Tsao Chia-Ling, Chan Shu-Yen, Lee Meng-Hsun, Hsieh Tina Yi Jin, Phipatanakul Wanda, Ruran Hana B, Ma Kevin Sheng-Kai
Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
Allergy. 2025 Jun;80(6):1629-1646. doi: 10.1111/all.16538. Epub 2025 Jun 10.
The 2019 Global Initiative for Asthma (GINA) report no longer recommended short-acting beta-agonists (SABA) monotherapy due to associated complications and a lack of anti-inflammatory properties. This systematic review and meta-analysis aimed to evaluate adverse outcomes associated with SABA overuse in patients with asthma.
PubMed, Cochrane Library, EMBASE, and Web of Science databases were searched for studies on SABA overuse (≥ 3 SABA canisters/year) in patients with asthma, from 1981 to November 2023. Randomized controlled trials (RCTs), cohort studies, and cross-sectional studies were included. Pooled risk ratios (RRs) were calculated for dichotomous measures of all-cause mortality and acute exacerbations using random-effects models and Mantel-Haenszel weighting. Subgroup analyses were conducted based on study design.
Out of 626 records, 27 studies (2 RCTs, 1 prospective cohort study, 12 retrospective cohort studies, and 12 cross-sectional studies) were included. SABA overuse (≥ 3 SABA canisters/year) was associated with significantly higher mortality (2743 of 130,629 in the overuse group versus 3534 of 300,451 in controls; RR = 2.04, 95% confidence interval, CI = 1.37-3.04; p < 0.001) and a significantly higher rate of acute exacerbations (60,320 of 165,271 in the overuse group versus 84,439 of 376,845 in controls; RR = 1.93, 95% CI = 1.24-3.03; p < 0.001). An increased risk of acute exacerbations was observed in retrospective cohort studies (RR = 1.88, 95% CI = 1.43-2.47; p < 0.001) and cross-sectional studies (RR = 2.23, 95% CI = 1.04-4.77; p < 0.001).
SABA overuse was associated with increased rates of mortality and acute exacerbations in patients with asthma, supporting guidelines that advise against SABA monotherapy in asthma management.
2019年全球哮喘防治创议（GINA）报告不再推荐使用短效β受体激动剂（SABA）单药治疗，原因是其存在相关并发症且缺乏抗炎特性。本系统评价和荟萃分析旨在评估哮喘患者过度使用SABA的不良后果。
检索PubMed、Cochrane图书馆、EMBASE和Web of Science数据库，查找1981年至2023年11月期间关于哮喘患者过度使用SABA（≥3个SABA药罐/年）的研究。纳入随机对照试验（RCT）、队列研究和横断面研究。使用随机效应模型和Mantel-Haenszel加权法计算全因死亡率和急性加重二分指标的合并风险比（RR）。根据研究设计进行亚组分析。
在626条记录中，纳入了27项研究（2项RCT、1项前瞻性队列研究、12项回顾性队列研究和12项横断面研究）。过度使用SABA（≥3个SABA药罐/年）与显著更高的死亡率相关（过度使用组130629人中2743人死亡，对照组300451人中3534人死亡；RR = 2.04，95%置信区间，CI = 1.37 - 3.04；p < 0.001），以及显著更高的急性加重率（过度使用组165271人中60320人急性加重，对照组376845人中84439人急性加重；RR = 1.93，95% CI = 1.24 - 3.03；p < 0.001）。在回顾性队列研究（RR = 1.88，95% CI = 1.43 - 2.47；p < 0.001）和横断面研究（RR = 2.23，95% CI = 1.04 - 4.77；p < 0.001）中观察到急性加重风险增加。
哮喘患者过度使用SABA与死亡率和急性加重率增加相关，支持在哮喘管理中不建议使用SABA单药治疗的指南。
