Faculty of Health Science, Division of Medicine, The University of Adelaide, Adelaide, South Australia, Australia.
Clinical Practice Unit, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
Syst Rev. 2018 Nov 29;7(1):213. doi: 10.1186/s13643-018-0860-0.
Currently, there is a lack of guidelines for the use of short-acting bronchodilators (SABD) in people admitted to hospital for acute exacerbation of chronic obstructive pulmonary disease (AECOPD), despite routine use in practice and risk of cardiac adverse events.
To review the evidence that underpins use and optimal dose, in terms of risk versus benefit, of SABD for inpatient management of AECOPD and collate the results for future guidelines.
Medline, Embase, the Cochrane Central Register of Controlled Trials, clinicaltrials.gov and International Clinical Trials Registry Platform were searched (inception to November 2017) for published and ongoing studies. Included studies were randomised controlled trials or controlled clinical trials investigating the effect of SABD (β2-agonist and/or ipratropium) on inpatients with a diagnosis of AECOPD. This review was undertaken in accordance with PRISMA guidelines and a pre-defined protocol. Due to heterogeneous methodologies, meta-analysis was not possible so the results were synthesised qualitatively.
Of 1378 studies identified, 10 met inclusion criteria. Narrative synthesis of 10 studies revealed no significant differences in most outcomes of interest relative to dose, delivery via inhaler or nebuliser, and type of β2-agonist used. However, some evidence demonstrated significantly increased cardiac side effects with increased dosage of β2-agonist (45% versus 24%), P<0.05).
This review identified a paucity of methodologically rigorous evidence evaluating use of SABD among AECOPD. The available evidence did not identify any additional benefits for participants receiving higher doses of short-acting β2-agonists compared to lower doses, or based on type of delivery method or β2-agonists used. However, there was a small increase in some adverse events for participants using higher doses of β2-agonists.
目前，尽管在实践中常规使用且存在心脏不良事件风险，但对于因慢性阻塞性肺疾病急性加重（AECOPD）而住院的患者，尚无使用短效支气管扩张剂（SABD）的指南。
综述 SABD 用于住院治疗 AECOPD 的证据，评估其获益与风险，确定最佳剂量，并为未来指南的制定提供参考。
通过检索 Medline、Embase、Cochrane 中心对照试验注册库、clinicaltrials.gov 和国际临床试验注册平台（自成立至 2017 年 11 月），收集已发表和正在进行的 SABD（β2-激动剂和/或异丙托溴铵）治疗 AECOPD 住院患者的研究。本研究遵循 PRISMA 指南和预先制定的方案。由于方法学存在异质性，无法进行荟萃分析，因此对结果进行定性综合。
共纳入 1378 项研究，其中 10 项符合纳入标准。对 10 项研究的综合分析显示，与剂量、吸入器或雾化器给药方式以及所使用的β2-激动剂类型相比，大多数研究终点无显著差异。但有证据表明，β2-激动剂剂量增加与心脏副作用增加相关（45%比 24%，P<0.05）。
本研究发现，评价 SABD 在 AECOPD 中的应用的高质量证据有限。现有证据并未表明，与低剂量相比，高剂量 SABD 或不同给药方式或β2-激动剂类型可使患者获益更多。但高剂量β2-激动剂会增加某些不良反应的发生风险。
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