Intervention Review

Inhaled bronchodilators for cystic fibrosis

  1. Clare Halfhide1,*,
  2. Hazel J Evans2,
  3. Jon Couriel1

Editorial Group: Cochrane Cystic Fibrosis and Genetic Disorders Group

Published Online: 19 OCT 2005

Assessed as up-to-date: 4 APR 2011

DOI: 10.1002/14651858.CD003428.pub2


How to Cite

Halfhide C, Evans HJ, Couriel J. Inhaled bronchodilators for cystic fibrosis. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD003428. DOI: 10.1002/14651858.CD003428.pub2.

Author Information

  1. 1

    Alder Hey Children's NHS Foundation Trust, Respiratory Unit, Liverpool, Merseyside, UK

  2. 2

    Southampton University Hospitals Trust, Department of Respiratory Paediatrics, Southampton, UK

*Clare Halfhide, Respiratory Unit, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, Merseyside, L12 2AP, UK. halfhide@liverpool.ac.uk. chalfhide@hotmail.com.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 19 OCT 2005

SEARCH

 

Abstract

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

Background

Recurrent wheeze and breathlessness are common in people with cystic fibrosis, and bronchodilators are commonly prescribed. Despite their wide-scale and often long-term use, there is limited objective evidence about their efficacy in cystic fibrosis (CF).

Objectives

To evaluate the effectiveness of inhaled bronchodilators in people with CF.

Search methods

We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic databases searches, and handsearches of relevant journals and abstract books of conference proceedings.

Latest search of the Group's Trials Register: 09 September 2010.

Selection criteria

Randomised or quasi-randomised trials comparing inhaled bronchodilators to placebo or another inhaled bronchodilator in people with CF, diagnosed clinically and by sweat or genetic testing and at all stages and severity of lung disease.

Data collection and analysis

The authors independently extracted data and assessed trial quality. A trial's primary author was contacted for any missing data where possible. Data were grouped into classes of bronchodilator and, for each class, into short-term effects (less than one week) and long-term effects (greater to or equal to one week).

Main results

The search identified 66 references; eighteen trials (total of 369 participants) were suitable for inclusion. All but two of the trials were cross-over in design; a meta-analysis was not possible. There were varied conclusions from the different trials reflecting their heterogeneity. Compared to placebo, short-acting beta-2 agonists increased forced expiratory volume at one second (FEV1) in the short term in three out of five trials, and in the long-term increased peak expiratory flow rate in individuals who had been shown to have bronchial hyperreactivity, bronchodilator responsiveness or both. Compared to placebo, long-acting beta-2 agonists increased FEV1 and forced expiratory flow between 25% and 75% of expiratory flow in the short term in participants known to have bronchodilator responsiveness, but produced inconsistent results in long-term trials. Short acting-anticholinergics had no consistent effect on lung function tests in either the short or the long term. We found no published trials of fenoterol, formoterol or tiotropium.

Authors' conclusions

It was not possible to determine fully the effectiveness of inhaled bronchodilators in CF as a meta-analysis was not possible. However, short and long-acting beta-2 agonists can be beneficial both in the short and long term in individuals with demonstrable bronchodilator responsiveness or bronchial hyper-responsiveness. As we found no evidence, the use of fenoterol, formoterol or tiotropium in CF cannot be supported.

 

Plain language summary

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

Inhaled drugs to open up the airways of people with cystic fibrosis

People with cystic fibrosis are often given drugs to open up their airways when they are breathless or wheezy. The drugs are given either by metered dose inhalers or nebulisers. We looked at how well these drugs worked in both children and adults. We included 18 trials in the review. Some of these used beta-2 agonist bronchodilators and some used anticholinergic bronchodilators. Data for both long-acting and short-acting versions of both drug classes were collected. The results were split into short-term effects (less than one week) and long-term effects (one week or longer). The studies were too varied to allow results to be combined. Both short-acting and long-acting beta-2 agonists improved lung function in the short-term, but only in those people whose airways were found to be sensitive to the bronchodilator after their first dose. Results were not consistent in the long-term. It is reasonable to suggest that a long-term trial of inhaled bronchodilators be considered before their long-term use is recommended. Further large trials are needed to make clear the benefits of these drugs.

