Calzetta L, Rogliani P, Page C, Roncada P, Pistocchini E, Soggiu A, Piras C, Urbani A, Matera M G
Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy.
The Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, UK.
Equine Vet J. 2018 Sep;50(5):594-601. doi: 10.1111/evj.12815. Epub 2018 Feb 23.
There are limited findings from low-powered studies based on few number of subjects with equine asthma. Furthermore, no studies have been performed to assess a meaningful clinically detectable impact of corticosteroids in equine asthma.
To assess and compare the clinical effect of inhaled and systemic corticosteroids in equine asthma and identify a quantitative clinical score suitable to assess the Minimal Important Difference (MID), expressed as the Minimally Clinically Detectable Difference (MCDD).
Pair-wise and network meta-analysis.
Literature searches for studies on corticosteroid therapy in equine asthma were performed. The risk of publication bias was assessed by Funnel plots and Egger's test. The effect on changes in clinical scores vs. control was analysed via random-effects models and Bayesian networks.
Corticosteroids significantly improved the clinical condition (Standardised Mean Difference: -1.52, 95% CrI -2.07 to -0.98; P<0.001 vs. control). No difference was detected between inhaled and systemic corticosteroids with regard to the changes in clinical scores (Relative Effect: 0.08, 95% CrI -1.45 to 1.32; P = 0.8). An Improved clinically Detectable Equine Asthma Scoring System (IDEASS) indicated that corticosteroids improved the clinical condition of asthmatic horses by 30% compared with controls (IDEASS value: -2.36, 95% CI -3.39 to -1.33; P<0.001). A one-point change in IDEASS represented the MCDD in equine asthma.
Moderate quality of evidence for systemic corticosteroids.
Inhaled corticosteroids are effective in improving the clinical condition of horses with equine asthma and prevent exacerbations. Systemic corticosteroids should be used only in selected cases with symptomatic airway hyperresponsiveness during exacerbation. IDEASS requires further validation but may represent a suitable approach to rank the level of asthma severity and assess the clinical effect of pharmacotherapy in horses with equine asthma.
基于少数患有马哮喘的受试者的低效能研究结果有限。此外，尚未进行研究来评估皮质类固醇对马哮喘有意义的临床可检测影响。
评估和比较吸入性和全身性皮质类固醇对马哮喘的临床效果，并确定一个适合评估最小重要差异（MID）的定量临床评分，以最小临床可检测差异（MCDD）表示。
成对和网状荟萃分析。
检索关于马哮喘皮质类固醇治疗的研究。通过漏斗图和Egger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对临床评分变化与对照的影响。
皮质类固醇显著改善了临床状况（标准化均差：-1.52，95%可信区间-2.07至-0.98；与对照相比P<0.001）。吸入性和全身性皮质类固醇在临床评分变化方面未检测到差异（相对效应：0.08，95%可信区间-1.45至1.32；P = 0.8）。改良的临床可检测马哮喘评分系统（IDEASS）表明，与对照相比，皮质类固醇使哮喘马匹的临床状况改善了30%（IDEASS值：-2.36，95%可信区间-3.39至-1.33；P<0.001）。IDEASS中一分的变化代表马哮喘中的MCDD。
全身性皮质类固醇的证据质量中等。
吸入性皮质类固醇可有效改善马哮喘马匹的临床状况并预防病情加重。全身性皮质类固醇仅应在病情加重期间出现有症状气道高反应性的特定病例中使用。IDEASS需要进一步验证，但可能是对马哮喘严重程度进行分级以及评估药物治疗对马哮喘临床效果的合适方法。
