Regular treatment with long acting beta agonists versus daily regular treatment with short acting beta agonists in adults and children with stable asthma

 

Abstract

Background

Selective beta-adrenergic agonists for use in asthma are: short acting (2 to 6 hours) and long acting (> 12 hours). There has been little controversy about using short acting beta-agonists intermittently, but long acting beta-agonists are used regularly, and their regular use has been controversial.

Objectives

To determine the benefit or detriment of treatment with regular short- or long acting inhaled beta-agonists in chronic asthma.

Search methods

We carried out a search using the Cochrane Airways Group trial register. We searched bibliographies of identified RCTs for additional relevant RCTs and contacted authors of identified RCTs for other published and unpublished studies.

Selection criteria

All randomised studies of at least two weeks duration, comparing a long acting inhaled beta-agonist given twice daily with any short acting inhaled beta-agonist of equivalent bronchodilator effectiveness given regularly in chronic asthma.

Data collection and analysis

Two reviewers performed data extraction and study quality assessment independently. We contacted authors of studies for missing data.

Main results

Thirty one studies met the inclusion criteria, 24 of parallel group and seven cross over design. Salmeterol xinafoate was used as long acting agent in 22 studies and formoterol fumarate in nine.

Salbutamol was the short acting agent used in 27 studies and terbutaline in five. The treatment period was over two weeks in 29 studies, and at least 12 weeks in 20.

25 studies permitted a variety of co-intervention treatments, usually inhaled corticosteroid or cromones. One study did not permit inhaled corticosteroid.

Long acting beta-agonists were significantly better than short acting for a variety of lung function measurements including morning highest forced expiratory flow measured with a peak flow meter (PEF) (Weighted Mean Difference (WMD) 33 L/min 95% CI 25 to 42) or evening PEF (WMD 26 L/min 95% CI 18 to 33); and had significantly lower scores for day and night time asthma symptom scores and percentage of days and nights without symptoms. They were also associated with a significantly lower use of rescue medication both during the day and night. Risk of exacerbations was not different between the two types of agent, but most studies were of short duration which limits the power to test for such differences.

Authors' conclusions

Long acting inhaled beta-agonists have advantages across a wide range of physiological and clinical outcomes for regular treatment.

 

Plain language summary

Regular treatment with long acting beta agonists versus daily regular treatment with short acting beta agonists in adults and children with stable asthma

Patients with chronic asthma are generally treated with a 'preventer medication' to reduce the underlying airways inflammation but often require bronchodilators for their symptoms. Treatment with regular long acting Beta-agonist bronchodilator agents, such as salmeterol (Serevent) or formoterol (Foradil, Oxis), leads to fewer asthma symptoms during the day and the night, less bronchodilator medication requirement for symptoms, better lung function measurements and better quality of life measurements compared to short acting Beta-agonist bronchodilators such as salbutamol (Ventolin, Asmol, Airomir) or terbutaline (Bricanyl). There were no major adverse effects but there is little information on the effects in patients who do not use a 'preventer medication'.

 

摘要

背景

成人及兒童的穩定性氣喘以長效beta促效劑規律性治療相較於短效促效劑每日規律性治療

用於氣喘的選擇性促效劑包括短效(2至6小時)及長效(＞12小時)兩類。有關間歇性用短效促效劑並無太大爭議，但規律地使用長效beta促效劑或常規地使用仍有爭議。

目標

確認規律使用短效或長效吸入式beta促效劑治療慢性氣喘的效益或傷害。

搜尋策略

我們使用Cochrane Airways Group trials register進行搜尋。我們從找到的RCTs之文獻再搜尋額外的相關RCTs，並聯絡該等RCTs的作者以找到其他已刊載或未刊載的研究。

選擇標準

所有療程至少兩週比較長效吸入式beta促效劑每日二次與任何相等支氣管擴張效能短效吸入式beta促效劑規律地治療慢性氣喘的隨機研究若為隨機雙盲的研究則會被納入。研究可比較任何吸入式皮質類固醇及長效配方及安慰劑。

資料收集與分析

兩位審查者獨立地進行數據摘取及研究品質評估。我們與作者聯繫以取得失去的資料。

主要結論

有31項研究符合納入標準，24項為平行組而七項為交叉設計。有22項使用salmeterol xinafoate為長效藥劑而九項用formoterol fumarate。有27項研究使用salbutamol為短效藥物而另五項則是使用terbutaline。在29項研究的治療期超過兩星期，20項至少治療12週。有25項研究容許一種不同的伴隨治療，通常是吸入式皮質類固醇或cromones。有一項研究則不容許使用吸入式皮質類固醇。在一些肺功能測量中顯示長效beta促效劑顯著地優於短效者，包括使用頂?流量計測量的清晨最高用力呼氣流量(PEF)(權重平均差[WMD]33 L/min，95% CI 25至42)或夜間PEF(WMD 26 L/min，95% CI 18至33)；日間及夜間氣喘症狀評分顯著較低的分數，以及無症狀白天或夜晚數目的百分比等。此外，無論日或夜，亦使用顯著較少的救援藥物。惡化的風險在兩類型的藥物間都沒有差異，但大多數研究的研究期間較短而限制測量此項差異的效力。

作者結論

長效吸入式beta促效劑用作常規治療可在廣泛的生理學及臨床結果上顯露其優點。

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

慢性氣喘病人以常規使用長效beta促效劑支氣管擴張藥物作為常規預防性藥物對氣喘的控制較優於常規使用短效促效劑支氣管擴張藥物。慢性氣喘患者通常會接受預防性藥物來減緩潛在的氣道發炎，但常需使用支氣管擴張劑來緩解症狀。規律使用長效beta促效劑如salmeterol(Serevent)或formoterol(Foradile，Oxis)作治療，在與短效促效劑支氣管擴張藥物如salbutamol(Ventolin，Asmol，Airomir)或terbutaline(Bricanyl)相比較時，可使日間與夜間的氣喘症狀較少出現，因症狀發生使用的支氣管擴張藥物的需求減少，較佳的肺功能測量結果及較佳的生活品質測量結果。並無重大的不良效益，但對不使用預防性藥物的病人則資料不多。