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短效吸入性支气管扩张剂在囊性纤维化中的应用。

Short-acting inhaled bronchodilators for cystic fibrosis.

机构信息

Academic Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK.

Leeds Regional Paediatric Respiratory & Cystic Fibrosis Centre, A Floor, Clarendon Wing, Leeds Children's Hospital, Leeds, UK.

出版信息

Cochrane Database Syst Rev. 2022 Jun 24;6(6):CD013666. doi: 10.1002/14651858.CD013666.pub2.


DOI:10.1002/14651858.CD013666.pub2
PMID:35749226
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9231652/
Abstract

BACKGROUND: Respiratory disease is the main cause of morbidity and mortality in cystic fibrosis (CF), and many different therapies are used by people with CF in the management of respiratory problems. Bronchodilator therapy is used to relieve symptoms of shortness of breath and to open the airways to allow clearance of mucus. Despite the widespread use of inhaled bronchodilators in CF, there is little objective evidence of their efficacy. A Cochrane Review looking at both short- and long-acting inhaled bronchodilators for CF was withdrawn from the Cochrane Library in 2016. That review has been replaced by two separate Cochrane Reviews: one on long-acting inhaled bronchodilators for CF, and this review on short-acting inhaled bronchodilators for CF. For this review 'inhaled' includes the use of pressurised metered dose inhalers (MDIs), with or without a spacer, dry powder devices and nebulisers. OBJECTIVES: To evaluate short-acting inhaled bronchodilators in children and adults with CF in terms of clinical outcomes and safety. SEARCH METHODS: We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books on 28 March 2022 and searched trial registries for any new or ongoing trials on 12 April 2022. We also searched the reference lists of relevant articles and reviews. SELECTION CRITERIA: We searched for randomised controlled trials (RCTs) or quasi-RCTs that looked at the effect of any short-acting inhaled bronchodilator delivered by any device, at any dose, at any frequency and for any duration compared to either placebo or another short-acting inhaled bronchodilator in people with CF. We screened references as per standard Cochrane methodology. DATA COLLECTION AND ANALYSIS: Two review authors extracted data and assessed risk of bias using the Cochrane RoB 1 tool. Where we were not able to enter data into our analyses we reported results directly from the papers. We assessed the certainty of evidence using GRADE. MAIN RESULTS: We included 11 trials from our systematic search, with 191 participants meeting our inclusion criteria; three of these trials had three treatment arms. Eight trials compared short-acting inhaled beta-2 agonists to placebo and four trials compared short-acting inhaled muscarinic antagonists to placebo. Three trials compared short-acting inhaled beta-2 agonists to short-acting inhaled muscarinic antagonists. All were cross-over trials with only small numbers of participants. We were only able to enter data into the analysis from three trials comparing short-acting inhaled beta-2 agonists to placebo. Short-acting inhaled beta-2 agonists versus placebo All eight trials (six single-dose trials and two longer-term trials) reporting on this comparison reported on forced expiratory volume in 1 second (FEV), either as per cent predicted (% predicted) or L. We were able to combine the data from two trials in a meta-analysis which showed a greater per cent change from baseline in FEV L after beta-2 agonists compared to placebo (mean difference (MD) 6.95%, 95% confidence interval (CI) 1.88 to 12.02; 2 trials, 82 participants). Only one of the longer-term trials reported on exacerbations, as measured by hospitalisations and courses of antibiotics. Only the second longer-term trial presented results for participant-reported outcomes. Three trials narratively reported adverse events, and these were all mild. Three single-dose trials and the two longer trials reported on forced vital capacity (FVC), and five trials reported on peak expiratory flow, i.e. forced expiratory flow between 25% and 75% (FEF). One trial reported on airway clearance in terms of sputum weight. We judged the certainty of evidence for each of these outcomes to be very low, meaning we are very uncertain about the effect of short-acting inhaled beta-2 agonists on any of the outcomes we assessed. Short-acting inhaled muscarinic antagonists versus placebo All four trials reporting on this comparison looked at the effects of ipratropium bromide, but in different doses and via different delivery methods. One trial reported FEV % predicted; three trials measured this in L. Two trials reported adverse events, but these were few and mild. One trial reported FVC and three trials reported FEF. None of the trials reported on quality of life, exacerbations or airway clearance. We judged the certainty of evidence for each of these outcomes to be very low, meaning we are very uncertain about the effect of short-acting inhaled muscarinic antagonists on any of the outcomes we assessed. Short-acting inhaled beta-2 agonists versus short-acting inhaled muscarinic antagonists  None of the three single-dose trials reporting on this comparison provided data we could analyse. The original papers from three trials report that both treatments lead to an improvement in FEV L. Only one trial reported on adverse events; but none were experienced by any participant. No trial reported on any of our other outcomes. We judged the certainty of evidence to be very low, meaning we are very uncertain about the effect of short-acting inhaled beta-2 agonists compared to short-acting inhaled muscarinic antagonists on any of the outcomes we assessed. AUTHORS' CONCLUSIONS: All included trials in this review are small and of a cross-over design. Most trials looked at very short-term effects of inhaled bronchodilators, and therefore did not measure longer-term outcomes. The certainty of evidence across all outcomes was very low, and therefore we have been unable to describe any effects with certainty.

