Department of Respiratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
J Clin Pharm Ther. 2012 Apr;37(2):204-11. doi: 10.1111/j.1365-2710.2011.01285.x. Epub 2011 Jul 11.
Inhaled long-acting beta-agonists have been licensed for the treatment of chronic obstructive pulmonary disease (COPD) since the late 1990s, and they improve lung function and symptoms of dyspnoea. However, the evidence that long-acting beta-agonists alone can reduce the rate of COPD exacerbations is not conclusive. This meta-analysis was performed to evaluate their effect on the frequency of exacerbations.
MEDLINE, EMBASE, CINAHL and the Cochrane trials database were searched for the review. Randomized controlled trials of greater than or equal to 24weeks' treatment duration comparing long-acting beta-agonists (LABAs) with placebo were reviewed. Studies were pooled to yield odds ratios (ORs) with 95% confidence intervals (CIs).
Seventeen randomized controlled trials (11871 randomized subjects) met the inclusion criteria and were selected for analysis. Salmeterol, formoterol and indacaterol significantly reduced COPD exacerbations compared with placebo. Salmeterol significantly reduced COPD exacerbations with both study arms exposed or not exposed to inhaled corticosteroids (ICS). The summary ORs were 0·79 (95% CI: 0·67-0·92; P<0·01) and 0·80 (95% CI: 0·65-0·99; P=0·04), respectively. However, when both arms were not exposed to ICS, there was no significant reduction in exacerbations with formoterol compared with placebo. The 'summary OR was 0·93 (95% CI: 0·75-1·15; P=0·50).
Long-acting beta-agonists reduce the frequency of COPD exacerbations. Salmeterol, formoterol and indacaterol significantly reduced COPD exacerbations compared with placebo. Salmeterol but not formoterol decreased exacerbations significantly in the absence of ICS.
自 20 世纪 90 年代末以来，吸入长效β-激动剂（LABA）已获准用于治疗慢性阻塞性肺疾病（COPD），并可改善肺功能和呼吸困难症状。然而，LABA 单独使用可以降低 COPD 加重频率的证据尚不确定。进行这项荟萃分析是为了评估其对加重频率的影响。
对 MEDLINE、EMBASE、CINAHL 和 Cochrane 试验数据库进行了综述搜索。对持续时间大于或等于 24 周的 LABA 与安慰剂进行比较的随机对照试验进行了综述。将研究合并为优势比（OR），并给出 95%置信区间（CI）。
17 项随机对照试验（11871 名随机受试者）符合纳入标准并被选中进行分析。沙美特罗、福莫特罗和茚达特罗与安慰剂相比显著降低了 COPD 加重。沙美特罗在暴露于或未暴露于吸入性皮质类固醇（ICS）的研究臂中均显著降低了 COPD 加重。汇总 OR 分别为 0.79（95%CI：0.67-0.92；P<0.01）和 0.80（95%CI：0.65-0.99；P=0.04）。然而，当两个臂均未暴露于 ICS 时，与安慰剂相比，福莫特罗并未显著减少加重。“汇总 OR 为 0.93（95%CI：0.75-1.15；P=0.50）。
长效β-激动剂可降低 COPD 加重频率。沙美特罗、福莫特罗和茚达特罗与安慰剂相比显著降低了 COPD 加重。沙美特罗在不使用 ICS 的情况下显著减少了加重，但福莫特罗则不然。
