Intervention Review

Inhaled short-acting beta2-agonists versus ipratropium for acute exacerbations of chronic obstructive pulmonary disease

  1. Cynthia D Brown1,*,
  2. Douglas C McCrory2,
  3. John White3

Editorial Group: Cochrane Airways Group

Published Online: 22 JAN 2001

Assessed as up-to-date: 7 MAY 2002

DOI: 10.1002/14651858.CD002984


How to Cite

Brown CD, McCrory DC, White J. Inhaled short-acting beta2-agonists versus ipratropium for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2001, Issue 1. Art. No.: CD002984. DOI: 10.1002/14651858.CD002984.

Author Information

  1. 1

    Brody School of Medicine, Section of Pulmonary & Critical Care Medicine, Greenville, North Carolina, USA

  2. 2

    Duke University, Center for Clinical Health Policy Research, Durham, NC, USA

  3. 3

    York District Hospital, Respiratory Medicine, York, North Yorks, UK

*Cynthia D Brown, Section of Pulmonary & Critical Care Medicine, Brody School of Medicine, Room E-149B, Brody Medical Science Building, 600 Moye Blvd, Greenville, North Carolina, 27858, USA. cdbrownmd@yahoo.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 22 JAN 2001

SEARCH

 

Abstract

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

Background

Inhaled short acting beta2 adrenergic agonists and ipratropium bromide are both used in the treatment of acute exacerbations of chronic obstructive pulmonary disease.

Objectives

In patients with acute exacerbations of COPD to: 1. To assess the efficacy of short-acting beta-2 agonists against placebo ; 2. Compare the efficacy of short-acting beta-2 agonists and ipratropium.

Search methods

A comprehensive search of the literature was carried out of EMBASE, MEDLINE, CINAHL and the Cochrane COPD trials register was carried out using the terms: bronchodilator* OR albuterol OR metaproterenol OR terbutaline OR isoetharine OR pirbuterol OR salbutamol OR beta-2 agonist.

Selection criteria

All trials that appeared to be relevant were assessed by two reviewers who independently selected trials for inclusion. Differences were resolved by consensus.

Data collection and analysis

All trials that appeared to be relevant were assessed by two reviewers who independently selected trials for inclusion. Differences were resolved by consensus. References listed in each included trial were searched for additional trial reports. Trials were combined using Review Manager using a fixed effects model. The size of the treatment effects were tested for heterogeneity.

Main results

We identified no placebo-controlled comparisons of beta-2 agonists. Three studies permitted comparison of ipratropium to an inhaled beta-2 agonist. These studies included a total of 103 patients. The beta2-agonists used were: fenoterol and metaproterenol. One study was a parallel group trial of regular therapy for seven days. The other two were cross over studies of single dose treatments, with efficacy measured 90 min post dose. There was no washout period between treatments.

Both treatments produced an improvement in forced expiratory volume (FEV1) after 90 min in the range 150-250 ml. The was no difference between treatments, mean difference in FEV1 10 ml; 95% CI -220, 230 ml. In one small crossover study (n=10) there was a significant improvement in arterial PaO2 after 30 minutes with ipratropium (+5.8 mm Hg ± 3.0 (SEM)) compared to metaproterenol (-6.2 ± 1.2 mm Hg), but this was not significant at 90 min. There were no data concerning respiratory symptoms. The crossover studies showed no evidence of an additive effect of the two treatments, although they were not designed specifically to test this. An update search conducted in February 2002 yielded one further excluded study.

Authors' conclusions

There are few controlled trial data concerning the use of inhaled beta2-agonist agents in acute exacerbations of COPD and none that have compared these agents directly with placebo. None of the studies used the more modern beta2-agonists used most widely in this setting (salbutamol and terbutaline). Beta2-agonists and ipratropium both produce small improvements in FEV1, but beta2-agonists may worsen PaO2 for a period. We could not draw conclusions concerning possible additive effects.

