Chen Chao Feng, Lv Yan, Zhang Hong Ping, Wang Gang
Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China.
Multidiscip Respir Med. 2014 May 28;9(1):30. doi: 10.1186/2049-6958-9-30. eCollection 2014.
The purpose of asthma management is to achieve a total asthma control that involves current control and future risk. It has proven efficacy in reducing asthma exacerbations, but the effect size of zafirlukast for asthma exacerbations of various severity is not systematically explored.
Randomized controlled trials were searched in PubMed Central, Web of Science, and Embase, where zafirlukast prevented asthma exacerbations in adults. The primary outcome was asthma exacerbations, the secondary outcomes were asthma exacerbations requiring systemic corticosteroids and emergency visits, respectively. Odds ratio (OR) with 95% confidence intervals (CI) were pooled.
Twelve trials were identified. As first-line therapy, compared to those having placebo, the patients with chronic asthma receiving zafirlukast experienced statistically lower asthma exacerbations (OR = 0.68, 95% CI = [0.45, 1.00]), but it was not found that zafirlukast was superior to placebo in asthma exacerbations requiring systemic corticosteroids (OR = 0.76, 95% CI = [0.45, 1.29]). Furthermore, zafirlukast was inferior to ICs in asthma exacerbations (OR = 2.11, 95% CI = [1.35, 3.30]) and requiring systemic corticosteroids (OR = 3.71, 95% CI = [1.82, 7.59]). As add-on therapy, zafirlukast was not superior to placebo in asthma exacerbations (OR =0.99, 95% CI = [0.54, 1.81] and requiring emergency visits (OR = 0.72, 95% CI = [0.18, 2.99]). Intriguingly, there was not a significant difference in asthma exacerbations between zafirlukast and ICs (OR = 1.12, 95% CI = [0.53, 2.34]).
Our study suggests that zafirlukast, as the first-line therapy, significantly reduces mild to moderate but not severe asthma exacerbations. In the add-on regimen, zafirlukast could not reduce asthma exacerbations, which would perhaps result from small sample size and needs to be further studied.
哮喘管理的目的是实现全面的哮喘控制，包括当前的控制和未来的风险。已证实其在减少哮喘急性发作方面具有疗效，但未系统探讨扎鲁司特对各种严重程度哮喘急性发作的效应大小。
在PubMed Central、Web of Science和Embase中检索扎鲁司特预防成人哮喘急性发作的随机对照试验。主要结局为哮喘急性发作，次要结局分别为需要全身使用糖皮质激素的哮喘急性发作和急诊就诊。汇总比值比（OR）及95%置信区间（CI）。
共纳入12项试验。作为一线治疗，与接受安慰剂的患者相比，接受扎鲁司特治疗的慢性哮喘患者哮喘急性发作在统计学上显著减少（OR = 0.68，95%CI = [0.45, 1.00]），但未发现扎鲁司特在需要全身使用糖皮质激素的哮喘急性发作方面优于安慰剂（OR = 0.76，95%CI = [0.45, 1.29]）。此外，在哮喘急性发作（OR = 2.11，95%CI = [1.35, 3.30]）及需要全身使用糖皮质激素方面（OR = 3.71，95%CI = [1.82, 7.59]），扎鲁司特不如吸入性糖皮质激素（ICS）。作为附加治疗，扎鲁司特在哮喘急性发作（OR = 0.99，95%CI = [0.54, 1.81]）及需要急诊就诊方面（OR = 0.72，95%CI = [0.18, 2.99]）并不优于安慰剂。有趣的是，扎鲁司特与ICS在哮喘急性发作方面无显著差异（OR = 1.12，95%CI = [0.53, 2.34]）。
我们的研究表明，扎鲁司特作为一线治疗可显著减少轻度至中度而非重度哮喘急性发作。在附加治疗方案中，扎鲁司特不能减少哮喘急性发作，这可能是由于样本量小所致，需要进一步研究。