摘要

背景:呼吸系统疾病是囊性纤维化(CF)患者发病和死亡的主要原因,许多 CF 患者在管理呼吸问题时会使用多种不同的治疗方法。支气管扩张剂疗法用于缓解呼吸急促的症状,并打开气道以清除黏液。尽管 CF 患者广泛使用吸入型支气管扩张剂,但几乎没有客观证据表明其疗效。2016 年,Cochrane 评价系统撤回了一项关于短效和长效吸入型支气管扩张剂治疗 CF 的 Cochrane 评价,该评价已被两项单独的 Cochrane 评价取代:一项是长效吸入型支气管扩张剂治疗 CF,另一项是本项关于短效吸入型支气管扩张剂治疗 CF 的评价。本项评价中,“吸入”包括使用带或不带储雾器的压力定量气雾剂(MDI)、干粉吸入器和雾化器。

目的:评价短效吸入型支气管扩张剂在 CF 儿童和成人患者中的临床结局和安全性。

检索方法:我们于 2022 年 3 月 28 日检索了 Cochrane 囊性纤维化试验注册库,检索方法包括电子数据库检索、手工检索期刊和会议摘要集,并于 2022 年 4 月 12 日检索了试验注册库,以查找任何新的或正在进行的试验。我们还检索了相关文章和综述的参考文献列表。

纳入排除标准:我们纳入了比较任何一种短效吸入型支气管扩张剂(通过任何一种设备、任何剂量、任何频率和任何持续时间给药)与安慰剂或另一种短效吸入型支气管扩张剂对 CF 患者影响的随机对照试验(RCT)或准 RCT。我们按照标准 Cochrane 方法筛选参考文献。

数据收集和分析:两位评价员使用 Cochrane RoB 1 工具提取数据并评估偏倚风险。如果我们无法将数据纳入分析,我们将直接从论文中报告结果。我们使用 GRADE 评估证据的确定性。

主要结果:我们从系统检索中纳入了 11 项试验,共有 191 名符合纳入标准的参与者;其中三项试验有三个治疗组。八项试验比较了短效吸入型β2 激动剂与安慰剂,四项试验比较了短效吸入型抗胆碱能拮抗剂与安慰剂。三项试验比较了短效吸入型β2 激动剂与短效吸入型抗胆碱能拮抗剂。所有这些试验均为交叉试验,参与者人数较少。我们仅能够将三项比较短效吸入型β2 激动剂与安慰剂的试验的数据纳入分析。