 

Plain language summary

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

Inhaled short-acting beta2-agonists versus ipratropium for acute exacerbations of chronic obstructive pulmonary disease

During an acute worsening of chronic obstructive pulmonary disease, there may be a worsening in airway function. Two different types of drugs may be given as inhaled therapy to improve this: anticholinergic drugs such as ipratropium and beta2-agonists. These days the drugs of the latter type that are used for acute COPD are salbutamol and terbutaline, but neither of these drugs have been used in the only studies that we could find. We found only three small studies. Overall, both types of drug showed a small but worthwhile effect. There was no difference between them. Our review was not designed to test whether they would have had a greater effect if both were given at the same time.

 

摘要

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

背景

慢性阻塞性肺病急性發作時,比較吸入型短效乙二型作用劑和ipratropium的治療效果

吸入型短效乙二型腎上腺素作用劑和ipratropium bromide兩者都用於治療慢性阻塞性肺病的急性發作。

目標

對慢性阻塞性肺病急性發作的患者:1)比較短效乙二型作用劑和安慰劑的療效;2)比較短效乙二型作用劑和ipratropium的療效。

搜尋策略

以下列字彙:bronchodilator* OR albuterol OR metaproterenol OR terbutaline OR isoetharine OR pirbuterol OR salbutamol OR beta2 agonist,在EMBASE、MEDLINE、CINAHL和Cochrane COPD trials register等資料庫中 進行全面搜尋。

選擇標準

兩位審查員各自選擇所要納入的試驗,並評估所有可能相關的研究。意見不同時則經協議解決。

資料收集與分析

兩位審查員評估所有看起來有相關的試驗,他們各自獨立地找出要選入的試驗。如果有爭議則協議解決。同時搜尋所有納入試驗的參考資料表,以找出更多的研究報告。以Review Manager合併所有試驗,使用固定效應模式。檢測治療效果的大小,看是否存在歧異性。

主要結論

沒有找到與乙二型作用劑有關的安慰劑控制比較研究。三個研究比較ipratropium和吸入型乙二型作用劑,共103位病患。所使用的乙二型作用劑為fenoterol和metaproterenol。其中一個研究是常規治療七天的平行組試驗。另外兩個則是單一劑量治療的交叉研究,測量給藥後90分鐘的療效。兩次治療間沒有廓清期。兩種治療方法都可以改善90分鐘後的第一秒用力吐氣量(FEV1),改善程度在150 – 250毫升之間。但兩種治療間沒有差別,FEV1平均差是10毫升,95%信賴區間220,230毫升。在一個小型交叉研究(n = 10)中,與 metaproterenol (6.2 1.2 mm Hg)相比,使用ipratropium(+5.8 mm Hg 3.0(SEM)) 30分鐘後,動脈血氧分壓(PaO2)明顯改善;但90分鐘時則沒有顯著的差別。沒有關於呼吸道症狀的數據。這些交叉研究無法證實兩種治療的附加效果,儘管這些試驗並非設計來檢測此一項目的。2002年2月的更新搜尋,找到另外一篇被排除的研究。

作者結論

關於慢性阻塞性肺病急性發作時使用吸入型乙二型作用劑的對照試驗數據很少,而且沒有直接比較這些藥物和安慰劑的研究。而且沒有一個研究是使用目前應用廣泛的新型乙二型作用劑(salbutamol和terbutaline)。 乙二型作用劑和ipratropium都可以稍微改善FEV1,但是乙二型作用劑可能會短時間惡化PaO2。因此,關於可能的附加效果,目前無法下定論。

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

沒有證據可以顯示:慢性阻塞性肺病急性發作時,吸入型短效乙二型作用劑是否優於抗膽鹼藥物ipratropium。 在慢性阻塞性肺病急性惡化期間,呼吸道功能可能惡化。有兩種不同類型的藥物吸入治療可以改善此一狀況:抗膽鹼藥物(如ipratropium)和乙二型作用劑。在後面這一類藥物中,近來被用於急性慢性阻塞性肺病的是salbutamol和terbutaline,但在我們找到的研究中都沒有使用這兩種藥物。我們只找到三個小型研究。整體而言,這兩類藥物的效果雖小但仍有其價值。但兩者之間沒有差異。本回顧並非設計來檢測『兩者同時給藥時,是否有更大的效益』。