Intervention Review

Long-acting beta2-agonists versus theophylline for maintenance treatment of asthma

  1. Augustine Tee1,*,
  2. Mariko S Koh2,
  3. Peter G Gibson3,
  4. Toby J Lasserson4,
  5. Amanda Wilson5,
  6. Louis B Irving6

Editorial Group: Cochrane Airways Group

Published Online: 8 JUL 2009

Assessed as up-to-date: 14 NOV 2007

DOI: 10.1002/14651858.CD001281.pub2

Database Title

Additional Information

How to Cite

Tee A, Koh MS, Gibson PG, Lasserson TJ, Wilson A, Irving LB. Long-acting beta2-agonists versus theophylline for maintenance treatment of asthma. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD001281. DOI: 10.1002/14651858.CD001281.pub2.

Author Information

  1. 1

    Changi General Hospital, Respiratory Medicine, Singapore, Singapore

  2. 2

    Singapore General Hospital, Respiratory and Critical Care Medicine, Singapore, Singapore, Singapore

  3. 3

    John Hunter Hospital, Department of Respiratory and Sleep Medicine, Hunter Mail Centre, NSW, Australia

  4. 4

    St George's, University of London, Community Health Sciences, London, UK

  5. 5

    Unviersity of Newcastle, Newcastle, New South Wales, Australia

  6. 6

    Royal Melbourne Hospital, Respiratory and Sleep Medicine, Parkville, Victoria, Australia

*Augustine Tee, Respiratory Medicine, Changi General Hospital, Singapore, 529889, Singapore. augustine_tee@cgh.com.sg. augustine_tee@cgh.com.sg.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 8 JUL 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Theophylline and long acting beta-2 agonists are bronchodilators used for the management of persistent asthma symptoms, especially nocturnal asthma. They represent different classes of drug with differing side-effect profiles.

Objectives

To assess the comparative efficacy, safety and side-effects of long-acting beta-2 agonists and theophylline in the maintenance treatment of adults and adolescents with asthma.

Search methods

We searched the Cochrane Airways Group trials register and reference lists of articles. We also contacted authors of identified RCTs for other relevant published and unpublished studies and pharmaceutical manufacturers. Most recent search: November 2007.

Selection criteria

All included studies were RCTs involving adults and children with clinical evidence of asthma. These studies must have compared oral sustained release and/or dose adjusted theophylline with an inhaled long-acting beta-2 agonist.

Data collection and analysis

In original review, two reviewers independently assessed trial quality and extracted data, similarly in this update two reviewers undertook this. Study authors were contacted for additional information.

Main results

Thirteen studies with a total of 1344 participants met the inclusion criteria of the review. They were of varying quality. There was no significant difference between salmeterol and theophylline in FEV1 predicted (6.5%; 95% CI -0.84 to 13.83). However, salmeterol treatment led to significantly better morning PEF (mean difference 16.71 L/min, 95% CI 8.91 to 24.51) and evening PEF (mean difference 15.58 L/min, 95% CI 8.33 to 22.83). Salmeterol also reduced the use of rescue medication. Formoterol, used in two studies was reported to be as effective as theophylline. Bitolterol, used in only one study, was reported to be less effective than theophylline. Participants taking salmeterol experienced fewer adverse events than those using theophylline (Parallel studies: Relative Risk 0.44; 95% CI 0.30 to 0.63, Risk Difference -0.11; 95% CI -0.16 to -0.07, Numbers Needed to Treat (NNT) 9; 95% CI 6 to 14). Significant reductions were reported for central nervous system adverse events (Relative Risk 0.50; 95% CI 0.29 to 0.86, Risk Difference -0.07; 95% CI -0.12 to -0.02, NNT 14; 95% CI 8 to 50) and gastrointestinal adverse events (Relative Risk 0.30; 95% CI 0.17 to 0.55, Risk Difference -0.11; 95% CI -0.16 to -0.06, NNT 9; 95% CI 6 to 16).