短效吸入型β2 激动剂与安慰剂:八项报告这一比较结果的试验(六项单剂量试验和两项长期试验)均报告了用力呼气量(FEV),要么是预测值的百分比(%pred),要么是 L。我们能够将两项试验的数据合并进行 meta 分析,结果显示β2 激动剂治疗后 FEV L 的百分比变化大于安慰剂(平均差值(MD)6.95%,95%置信区间(CI)1.88 至 12.02;2 项试验,82 名参与者)。只有一项长期试验报告了因住院和抗生素疗程而导致的加重情况。只有第二项长期试验报告了参与者报告的结局。三项试验报告了不良事件,但均为轻度。三项单剂量试验和两项长期试验报告了用力肺活量(FVC),五项试验报告了呼气峰流速(FEF),即 25%至 75%之间的用力呼气量。一项试验报告了痰量与气道清除的关系。我们认为这些结局的证据确定性均为极低,这意味着我们对短效吸入型β2 激动剂对我们评估的任何结局的影响非常不确定。

短效吸入型抗胆碱能拮抗剂与安慰剂:四项报告这一比较结果的试验均研究了异丙托溴铵的效果,但剂量和给药方式不同。一项试验报告了 FEV %pred;三项试验测量了 L。三项试验报告了不良事件,但数量少且为轻度。一项试验报告了 FVC,三项试验报告了 FEF。没有试验报告生活质量、加重或气道清除。我们认为这些结局的证据确定性均为极低,这意味着我们对短效吸入型抗胆碱能拮抗剂对我们评估的任何结局的影响非常不确定。

短效吸入型β2 激动剂与短效吸入型抗胆碱能拮抗剂:比较这两种治疗方法的三项单剂量试验均未提供我们可以分析的数据。三项试验的原始论文报告称,两种治疗均改善了 FEV L。只有一项试验报告了不良事件,但没有任何参与者经历过。没有试验报告任何其他结局。我们认为证据确定性为极低,这意味着我们对短效吸入型β2 激动剂与短效吸入型抗胆碱能拮抗剂相比对我们评估的任何结局的影响非常不确定。

作者结论:本评价纳入的所有试验均较小,且为交叉设计。大多数试验均观察了吸入型支气管扩张剂的短期效果,因此未测量长期结局。所有结局的证据确定性均非常低,因此我们无法确定任何效果。

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引用本文的文献

[1]
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Signal Transduct Target Ther. 2024-12-6

[2]
Bronchodilator response assessment through impulse oscillometry system and spirometry in children and adolescents with cystic fibrosis.

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[3]
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本文引用的文献

[1]
The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.

BMJ. 2021-3-29

[2]
Characterising burden of treatment in cystic fibrosis to identify priority areas for clinical trials.

J Cyst Fibros. 2020-5

[3]
Estimating the age of p.(Phe508del) with family studies of geographically distinct European populations and the early spread of cystic fibrosis.

Eur J Hum Genet. 2018-8-8

[4]
Long-acting inhaled bronchodilators for cystic fibrosis.

Cochrane Database Syst Rev. 2017-12-19

[5]
The top 10 research priorities in cystic fibrosis developed by a partnership between people with CF and healthcare providers.

Thorax. 2017-8-4

[6]
Bronchodilators in cystic fibrosis: a critical analysis.

Expert Rev Respir Med. 2017-1

[7]
WITHDRAWN: Inhaled bronchodilators for cystic fibrosis.

Cochrane Database Syst Rev. 2016-2-11

[8]
Reversible airway obstruction in cystic fibrosis: Common, but not associated with characteristics of asthma.

J Cyst Fibros. 2016-9

[9]
Pharmacologic Agents That Promote Airway Clearance in Hospitalized Subjects: A Systematic Review.

Respir Care. 2015-7

[10]
Tiotropium Respimat in cystic fibrosis: Phase 3 and Pooled phase 2/3 randomized trials.

J Cyst Fibros. 2015-9

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