Nedocromil sodium versus sodium cromoglycate for preventing exercise-induced bronchoconstriction

  • Review
  • Intervention

Authors


Abstract

Background

Nedocromil sodium and sodium cromoglycate inhaled shortly before exercise appear to reduce the severity of exercise-induced bronchoconstriction. There is some debate over which drug may be more effective.

Objectives

The objective of this review was to compare the effects on post-exercise lung function between prophylactic doses of nedocromil sodium (NSG) and sodium cromoglycate (SCG) in persons diagnosed with exercise-induced bronchoconstriction.

Search methods

Randomized controlled trials were identified from the Cochrane Airways Review Group Asthma Register. Bibliographies of relevant studies and review articles were searched and primary authors, content experts and manufacturers of drugs were contacted for additional relevant studies. No language restrictions were applied. Searches were current as of December 2007.

Selection criteria

Randomized controlled trials comparing NCS to SCG in prophylactic treatment of exercise-induced bronchoconstriction were eligible. Studies were included if: the participants, aged 6 or over, had a confirmed diagnosis of asthma with exercise-induced bronchoconstriction, were subjected to an exercise challenge sufficient to trigger bronchoconstriction, and the measures of lung function were reported as either changes in forced expiratory volume in one second or peak expiratory flow rate.

Data collection and analysis

Data extraction and methodological quality assessments were conducted independently by two reviewers using standard forms and validated assessment criteria. In some cases results were extrapolated from graphs. Results from similar studies were pooled and reported as the weighted mean difference (WMD) or odds ratio (OR) with 95% confidence intervals (CI) using the random effects model.

Main results

Nine studies (162 participants) are included in this review. No significant difference was noted between NCS and SCG with respect to the maximum percent decrease in FEV1 (WMD = -0.88; 95% CI: -4.50, 2.74), complete protection (i.e. maximum % fall FEV1 still =>10%); OR = 0.95; 95% CI: 0.50 to 1.8, clinical protection (i.e. < 50% improvement over placebo); OR = 0.71; 95% CI: 0.36 to 1.39; unpleasant taste (OR = 6.85; 95% CI: 0.77, 60.73), or sore throat (OR = 3.46; 95% CI: 0.32, 37.48). For these pooled comparisons, no statistically significant heterogeneity was identified. Subgroup analyses based on age, dosage of medications and timing of exercise post-inhalation were consistent with the overall pooled analyses.

Authors' conclusions

No significant differences were evident between the effect of NCS and SCG during the immediate post-exercise period in adults and children with EIB with regards to pulmonary function - specifically maximum percent decrease in FEV1, complete protection, clinical protection, or side effects.

摘要

背景

比較nedocromil sodium和sodium cromoglycate 對氣喘患者的運動誘發型支氣管收縮的預防效果

運動前吸入nedocromil sodium和sodium cromoglycate,似乎可以減輕運動誘發型支氣管收縮的嚴重度。至於哪一種藥物比較有效?還有一些爭議。

目標

本回顧的目的在於-在被診斷為運動誘發型支氣管收縮的患者身上,比較預防性劑量的nedocromil sodium (NCS)和sodium cromoglycate (SCG)對運動後肺功能的影響。

搜尋策略

從Cochrane Airways Review Group Asthma Register 找出隨機對照試驗,包括CINAHL、EMBASE、MEDLINE和CENTRAL等資料庫搜尋;並以人工搜尋二十種期刊;同時搜尋相關研究和回顧文章的參考書目;並連絡第一作者、內容專家和藥物製造廠商,以取得其他相關研究。搜尋到2003年12月為止。未採取語言限制。

選擇標準

僅納入隨機對照試驗,比較NCS和SCG對運動誘發型支氣管收縮的預防性治療。其它納入條件包括:研究參與者年齡在6歲及以上、有運動誘發型氣喘的確定診斷、接受過足以誘發支氣管收縮的運動挑戰,且肺功能計量以第一秒用力吐氣量(FEV1)或尖峰吐氣流速(PEFR)的改變表示者。

資料收集與分析

兩位審查員各自利用標準格式和有效認證的評估準則進行數據擷取和方法學品質評估。有些結果是由圖形外推而來。將類似研究的結果加以匯整,報告以加權平均差(weighted mean difference,WMD)或危險對比值(odds ratio,OR)呈現,附帶隨機效應模式的95%信賴區間(confidence intervals,CI)。

主要結論

從原始搜尋獲取的九十二篇引用文章中,本回顧納入其中八篇、共117位參與者。在NCS和SCG兩組間,無論是FEV1的最大降幅(加權均數差 = 0.88;95%信賴區間:4.50,2.74)、完全防護(FEV1最大降幅≧10%) (危險對比值 = 0.95;95%信賴區間:0.50到 1.8)、臨床防護(與安慰劑相比,小於50%的改善) (危險對比值 = 0.71;95%信賴區間:0.36到1.39)、異味(危險對比值 = 6.85;95%信賴區間:0.77,60.73)或喉嚨痛(危險對比值 = 3.46;95%信賴區間:0.32,37.48)各方面,都沒有顯著的差異。在這些匯整的比較項目中,並沒有發現任何具有統計意義的岐異性。次組分析無論是根據年齡、藥物劑量,和吸入藥物到運動的時間,與所有匯整分析呈現一致性的結果。2003年12月再進行一次搜尋,但沒有找到其他適合納入本回顧的新研究。

作者結論

運動誘發型支氣管收縮的成人和兒童,運動後立即使用NCS和SCG,兩者的效果沒有明顯差異-無論是肺功能,特別是FEV1最大降幅、完全防護、臨床防護或副作用各方面都沒有顯著的差異。

翻譯人

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

總結

nedocromil sodium和sodium cromoglycate對於運動誘發性氣喘的緩解效果相近。但是,較多使用nedocromil sodium者抱怨喉嚨痛和異味。運動誘發型氣喘使得患者的耐力受限、運動後的恢復時間延長,進而導致患者不愛運動。發作時的症狀有咳嗽、哮喘、呼吸急促和胸部緊繃等。nedocromil sodium (Tilade)和sodium cromoglycate這兩種藥物有時會在運動前使用以防止氣喘。本回顧發現:兩者在舒緩兒童和成人的運動誘發型氣喘方面效果相近。較多使用nedocromil sodium的患者抱怨喉嚨痛和使用後異味。

Plain language summary

Nedocromil sodium versus sodium cromoglycate for preventing exercise-induced bronchoconstriction

Exercise-induced asthma can limit people's endurance, prolong recovery time after exercise, and lead to people avoiding exercise. The episode involves symptoms such as coughing, wheezing, shortness of breath and chest tightness. Two drugs, nedocromil sodium (Tilade) and sodium cromoglycate are sometimes used before exercise to prevent asthma. The review of trials found that both were similarly effective in relieving exercise-induced asthma for both children and adults. More people have sore throats and an unpleasant after-taste after using nedocromil sodium.

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