rev. 2003(2):CD001285. doi: 10.1002/14651858.CD001285.
Inhaled short-acting beta-2 agonists are the major class of bronchodilators used for relief of symptoms in asthma. There has been concern that excessive uncontrolled use of beta-2 agonists might have contributed to rises in asthma mortality seen in some countries. International consensus guidelines now generally recommend using short-acting beta-2 agonists only for relief of symptoms on an as needed basis.
To assess the effects of using short-acting inhaled beta-2 agonists regularly or only on demand in asthmatic adults and children on indices of asthma control.
Searches were carried out of the Cochrane Airways Group "Asthma and Wheez* RCT" register in 1997, 1999 and 2002. Pharmaceutical companies and researchers with an interest in the area were asked directly for details of any studies that they knew of.
Randomised controlled trials in which the short-acting beta-2 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 '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.
800 abstracts were identified for the first version and 60 papers were requested for full assessment. In this update 15 studies were added to the 34 trials which met the entry criteria for the first version in 2000. No clinically or statistically significant differences were found in airway calibre measurements. The regular treatment groups required less rescue medication, -0.80 puffs/24 hours (95% CI -0.07 to -1.30) and -0.42 puffs/daytime (95% CI -0.12 to -0.72), and had fewer days with asthma symptoms, -6.7% (95% CI -2.7 to -10.7). There was no significant difference in the odds ratio for the occurrence of at least one major asthma exacerbation either in parallel group or cross over studies.
REVIEWER'S CONCLUSIONS: In general, these results support current guidelines, although it has given reassuring evidence against concerns over regular use of inhaled short-acting beta-2 agonists.
吸入性短效β2激动剂是用于缓解哮喘症状的主要一类支气管扩张剂。有人担心，β2激动剂的过度无节制使用可能导致了一些国家哮喘死亡率的上升。目前国际共识指南普遍建议仅在需要时使用短效β2激动剂来缓解症状。
评估在哮喘成人和儿童中定期使用或仅按需使用短效吸入性β2激动剂对哮喘控制指标的影响。
于1997年、1999年和2002年检索了Cochrane Airways Group的“Asthma and Wheez* RCT”登记册。直接向对该领域感兴趣的制药公司和研究人员询问他们所知的任何研究的详细信息。
随机对照试验，其中试验组定期给予短效β2激动剂，并联合使用吸入性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，并使用吸入性支气管扩张剂进行“急救使用”。
两位综述作者均提取数据并进行质量评估。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。
第一版共识别出800篇摘要，索要了60篇论文进行全面评估。在本次更新中，在2000年符合第一版纳入标准的34项试验基础上又增加了15项研究。在气道管径测量方面未发现临床或统计学上的显著差异。规律治疗组所需的急救药物较少，每24小时少用0.80喷（95%可信区间 -0.07至 -1.30），白天少用0.42喷（95%可信区间 -0.12至 -0.72），哮喘症状天数也较少，少6.7%（95%可信区间 -2.7至 -10.7）。在平行组试验或交叉试验中，至少发生一次严重哮喘发作的比值比无显著差异。
总体而言，这些结果支持当前指南，尽管它为消除对定期使用吸入性短效β2激动剂的担忧提供了令人安心的证据。
