Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Australia.
Faculty of Medicine, University of New South Wales, Randwick, Australia.
Eur Respir Rev. 2021 Jan 19;30(159). doi: 10.1183/16000617.0185-2020. Print 2021 Mar 31.
While asthma is known to be associated with an increased risk of progressive lung function impairments and fixed airflow obstruction, there is ongoing debate on whether inhaled corticosteroids (ICS) modify these long-term risks. Searches were performed of the PubMed, Embase and CENTRAL databases up to 22 July 2019 for studies with follow-up ≥1 year that investigated the effects of maintenance ICS on changes in lung function in asthma.Inclusion criteria were met by 13 randomised controlled trials (RCTs) (n=11 678) and 11 observational studies (n=3720). Median (interquartile range) follow-up was 1.0 (1-4) and 8.4 (3-28) years, respectively. In the RCTs, predominantly in individuals with mild asthma, ICS use was associated with improved pre-bronchodilator (BD) forced expiratory volume in 1 s (FEV) across all age groups (2.22% predicted (95% CI 1.32-3.12), n=8332), with similar estimates of strength in association for children and adults. Improvements in post-BD FEV were observed in adults (1.54% (0.87-2.21), n=3970), but not in children (0.20% (-0.49-0.90), n=3924) (subgroup difference, p=0.006). Estimates were similar between smokers and nonsmokers. There were no RCT data on incidence of fixed airflow obstruction. In the observational studies, ICS use was associated with improved pre-BD FEV in children and adults. There were limited observational data for post-BD outcomes.In patients with mild asthma, maintenance ICS are associated with modest, age-dependent improvements in long-term lung function, representing an added benefit to the broader clinical actions of ICS in asthma. There is currently insufficient evidence to determine whether treatment reduces incidence of fixed airflow obstruction in later life.
虽然哮喘与肺功能进行性损害和固定气流阻塞的风险增加有关，但吸入皮质类固醇（ICS）是否会改变这些长期风险仍存在争议。检索了截至 2019 年 7 月 22 日的 PubMed、Embase 和 CENTRAL 数据库，以寻找随访时间≥1 年的研究，这些研究调查了维持 ICS 对哮喘患者肺功能变化的影响。13 项随机对照试验（RCT）（n=11678）和 11 项观察性研究（n=3720）符合纳入标准。RCT 的中位（四分位间距）随访时间为 1.0（1-4）年，观察性研究为 8.4（3-28）年。在 RCT 中，ICS 的使用主要在轻度哮喘患者中，与所有年龄组的预支气管扩张剂（BD）用力呼气量 1 秒（FEV1）改善相关（预测值的 2.22%（95%CI 1.32-3.12），n=8332），儿童和成人的关联强度估计相似。在成人（1.54%（0.87-2.21），n=3970）中观察到 BD 后 FEV1 的改善，但在儿童（0.20%（-0.49-0.90），n=3924）中未观察到（亚组差异，p=0.006）。吸烟和不吸烟者的估计值相似。没有 RCT 数据关于固定气流阻塞的发生率。在观察性研究中，ICS 的使用与儿童和成人的预 BD FEV1 改善相关。BD 后结果的观察性数据有限。在轻度哮喘患者中，维持 ICS 与肺功能的适度、年龄相关改善相关，这是 ICS 在哮喘中的广泛临床作用的额外获益。目前尚无足够的证据确定治疗是否会降低晚年固定气流阻塞的发生率。
