Short acting beta2-agonists for recurrent wheeze in children under two years of age

 

Abstract

Background

Wheeze is a common symptom in infancy and is a common cause for both primary care consultations and hospital admission. Beta2-adrenoceptor agonists (b2-agonists) are the most frequently used as bronchodilator but their efficacy is questionable.

Objectives

To determine the effectiveness of b2-agonist for the treatment of infants with recurrent and persistent wheeze.

Search methods

We identified relevant trials using the Cochrane Airways Group Specialised register composed of records identified in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and PUBMED. We used the following terms to search the database: Wheeze or asthma and Infant or Child and Short acting beta-agonist or Salbutamol (variants), Albuterol, Terbutaline (variants), Orciprenaline, Fenoterol.

Selection criteria

Randomised controlled trials comparing the effect of b2-agonist against placebo in children under two years of age who had two or more previous episodes of wheeze, not related to another form of chronic lung disease.

Data collection and analysis

Eight studies met the criteria for inclusion in this meta-analysis. The studies investigated patients in three settings: at home (three studies), in hospital (two studies) and in the pulmonary function laboratory (three studies). The main outcome measure was change in respiratory rate except for community based studies where symptom scores were used.

Main results

The studies were markedly heterogeneous and between study comparisons were limited. Improvement in respiratory rate, symptom score and oxygen saturation were noted in one study in the emergency department following two salbutamol nebulisers but this had no impact on hospital admission. There was a reduction in bronchial reactivity following salbutamol. There was no significant benefit from taking regular inhaled salbutamol on symptom scores recorded at home.

Authors' conclusions

There is no clear benefit of using b2-agonists in the management of recurrent wheeze in the first two years of life although there is conflicting evidence. At present, further studies should only be performed if the patient group can be clearly defined and there is a suitable outcome parameter capable of measuring a response.

 

Plain language summary

Short acting beta2-agonists for recurrent wheeze in children under two years of age

Beta-agonists such as salbutamol are the most frequently prescribed reliever medication for asthma. They work well in adults and children but their effectiveness in infants is less clear. Eight trials were reviewed involving 229 patients in four different settings. Although infants have the capability to respond to salbutamol, there is only limited relief of acute symptoms when given to acutely ill patients. This did not impact on requirement for hospital admission or length of hospital stay. Regular salbutamol has not been shown to offer protection against developing symptoms.

 

摘要

背景

短效乙二型作用劑對兩歲以下幼童反覆性哮喘的治療

哮喘是嬰兒時期常見的症狀，也是就醫和住院的常見原因。乙二型作用劑是最常使用的支氣管擴張劑，但療效還有爭議。

目標

確定乙二型作用劑對嬰兒反覆及持續哮喘的療效。

搜尋策略

從Cochrane Airways Group Specialised register中找出相關試驗，包括在Cochrane Central Register of Controlled Trials (CENTRAL)、MEDLINE和 PUBMED中找到的紀錄。使用下列字彙搜尋資料庫：Wheeze或asthma、Infant或Child和Short acting betaagonist或Salbutamol(variants)、Albuterol、Terbutaline (variants)、Orciprenaline、Fenoterol等。

選擇標準

隨機對照試驗，在兩歲以下、有過兩次或更多次哮喘發作、且與其他慢性肺病無關的幼童中，比較乙二型作用劑和安慰劑的效果

資料收集與分析

八篇研究符合這個統合分析的納入標準。這些研究調查三個場所的病患：住家(三項研究)、醫院(兩項研究)和肺功能實驗室(三項研究)。主要的結果測量值是呼吸速率的變化，但社區型研究則以症狀計分。

主要結論

這些研究有明顯的歧異性，因此限制了研究間的比較。一項在急診室的研究發現：使用兩次噴霧式salbutamol後，呼吸速率、症狀計分和氧飽和度都有改善，但對住院率沒有影響。使用salbutamol後，支氣管反應性下降。常規使用吸入型salbutamol對居家紀錄的症狀分數沒有顯著的效益。

作者結論

雖然有一些爭議性的證據，但是，在兩歲以前使用乙二型作用劑處理反覆哮喘，並沒有明顯的效益。若能明確定義病患族群，並有適當的結果參數作為反應的測量值，才能進行進一步的研究。

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

乙型作用劑(如salbutamol)是最常開立的氣喘舒緩藥物，對成人和兒童作用良好，但對嬰兒的效果則不清楚。我們審查了八個試驗，包括四個不同醫療院所的229位病患。雖然嬰兒對salbutamol有反應，但是對危急病患的急性症狀舒緩效果卻很有限。對住院需求和住院天數都沒有影響。沒有證據顯示：常規使用salbutamol可以預防症狀發生。