Authors' conclusions

Long-acting beta-2 agonists, particularly salmeterol, are more effective than theophylline in improving morning and evening PEF, but are not significantly different in their effect on FEV1. There is evidence of decreased daytime and nighttime short-acting beta-2 agonist requirement with salmeterol. Fewer adverse events occurred in participants using long-acting beta-2 agonists (salmeterol and formoterol) as compared to theophylline.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Long-acting beta2-agonists versus theophylline for maintenance treatment of asthma

This review compared three asthma medications, salmeterol, formoterol (both long acting beta-agonists) and theophylline. These medications are used to help control symptoms of asthma, especially those which occur during the night. This review found that salmeterol showed a greater improvement in lung function, and reduced the need for extra short-term inhalers in the day and the night. Salmeterol and formoterol are less likely to produce side-effects (such as headaches and nausea) when compared to theophylline.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

以長效乙型交感神經興奮劑(beta2agonist)和茶葉素(theophylline)對氣喘病作維持治療(maintenance treatment)

茶葉素和長效乙型交感神經興奮劑被使用來管理持續性氣喘病症狀,尤其是夜間氣喘(nocturnal asthma)。他們代表了不同種類的藥物並具有不同的副作用。

目標

評估以長效乙型交感神經興奮劑和茶葉素來進行成人和青少年氣喘病維持治療的療效，安全性和副作用。

搜尋策略

我們搜尋了Cochrane Airways Group trials登錄資料以及文章的書目。我們也連絡了選定的隨機對照試驗(RCTs)作者來找出其他相關的製藥公司,以及已發表和未發表的研究。最新搜詢日期：2006年11月。

選擇標準

所有納入的隨機對照試驗研究，都涉及成人和兒童氣喘病的臨床證據。這些研究必須把口服緩釋和/或茶葉素調整劑量,與吸入長效乙型交感神經興奮劑相比較。

資料收集與分析

在原來的審查中，兩名審查員獨立評估試驗品質和萃取數據。在此更新審查中 兩個審查員也這麼做。我們為了獲得更多信息也聯繫了研究作者。

主要結論

13個試驗,以及一共1344名病人有資格納入這次審查。他們的品質良莠不齊。沙美特羅(salmeterol)和茶葉素 在預測的1秒鐘的用力呼氣量(FEV1)沒有顯著的差異(6.5%; 95% CI −0.84 to 13.83)。然而,沙美特羅療法導致早上呼氣峰(PEF)(平均差異16.71 L/min, 95% CI 8.91 to 24.51)及下午呼氣峰的顯著改善(平均差異15.58 L/min, 95% CI 8.33 to 22.83)。在兩個使用福莫特羅(Formoterol)的研究中指出,福莫特羅跟茶葉素一樣有效。在一個使用比托特羅(Bitolterol)的研究中指出,比托特羅沒有比茶葉素來的有效。和使用茶葉素的病人相比,使用沙美特羅的病人經歷較少的副作用(平行試驗:相對危險性(RR)0.44; 95% CI 0.30 to 0.63,危險性差(Risk Difference) −0.11;95% CI −0.16 to −0.07,益一需治數(NNT) 9; 95% CI 6 to 14)。 中樞神經系統的副作用(相對危險性 0.50; 95% CI 0.29 to 0.86, 危險性差−0.07; 95% CI0.12 to −0.02, 需要被治療的病人數目14; 95% CI 8 to 50)和腸胃方面的副作用(相對危險性 0.30; 95% CI 0.17 to 0.55, 危險性差−0.11; 95% CI −0.16 to −0.06, 需要被治療的病人數目9; 95% CI 6 to 16)在報告中大幅降低。

作者結論

長效乙型交感神經興奮劑,尤其是沙美特羅,在改善早上和下午的呼氣峰的功效上比茶葉素來的有效。但是對於1秒鐘的用力呼氣量,兩者沒有顯著的差別。我們發現使用沙美特羅可以減低白天和晚上的長效乙型交感神經興奮劑需要量。比起茶葉素,使用長效乙型交感神經興奮劑需要量(沙美特羅和福莫特羅)產生比較少的副作用。

翻譯人

本摘要由臺北醫學大學萬芳醫院楊璧如翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

沙美特羅和茶葉素在降低氣喘症狀上有相似的功效,但是沙美特羅產生比較少的副作用。這篇回顧比較了三種氣喘藥，沙美特羅，福莫特羅(包括長效乙型交感神經興奮劑)和茶葉素。這些藥物用來幫助控制氣喘症狀，特別是那些發生在夜間的氣喘症狀。這次回顧發現，沙美特羅可以大幅度的改善肺功能，降低了白天和夜晚短期吸入器的額外需求。和茶葉素相比,沙美特羅和福莫特羅比較少產生副作用(如頭痛，噁心)。

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