Tanimura Kazuya, Sato Susumu, Fujita Yukio, Yamamoto Yoshifumi, Hajiro Takashi, Horita Nobuyuki, Kawayama Tomotaka, Muro Shigeo
Department of Respiratory Medicine, 12967Nara Medical University, Kashihara, Japan.
Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Chron Respir Dis. 2023 Jan-Dec;20:14799731231166008. doi: 10.1177/14799731231166008.
The rationale for additional treatment with short-acting bronchodilators combined with long-acting bronchodilators for patients with chronic obstructive pulmonary disease (COPD) is not adequately studied.
We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of a short-acting muscarinic antagonist (SAMA) therapy combined with a long-acting beta-2 agonist (LABA) in patients with stable COPD. Pulmonary function, dyspnea, health-related quality of life, exercise tolerance, physical activity, exacerbations of COPD, and adverse events during regular use were set as outcomes of interest.
We included five controlled trials including two sets of publicly available online data without article publications for the meta-analysis. Additional use of SAMA plus LABA showed a significant improvement in the peak response in FEV (mean difference (MD) 98.70 mL, < .00001), transitional dyspnea index score (MD .85, = .02), and St George's Respiratory Questionnaire score (MD -2.00, = .008) compared to LABA treatment. There was no significant difference in the risk of exacerbation of COPD ( = .20) and only a slight trend of increased severe adverse events (OR: 2.16, = .08) and cardiovascular events (OR: 2.38, = .06).
Additional treatment with SAMA combined with LABA could be a feasible choice due to its efficacy and safety.
对于慢性阻塞性肺疾病（COPD）患者，联用短效支气管扩张剂和长效支气管扩张剂进行额外治疗的基本原理尚未得到充分研究。
我们进行了一项系统评价和荟萃分析，以评估短效毒蕈碱拮抗剂（SAMA）疗法联合长效β2受体激动剂（LABA）治疗稳定期COPD患者的疗效和安全性。将肺功能、呼吸困难、健康相关生活质量、运动耐力、身体活动、COPD急性加重以及常规使用期间的不良事件作为感兴趣的结局指标。
我们纳入了五项对照试验，其中包括两组未发表文章但可公开获取的在线数据用于荟萃分析。与LABA治疗相比，额外使用SAMA加LABA在第一秒用力呼气容积（FEV）的峰值反应（平均差（MD）98.70 mL，P<0.00001）、过渡性呼吸困难指数评分（MD 0.85，P = 0.02）和圣乔治呼吸问卷评分（MD -2.00，P = 0.008）方面有显著改善。COPD急性加重风险无显著差异（P = 0.20），严重不良事件（OR：2.16，P = 0.08）和心血管事件（OR：2.38，P = 0.06）仅有轻微增加趋势。
联用SAMA和LABA进行额外治疗因其疗效和安全性可能是一种可行的选择。
