Calzetta L, Roncada P, di Cave D, Bonizzi L, Urbani A, Pistocchini E, Rogliani P, Matera M G
Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
Istituto Sperimentale Italiano Lazzaro Spallanzani, Milan, Italy.
Equine Vet J. 2017 Nov;49(6):710-717. doi: 10.1111/evj.12680. Epub 2017 Apr 9.
Equine asthma is a disease characterised by reversible airflow obstruction, bronchial hyper-responsiveness and airway inflammation following exposure of susceptible horses to specific airborne agents. Although clinical remission can be achieved in a low-airborne dust environment, repeated exacerbations may lead to irreversible airway remodelling. The available data on the pharmacotherapy of equine asthma result from several small studies, and no head-to-head clinical trials have been conducted among the available medications.
To assess the impact of the pharmacological interventions in equine asthma and compare the effect of different classes of drugs on lung function.
Pair-wise and network meta-analysis.
Literature searches for clinical trials on the pharmacotherapy of equine asthma were performed. The risk of publication bias was assessed by funnel plots and Egger's test. Changes in maximum transpulmonary or pleural pressure, pulmonary resistance and dynamic lung compliance vs. control were analysed via random-effects models and Bayesian networks.
The results obtained from 319 equine asthma-affected horses were extracted from 32 studies. Bronchodilators, corticosteroids and chromones improved maximum transpulmonary or pleural pressure (range: -8.0 to -21.4 cmH O; P<0.001). Bronchodilators, corticosteroids and furosemide reduced pulmonary resistance (range: -1.2 to -1.9 cmH O/L/s; P<0.001), and weakly increased dynamic lung compliance. Inhaled β -adrenoreceptor (β -AR) agonists and inhaled corticosteroids had the highest probability of being the best therapies. Long-term treatments were more effective than short-term treatments.
Weak publication bias was detected.
This study demonstrates that long-term treatments with inhaled corticosteroids and long-acting β -AR agonists may represent the first choice for treating equine asthma. Further high quality clinical trials are needed to clarify whether inhaled bronchodilators should be preferred to inhaled corticosteroids or vice versa, and to investigate the potential superiority of combination therapy in equine asthma.
马哮喘是一种疾病，其特征为易感马匹暴露于特定空气传播因子后出现可逆性气流阻塞、支气管高反应性和气道炎症。尽管在低空气尘埃环境中可实现临床缓解，但反复加重可能导致不可逆的气道重塑。关于马哮喘药物治疗的现有数据来自几项小型研究，且尚未在现有药物之间进行直接对比的临床试验。
评估药物干预对马哮喘的影响，并比较不同类别药物对肺功能的效果。
成对和网状荟萃分析。
检索关于马哮喘药物治疗的临床试验文献。通过漏斗图和埃格检验评估发表偏倚风险。通过随机效应模型和贝叶斯网络分析最大跨肺压或胸膜压、肺阻力和动态肺顺应性相对于对照组的变化。
从32项研究中提取了319匹受马哮喘影响马匹的结果。支气管扩张剂、皮质类固醇和色酮可改善最大跨肺压或胸膜压（范围：-8.0至-21.4 cmH₂O；P<0.001）。支气管扩张剂、皮质类固醇和呋塞米可降低肺阻力（范围：-1.2至-1.9 cmH₂O/L/s；P<0.001），并轻微增加动态肺顺应性。吸入β-肾上腺素能受体（β-AR）激动剂和吸入皮质类固醇最有可能是最佳治疗方法。长期治疗比短期治疗更有效。
检测到微弱的发表偏倚。
本研究表明，吸入皮质类固醇和长效β-AR激动剂的长期治疗可能是治疗马哮喘的首选。需要进一步的高质量临床试验来阐明吸入支气管扩张剂是否应优于吸入皮质类固醇，反之亦然，并研究联合治疗在马哮喘中的潜在优势。
