Intervention Review

Anticholinergic bronchodilators versus beta2-sympathomimetic agents for acute exacerbations of chronic obstructive pulmonary disease

  1. Douglas C McCrory1,*,
  2. Cynthia D Brown2

Editorial Group: Cochrane Airways Group

Published Online: 20 JAN 2003

Assessed as up-to-date: 3 OCT 2005

DOI: 10.1002/14651858.CD003900


How to Cite

McCrory DC, Brown CD. Anticholinergic bronchodilators versus beta2-sympathomimetic agents for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD003900. DOI: 10.1002/14651858.CD003900.

Author Information

  1. 1

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

  2. 2

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

*Douglas C McCrory, Center for Clinical Health Policy Research, Duke University, 2200 W. Main Street, Suite 220, Durham, NC, 27705, USA. mccro002@mc.duke.edu.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 JAN 2003

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Abstract

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

Background

Inhaled bronchodilators form the mainstay of treatment for acute exacerbations of COPD. Two types of agent are used routinely, either singly or in combination: anticholinergic agents and beta2-sympathomimetic agonists.

Objectives

To assess the effect of anti-cholinergic agents on lung function and dyspnea in patients with acute exacerbations of COPD, compared with placebo or short-acting beta-2 agonists.

Search methods

We searched the Cochrane Airways Group Specialised Register using pre-specified terms. We also searched references listed in each included trial for additional trial reports. Searches were current as of October 2005 and will be updated annually.

Selection criteria

We included studies if the participants were adult patients with a known diagnosis of COPD and had symptoms consistent with criteria for acute exacerbation of COPD. All randomized controlled trials that compared inhaled ipratropium bromide or oxitropium bromide to appropriate controls were considered. Appropriate control treatments included placebo, other bronchodilating agents, or combination therapies. Studies of acute asthma or ventilated patients were excluded.

Data collection and analysis

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

Main results

Four trials compared the short-term effects of ipratropium bromide versus a beta2-agonist. Short-term changes in FEV1 (up to 90 minutes) showed no significant difference between beta2-agonist and ipratropium bromide treated patients. The differences were similar among the studies and when combined: Weighted Mean Difference (WMD) 0.0 liters (95% Confidence Interval (95% CI) -0.19 to 0.19). There was no significant additional increase in change in FEV1 on adding ipratropium to beta2-agonist: WMD 0.02 liter (95% CI -0.08 to 0.12). Long-term effects (24 hours) of the ipratropium bromide and beta2-agonist treatment combination were similar: WMD 0.05 liters (95% CI -0.14 to 0.05).

Neither of two studies found significant changes in PaO2, either short- or long-term, with ipratropium versus beta-agonist, although one showed an increase in PaO2 in subjects receiving ipratropium bromide at 60 minutes. Adverse drug reactions included dry mouth and tremor.

Authors' conclusions

There was no evidence that the degree of bronchodilation achieved with ipratropium bromide was greater than that using a short-acting beta2-agonist. The combination of a beta2-agonist and ipratropium did not appear to increase the effect on FEV1 more than either used alone.

 

Plain language summary

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

Anticholinergic bronchodilators versus beta2-sympathomimetic agents for acute exacerbations of chronic obstructive pulmonary disease

Shortness of breath is the main complaint of persons with chronic obstructive pulmonary disease (COPD). This symptom worsens during an exacerbation or 'flare' of COPD. Trials comparing ipratropium bromide versus beta-agonists showed no significant difference in short-term or long-term effects (24 hours) on ease of breathing. Side effects of these drugs were reported by only a minority of patients and include dry mouth and tremor, and a 'strange feeling' after drug administration.

 

摘要

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

背景

抗膽鹼支氣管擴張劑相較於2擬交感神經藥物用來治療慢性阻塞肺病急性發作

吸入式支氣管擴張劑是COPD急性惡化的主流療法,常規使用兩類型的藥物,抗膽鹼藥物及2擬交感神經藥物。

目標

評估抗膽鹼藥物相較於安慰劑或短效2促效劑在治療COPD急性惡化病患肺功能及呼吸困難的效應。

搜尋策略

我們使用具特異性的名詞搜尋Cochrane Airways Group Specialised Register。我們亦搜尋納入試驗之參考文獻以取得額外的試驗報告。目前搜尋至2005年10月並將每年更新。

選擇標準

我們納入的研究其參與者為已知患有COPD且症狀符合COPD急性惡化標準的成年患者。所有隨機控制試驗比較吸入式ipratropium bromide或oxitropium bromide與合適的對照均考慮納入。合適的對照治療包括安慰劑、其他支氣管擴張劑、或合併治療。急性氣喘或使用呼吸器患者之研究則予排除。

資料收集與分析

兩位審查者意見不同者以建立共識來解決,評估所有看來相關的試驗,並獨立地選擇納入的試驗。

主要結論

有四項研究比較ipratropium與2促效劑的短期效應。接受2促效劑及ipratropium的患者其FEV1之短暫改變(至90分鐘)並未呈現有意義的差別。在各研究之間以及將其合併之差異均相近:權重平均差(WMD)0.0公升(95%信賴區間[95%CI]−0.19至0.19)。將ipratropium加上2促效劑在FEV1的變化上並未具有意義的增加:WMD 0.02公升(95% CI −0.08至0.12)。合併ipratropium bromide及2促效劑治療之長期效應(24小時)乃相近:WMD 0.05公升(95% CI 0.14至0.05)。以ipratropium對促效劑作比較的兩項研究中並無一項在PaO2發現具有意義的變化,雖然有一次接受ipratropium bromide的受試者在60分鐘時曾呈現PaO2增加。藥物不良反應包括口乾及震顫。

作者結論

沒有證據顯示接受ipratropium bromide所產生支氣管擴張的程度大於接受2促效劑者。合併使用2促效劑及ipratropium較之其中一者並未呈現增加FEV1的效應。

翻譯人

本摘要由中國醫藥大學附設醫院陳祖裕翻譯。

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

總結

對慢性阻塞性肺病發生呼吸阻塞的患者,ipratropium bromide提供與2促效劑相近的緩解功效。呼吸短促是慢性阻塞性肺病(COPD)的主要抱怨,此症狀在COPD發作或惡化時變得更差。比較ipratropium bromide與促效劑之試驗並未在短期或長期呼吸順暢(24小時)的效應上呈現有意義的差別。只有少數病人報告用了這些藥會有副作用,包括口乾及震顫,以及在服藥後有一種奇怪的感覺。