 

摘要

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

背景

吸入性支氣管擴張劑用於囊狀纖維化患者之研究

哮喘與呼吸急促復發是囊狀纖維化(cystic fibrosis)患者常見的表徵,因此常會使用支氣管擴張劑來治療。儘管它們被廣泛、長期的使用,然而有關它們對囊狀纖維化患者的效用之客觀證據卻很有限。

目標

為了評估吸入性支氣管擴張劑對囊狀纖維化小孩或成人患者的效益。

搜尋策略

我們搜尋了the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register ,其中包含了綜合性電子資料庫的參考文獻,並且人工搜尋相關期刊以及研討會大會手冊等參考資料。最近的一次搜尋是在2009年10月9日。

選擇標準

對於那些臨床上藉由汗水或基因檢驗而確診之任何肺疾階段、嚴重度的CF患者,比較以吸入性支氣管擴張劑與安慰劑或其他種類的吸入性支氣管擴張劑治療的結果之隨機或半隨機對照試驗。

資料收集與分析

作者獨立的萃取資料並評估試驗的品質。如果有資料遺失,則會儘可能連絡原作者。這些資料以支氣管擴張劑為分類層級,而各級又再分以短效(小於一週)及長效(大於或等於一週)兩種。

主要結論

總共有61篇文獻被瀏覽。其中18項試驗、總共369位受試者符合納入條件。除了2個試驗以外,其他這些試驗的設計都是交叉試驗,因此無法進行統合分析。不同的試驗結果也互有差異,顯示其異質性。5項中有3項試驗顯示,與安慰劑相較之下,短效β2致效劑(β2 agonist)短期內可以增加第一秒內最大吐氣量(FEV1),長期下來對於那些被證實有支氣管過敏或對支氣管擴張劑有反應的患者而言,可以增加他們的尖峰呼氣流速(PEFR)。另一方面,與安慰劑相較之下,用長效β2致效劑治療已知對支氣管擴張劑有反應的受試者,在短期試驗中可以增加FEV1及最大中間呼氣流速(FEF 25−75%),然而此部份的結果在長期試驗中卻出現不一致的結果。不論在長期或是短期的試驗中,短效抗膽鹼劑(anticholinergics)對於肺功能測驗的影響並無一致的結論。我們並未發現有有關fenoterol、formoterol或tiotropium的試驗,因此並無證據支持這些藥物用於囊狀纖維化患者的效用。

作者結論

要完整的評估吸入性支氣管擴張劑對於囊狀纖維化患者之療效因為不可能進行統合分析,因此是不可能的。然而,無論是短效或長效的β2致效劑在短期及長期結果來說,都可能對已知有支氣管過敏或對支氣管擴張劑有反應的人是有效的。因為我們並未發現證據,因此並不支持使用fenoterol、formoterol或tiotropium於囊狀纖維化患者。

翻譯人

本摘要由臺灣大學附設醫院林珮璇翻譯。

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

總結

有關吸入性支氣管擴張劑能改善囊狀纖維化患者的肺功能之證據有限。我們回顧了過去有關吸入性支氣管擴張劑(經由計量的吸入器或噴霧器)治療囊狀纖維化小孩及成人患者的療效之研究。我們蒐集了18個試驗的資料,討論有關短效β2致效劑(salbutamol、albuterol、terbutaline及fenoterol)、長效β2致效劑(salmeterol及formoterol)、短效抗膽鹼劑(ipratropium)或是長效抗膽鹼劑(tiotropium)對於肺功能試驗的影響。這些試驗依其效用長短,又被分為短效(小於1週)及長效(大於或等於1週)2種。由於研究太多種,因此無法合併數據。無論是短效以及長效β2致效劑短期皆具改善肺功能的效益,但是只有在第一次劑量後氣管對於支氣管擴張劑有反應的病人身上有效。而且結果並無法長久持續。 這可以合理支持在建議長期使用之前,應該考慮進行長期使用吸入性支氣管擴張劑試驗。未來應該要有大型的試驗以釐清這些藥物的效益。