Dennis Rodolfo J, Solarte Ivan, Rodrigo Gustavo
Head, Departments of Medicine and Research, Fundacion Cardioinfantil Instituto de Cardiologia, Bogota, Colombia.
BMJ Clin Evid. 2010 Jan 21;2010:1501.
About 10% of adults have suffered an attack of asthma, and up to 5% of these have severe disease that responds poorly to treatment. Patients with severe disease have an increased risk of death, but patients with mild-to-moderate disease are also at risk of exacerbations. Most guidelines about the management of asthma follow stepwise protocols. This review does not endorse or follow any particular protocol, but presents the evidence about specific interventions.
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for chronic asthma? What are the effects of treatments for acute asthma? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2008 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 99 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review, we present information relating to the effectiveness and safety of the following interventions. For acute asthma: beta(2) agonists (plus ipratropium bromide, pressured metered-dose inhalers, short-acting continuous nebulised, short-acting intermittent nebulised, and short-acting intravenous); corticosteroids (inhaled); corticosteroids (single oral, combined inhaled, and short courses); education about acute asthma; generalist care; helium-oxygen mixture (heliox); magnesium sulphate (intravenous and adding isotonic nebulised magnesium to inhaled beta(2) agonists); mechanical ventilation; oxygen supplementation (controlled 28% oxygen and controlled 100% oxygen); and specialist care. For chronic asthma: beta(2) agonists (adding long-acting inhaled beta(2) agonists when asthma is poorly controlled by inhaled corticosteroids, or short-acting inhaled beta(2) agonists as needed for symptom relief); inhaled corticosteroids (low dose and increasing dose); leukotriene antagonists (with or without inhaled corticosteroids); and theophylline (when poorly controlled by inhaled corticosteroids).
约10%的成年人曾患哮喘发作，其中高达5%患有严重疾病，对治疗反应不佳。重症患者死亡风险增加，但轻至中度患者也有病情加重的风险。大多数哮喘管理指南遵循逐步方案。本综述不认可或遵循任何特定方案，而是呈现有关特定干预措施的证据。
我们进行了一项系统综述，旨在回答以下临床问题：慢性哮喘治疗的效果如何？急性哮喘治疗的效果如何？我们检索了：截至2008年6月的Medline、Embase、Cochrane图书馆及其他重要数据库（《临床证据》综述会定期更新；请查看我们的网站获取本综述的最新版本）。我们纳入了来自美国食品药品监督管理局（FDA）和英国药品及医疗保健产品监管局（MHRA）等相关组织的危害警示。
我们找到了99项符合我们纳入标准的系统综述、随机对照试验或观察性研究。我们对干预措施的证据质量进行了GRADE评估。
在本系统综述中，我们呈现了以下干预措施有效性和安全性的相关信息。对于急性哮喘：β₂激动剂（加异丙托溴铵、压力定量吸入器、短效持续雾化、短效间歇雾化和短效静脉注射）；吸入性糖皮质激素；糖皮质激素（单次口服、联合吸入和短疗程）；急性哮喘教育；全科护理；氦氧混合气（氦氧混合气）；硫酸镁（静脉注射以及在吸入β₂激动剂中添加等渗雾化硫酸镁）；机械通气；氧疗（控制性28%氧和控制性100%氧）；以及专科护理。对于慢性哮喘：β₂激动剂（当哮喘吸入糖皮质激素控制不佳时加用长效吸入β₂激动剂，或根据症状缓解需要使用短效吸入β₂激动剂）；吸入性糖皮质激素（低剂量和递增剂量）；白三烯拮抗剂（联合或不联合吸入性糖皮质激素）；以及茶碱（当吸入糖皮质激素控制不佳时）。
