Intervention Review

Inhaled short acting beta2-agonist use in chronic asthma: regular versus as needed treatment

  1. E. Haydn Walters1,*,
  2. Julia AE Walters2,
  3. Peter G Gibson3,
  4. Paul Jones4

Editorial Group: Cochrane Airways Group

Published Online: 8 JUL 2009

Assessed as up-to-date: 17 NOV 2002

DOI: 10.1002/14651858.CD001285

Database Title

Additional Information

How to Cite

Walters EH, Walters JAE, Gibson PG, Jones P. Inhaled short acting beta2-agonist use in chronic asthma: regular versus as needed treatment. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD001285. DOI: 10.1002/14651858.CD001285.

Author Information

  1. 1

    University of Tasmania Medical School, Discipline of Medicine, Hobart, Tasmania, Australia

  2. 2

    University of Tasmania, Menzies Research Institute, Hobart, Tasmania, Australia

  3. 3

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

  4. 4

    St George's Hospital Medical School, Cardiovascular Medicine, London, UK

*E. Haydn Walters, Discipline of Medicine, University of Tasmania Medical School, 43, Collins Street, PO BOX 252-34, Hobart, Tasmania, 7001, Australia. Haydn.Walters@utas.edu.au.

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

Inhaled short-acting beta-2 agonists are the major class of bronchodilators used for relief of symptoms in asthma. There has been concern that excessive uncontrolled use of beta-2 agonists might have contributed to rises in asthma mortality seen in some countries. International consensus guidelines now generally recommend using short-acting beta-2 agonists only for relief of symptoms on an as needed basis.

Objectives

To assess the effects of using short-acting inhaled beta-2 agonists regularly or only on demand in asthmatic adults and children on indices of asthma control.

Search methods

Searches were carried out of the Cochrane Airways Group "Asthma and Wheez* RCT" register in 1997, 1999 and 2002. Pharmaceutical companies and researchers with an interest in the area were asked directly for details of any studies that they knew of.

Selection criteria

Randomised controlled trials in which the short-acting beta-2 agonist was given regularly in the experimental group, together with an inhaled bronchodilator for relief of symptoms ('rescue use'). The control group consisted of matching placebo inhaled regularly, with an inhaled bronchodilator for 'rescue use'.

Data collection and analysis

Data were extracted and quality assessments were made by both reviewers. Parallel group and cross-over trials were analysed separately. Where possible data were pooled using a fixed effects model.

Main results

800 abstracts were identified for the first version and 60 papers were requested for full assessment. In this update 15 studies were added to the 34 trials which met the entry criteria for the first version in 2000. No clinically or statistically significant differences were found in airway calibre measurements. The regular treatment groups required less rescue medication, -0.80 puffs/24 hours (95% CI -0.07 to -1.30) and -0.42 puffs/daytime (95% CI -0.12 to -0.72), and had fewer days with asthma symptoms, -6.7% (95% CI -2.7 to -10.7). There was no significant difference in the odds ratio for the occurrence of at least one major asthma exacerbation either in parallel group or cross over studies.

Authors' conclusions

In general, these results support current guidelines, although it has given reassuring evidence against concerns over regular use of inhaled short-acting beta-2 agonists.

 

Plain language summary

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

Inhaled short acting beta2-agonist use in chronic asthma: regular versus as needed treatment

During an asthma attack, the airways narrow causing wheezing, coughing and breathlessness. Inhaled short acting beta-2 agonists, such as salbutamol or terbutaline, are commonly used as bronchodilators to relieve these symptoms. They can be used regularly or only when needed and are often used without medical supervision, raising concerns about the possibility of excessive use. The review of trials found little difference between the two methods.

 

摘要

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

背景

吸入式短效乙型交感神經興奮劑(beta2agonist)在慢性氣喘病上的使用:常規治療(regular treatment)與視需要而治療(as needed treatment)

吸入式短效乙型交感神經興奮劑是一種支氣管擴張劑,主要用於緩解氣喘症狀。人們一直擔心，過度濫用乙型交感神經興奮劑可能已經促使某些國家的氣喘死亡率上升。國際共識指引現在一般建議,只使用短效乙型交感神經興奮劑去緩解症狀,或是根據需要才使用。

目標

評估常規或是根據需要而使用吸入式短效乙型交感神經興奮劑在成人和兒童氣喘病上的控制指標。

搜尋策略

我們搜尋了1997,1999和2002的Cochrane Airways Group “Asthma and Wheez RCT”的登錄資料。我們也直接向製藥公司以及跟這個領域有關的研究人員詢問他們知道的研究詳情。

選擇標準

隨機對照試驗是以定期施予短效乙型交感神經興奮劑為實驗組,加上使用吸入式支氣管擴張劑來緩解症狀(“搶救時使用”(rescue use))。對照組包括了定期的吸入式安慰劑(Pleacebo),和在“搶救時使用”的吸入式支氣管擴張劑。

資料收集與分析

兩名審查員都萃取數據和評估品質。我們分別分析平行組(parallel group)和交叉試驗(crossover trials)。在有可能的時候,我們使用固定效應模型(fixed effects model)去統合資料。

主要結論

在第一版中,我們找出了800篇摘要,並索取60篇文章來進行整體評估。在這次更新中,我們把15篇文章加入了34個符合2000年第一版選取條件的試驗。我們在呼吸道口徑測量上沒有發現任何臨床或是統計學上的顯著差異。常規治療組需要比較少的搶救藥物, −0.80 puffs/每24小時(95% CI −0.07to −1.30)和−0.42 puffs/白天(95% CI −0.12 to −0.72),而且有氣喘症狀的天數較少−6.7%(95% CI −2.7 to −10.7)。至少一次主要氣喘病發作的勝算比(odds ratio),在平行組或交叉研究中無顯著差異。

作者結論

一般而言,這些研究結果支持現行指引，儘管它已對常規使用吸入式短效乙型交感神經興奮劑的擔憂提出提供可靠的反面證據。

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

常規使用吸入式短效乙型交感神經興奮劑藥物，而不是只在需要時使用，對減輕氣喘症狀沒有明顯的優勢。在氣喘病發作時，氣道狹窄引起氣喘，咳嗽和呼吸困難。吸入短效乙型交感神經興奮劑，如沙丁胺醇(salbutamol)或特布他林(terbutaline)這些支氣管擴張劑,一般被用來減輕這些症狀。 人們常在沒有醫療監督下經常或只在需要時使用這些藥物，提高了過度使用這些藥物的可能性。試驗回顧發現了二個方法之間的少許區別。

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