Inhaled bronchodilators for acute chest syndrome in people with sickle cell disease

 

Abstract

Background

Bronchodilators are used to treat bronchial hyper-responsiveness in asthma. Bronchial hyper-responsiveness may be a component of acute chest syndrome in people with sickle cell disease. Therefore, bronchodilators may be useful in the treatment of acute chest syndrome.

Objectives

To assess the benefits and risks associated with the use of bronchodilators in people with acute chest syndrome.

Search methods

We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches, handsearches of relevant journals and abstract books of conference proceedings. Additional searches were carried out on MEDLINE (1966 to 2002) and EMBASE (1981 to 2002).

Date of the most recent search of the Group's Haemoglobinopathies Trials Register: 09 April 2010.

Selection criteria

Randomised or quasi-randomised controlled trials. Trials using quasi-randomisation methods will be included in future updates of this review if there is sufficient evidence that the treatment and control groups are similar at baseline.

Data collection and analysis

We found no trials investigating the use of bronchodilators for acute chest syndrome in people with sickle cell disease.

Main results

We found no trials investigating the use of bronchodilators for acute chest syndrome in people with sickle cell disease.

Authors' conclusions

If bronchial hyper-responsiveness is an important component of some episodes of acute chest syndrome in people with sickle cell disease, the use of inhaled bronchodilators may be indicated. There is need for a well-designed, adequately-powered randomised controlled trial to assess the benefits and risks of the addition of inhaled bronchodilators to established therapies for acute chest syndrome in people with sickle cell disease.

 

Plain language summary

Inhaled drugs for opening up the airways in cases of acute chest syndrome in people with sickle cell disease

Sickle cell disease is an inherited blood disorder. People with sickle cell disease often suffer from acute chest syndrome, although it is not known why. Acute chest syndrome can cause fever, coughing, chest pain and shortness of breath and can be life-threatening. Often, people with sickle cell disease and acute chest syndrome also wheeze. This suggests that airways are narrowed, as with asthma. Bronchodilators are drugs which relax the muscles in the airways, thus opening them up to make breathing easier. They are used in this way for asthma, so may be of similar use in acute chest syndrome. However, we found no trials to show the effects of these drugs for this condition. Research needs to assess the benefits and risks of using inhaled bronchodilators for acute chest syndrome in people with sickle cell disease.

 

摘要

背景

吸入性支氣管擴張劑(inhaled bronchodilators)用於鐮刀型貧血症患者(sickle cell disease)的急性胸痛徵候群(acute chest syndrome)

支氣管擴張劑適用於治療哮喘之支氣管過敏反應(bronchial hyperresponsiveness)。支氣管過敏反應可能是鐮刀型貧血症患者發生急性胸痛徵候群的因素之一。因此，支氣管擴張劑可能有助於治療急性胸痛徵候群。

目標

評估急性胸痛徵候群發作者使用支氣管擴張劑的利益和風險。

搜尋策略

我們檢索了Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register，其主要是由廣泛搜尋電子資料庫所找到的參考書目，以及手動搜尋相關期刊及會議摘要冊所組成。額外的搜查是在MEDLINE(1966年至2002年)和EMBASE(1981年至2002年)進行。最近搜尋Group's Haemoglobinopathies Trials Register的時間：2006年10月。

選擇標準

隨機或半隨機對照試驗(randomised or quasirandomised controlled trials)。若有足夠的證據表示治療組和對照組的基線(baseline)是相似的，本回顧未來的更新將包括採使用半隨機方法(quasirandomisation methods) 的試驗。

資料收集與分析

我們沒有找到有關支氣管擴張劑用於鐮刀型貧血症患者之急性胸痛徵候群的試驗。

主要結論

我們沒有找到有關支氣管擴張劑用於鐮刀型貧血症患者之急性胸痛徵候群的試驗。

作者結論

如果支氣管過敏反應是鐮刀型貧血症患者急性胸痛徵候群發作的重要因素之一，就可能適合使用吸入性支氣管擴張劑。這需要一個設計良好，檢力足夠的隨機對照試驗以評估把吸入性支氣管擴張劑列入鐮刀型貧血症患者之急性胸痛徵候群的常規療法其利益和風險。

翻譯人

本摘要由臺灣大學附設醫院何天民翻譯。

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

總結

我們尚需證據以確認支氣管擴張劑(哮喘用藥)對鐮刀型貧血症患者之急性胸痛徵候群(ACS)是否有幫助。鐮刀型貧血症是一種遺傳性血液疾病。鐮刀型貧血症患者因不明原因常好發急性胸痛徵候群。急性胸痛徵候群可引起發燒、咳嗽、胸痛、呼吸急促、和疼痛，甚至危及生命。急性胸痛徵候群的鐮刀型貧血症患者常伴有哮鳴(wheeze)的症狀，意味著呼吸道(氣管)的縮小，與哮喘類似。支氣管擴張劑(症狀緩解吸入器reliever inhalers)使呼吸道的肌肉放鬆，讓其放寬而使呼吸更容易。支氣管擴張劑常用於哮喘，但是我們沒有找到有關鐮刀型貧血症患者之急性胸痛徵候群使用支氣管擴張劑之效果的試驗。