Intervention Review

Inhaled corticosteroids compared to placebo for prevention of exercise induced bronchoconstriction

  1. Mariko S Koh1,*,
  2. Augustine Tee2,
  3. Toby J Lasserson3,
  4. Louis B Irving4

Editorial Group: Cochrane Airways Group

Published Online: 15 APR 2009

Assessed as up-to-date: 28 OCT 2008

DOI: 10.1002/14651858.CD002739.pub3

Database Title

Additional Information

How to Cite

Koh MS, Tee A, Lasserson TJ, Irving LB. Inhaled corticosteroids compared to placebo for prevention of exercise induced bronchoconstriction. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD002739. DOI: 10.1002/14651858.CD002739.pub3.

Author Information

  1. 1

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

  2. 2

    Changi General Hospital , Respiratory Medicine, Singapore, Singapore

  3. 3

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

  4. 4

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

*Mariko S Koh, Respiratory and Critical Care Medicine, Singapore General Hospital, Outram Road, Singapore, Singapore, 169608, Singapore. kohsiyue@yahoo.com.sg.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 15 APR 2009

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Abstract

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

Background

The pathogenesis of exercise induced bronchoconstriction is likely multifactorial and is not completely understood. Inflammation plays an important role in the pathogenesis of exercise induced bronchoconstriction in asthmatic subjects but the evidence seems less strong in non-asthmatic subjects. The management of exercise induced bronchoconstriction focuses on prevention, through both pharmacologic and non-pharmacologic interventions.

Objectives

The objectives of this review were to evaluate the use of inhaled corticosteroids in the treatment of exercise induced bronchoconstriction in a systematic way. Specifically, the review was designed to:

determine whether inhaled corticosteroids (compared to placebo) has an attenuating effect on exercise induced bronchoconstriction in adult and pediatric asthmatic patients;
estimate the magnitude of the attenuating effect.

Search methods

We searched the Cochrane Airways Review Group Specialised Register of trials, the Cochrane Central Register of Controlled Trials, review articles, textbooks and reference list of articles.

Selection criteria

Randomised trials in adults or children comparing inhaled corticosteroids with placebo to prevent bronchoconstriction in patients with exercise induced bronchoconstriction.

Data collection and analysis

Trial quality assessment and data extraction were conducted independently by two reviewers.

Main results

The results from eight randomised controlled trials involving 162 participants were analyzed (two trials involving adults and six involving children). Combining results from the three parallel studies with at least 4 weeks duration of inhaled corticosteroids, the use of inhaled corticosteroids significantly attenuated the percent fall index in forced expiratory volume in 1 second (WMD (fixed): 11.74%; 95% CI: 10.06% to 13.42%). The result from one crossover study with duration of inhaled corticosteroids of 4 weeks revealed significant attenuation of percent fall in forced expiratory volume in 1 second ( WMD 11.70%; 95% CI: 7.51% to 15.90%) and the percent fall in peak expiratory flow ( WMD 11.50%; 95% CI: 6.31% to 16.69%). The small amount of data from placebo-controlled trials using a single treatment do not currently allow conclusions to be drawn.

Authors' conclusions

Inhaled corticosteroids used for 4 weeks or more before exercise testing significantly attenuated exercise-induced bronchoconstriction. The relative benefits of inhaled corticosteroids compared to other forms of exercise induced bronchoconstriction treatment (sodium cromoglycate, nedocromil sodium, salbutamol, and other anti-inflammatory agents) remains unclear.

 

Plain language summary

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

Inhaled corticosteroids compared to placebo for prevention of exercise induced bronchoconstriction

Exercise-induced asthma (bronchoconstriction) can limit a person's exercise endurance and lead to people avoiding exercise. This systematic review found that inhaled corticosteroids taken regularly can reduce exercise induced asthma in both children and adults.

 

摘要

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

背景

比較吸入型皮質類固醇和安慰劑對防止運動誘發型支氣管收縮的效果

運動誘發型支氣管收縮的致病原因可能是多方面的，目前還未完全瞭解。在氣喘患者運動誘發支氣管收縮的致病原因中，發炎扮演一個重要角色；但在非氣喘患者，證據則較弱。運動誘發支氣管收縮的處置首重經由藥物和非藥物介入防止其發作。

目標

本回顧的目的在於，以系統性方法評估吸入型皮質類固醇在治療運動誘發支氣管收縮時的使用。更明確地說，本回顧的設計是要確定吸入型皮質類固醇(與安慰劑比較)對成人和兒童氣喘患者運動誘發的支氣管收縮是否有減輕效果，並估算減輕的程度。

搜尋策略

在Cochrane Airways Review Group Specialised Register和Cochrane Central Register of Controlled Trials中搜尋登錄的試驗，也搜尋回顧文獻、教科書和文獻的參考資料表。

選擇標準

成人或兒童的隨機試驗，比較吸入型皮質類固醇和安慰劑對運動誘發支氣管收縮的預防效果。

資料收集與分析

由兩位審查員各自進行試驗的品質評估和數據擷取。

主要結論

結果由六個隨機對照試驗、共123位參與者分析而來(兩個試驗對象是成人，四個是兒童)。 合併這兩個平行研究的結果顯示：持續使用吸入型皮質類固醇至少四週，明顯減少第1秒用力吐氣量的百分比下降指標(加權平均差[WMD] = 14.07%；95%信賴區間[CI]：11.62%到16.52%)。 另外來自一個交叉研究的結果則顯示：持續使用吸入型皮質類固醇至少四週，明顯減少第1秒用力吐氣量的百分比下降(加權平均差 = 6.90%；95%信賴區間：1.40%到12.40%)和尖峰吐氣流速的百分比下降(加權平均差 = 11.50%；95%信賴區間：6.31%到16.69%)。因為單一治療的安慰劑對照試驗數據太少，目前無法下定論。

作者結論

運動測試前使用吸入型皮質類固醇四週以上，明顯減輕運動誘發的支氣管收縮。與運動誘發支氣管收縮的其他治療(sodium cromoglycate、nedocromil sodium、salbutamol和其他抗發炎藥物)相比，吸入型皮質類固醇的相對效益尚待確認。

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

運動誘發性氣喘(支氣管收縮)可能限制個人的運動耐力，導致患者不想運動。本系統性回顧發現：常規使用吸入型皮質類固醇可以減少成人和兒童的運動誘發型氣喘。

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