小儿哮喘中β2-激动剂的关注——临床视角。
Concerns with beta2-agonists in pediatric asthma - a clinical perspective.
机构信息
University of Groningen, University Medical Center Groningen, Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, GRIAC research institute, PO Box 30.001, 9700 RB Groningen, The Netherlands.
Department of Pediatrics, Medisch Spectrum Twente, 7512 KZ Enschede, The Netherlands.
出版信息
Paediatr Respir Rev. 2017 Jan;21:80-85. doi: 10.1016/j.prrv.2016.05.006. Epub 2016 Jun 16.
Beta2-adrenoreceptor agonists (β2-agonists) are extensively used in the treatment of childhood asthma. However, there have been concerns regarding their adverse effects and safety. In 2005, the FDA commissioned a "Black Box Warning" communicating the potential for an increased risk for serious asthma exacerbations or asthma related deaths, with the regular use of LABAs. In a meta-analysis of controlled clinical trials, the incidence of severe adverse events appeared to be highest in the 4-11 year age group. Several mechanisms have been proposed regarding the risk of regular use of β2-agonists, such as masking patients' perception of worsening asthma, desensitization and downregulation of the β2-adrenoreceptor, pro-inflammatory effects of β2-agonists, pharmacogenetic effects of β2-adrenoreceptor polymorphisms and age related differences in pathophysiology of asthma. In this paper, we review β2-receptor pharmacology, discuss the concerns regarding treatment with β2-agonists in childhood asthma, and provide suggestions for clinical pediatric practice in the light of current literature.
β2-肾上腺素受体激动剂（β2-agonists）被广泛用于儿童哮喘的治疗。然而，人们一直担心它们的不良反应和安全性。2005 年，FDA 发布了一项“黑框警告”，指出在常规使用 LABA 时，可能会增加严重哮喘恶化或哮喘相关死亡的风险。在一项对照临床试验的荟萃分析中，严重不良事件的发生率在 4-11 岁年龄组似乎最高。关于常规使用β2-激动剂的风险，已经提出了几种机制，例如掩盖患者对哮喘恶化的感知、β2-肾上腺素受体脱敏和下调、β2-激动剂的促炎作用、β2-肾上腺素受体多态性的遗传药理学作用以及哮喘病理生理学的年龄相关差异。在本文中，我们回顾了β2-受体药理学，讨论了在儿童哮喘中使用β2-激动剂的担忧，并根据当前文献为临床儿科实践提供了建议。
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