Small Airways Response to Bronchodilators in Adults with Asthma or COPD: A Systematic Review.
Small Airways Response to Bronchodilators in Adults with Asthma or COPD: A Systematic Review.
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DOI：
10.2147/copd.s331995
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发表时间：
2021
影响因子：
2.8
通讯作者：
Stockley JA
中科院分区：
文献类型：
--
作者：
Almeshari MA;Alobaidi NY;Sapey E;Usmani O;Stockley RA;Stockley JA
支气管扩张剂反应性（BDR）常用于肺部疾病的诊断。虽然小气道功能障碍是哮喘和COPD的一个特征，但小气道的生理学测试不包括在BDR测试指南中。本系统评价评估了使用哮喘和COPD小气道功能进行BDR的现有证据。系统性综述使用标准方法，方案在PROSPERO上前瞻性注册（CRD 42020164140）。使用相关关键词检索电子医学数据库（EMBASE和Medline）。摘要和全文由两名评审员独立筛选。纳入报道生理性小气道功能变化和FEV 1变化的研究。采用修订后的科克伦偏倚风险评价工具进行随机对照试验评价，采用NIH质量评价工具进行队列研究和横断面研究评价。共识别出934篇文章，其中12篇符合纳入标准。10项研究包括哮喘患者，1项研究包括COPD患者，1项研究包括哮喘和COPD。共纳入1104名参与者，其中941名为哮喘患者，64名为COPD患者，109名为健康对照。研究的设计具有异质性，包括BDR评估的器械、剂量和时间间隔。在哮喘和COPD中的大多数测试中观察到小气道BDR，包括呼气容积测定法（R5-20、电抗（X5）、电抗面积（AX）和共振频率（Fres））和最大呼气中段流量。在小气道中存在可测量的BDR。然而，由于对如何评估BDR没有达成共识，研究是异质的。需要进一步的研究来告知如何评估BDR，其临床影响以及在常规临床实践中的位置。
Bronchodilator responsiveness (BDR) is commonly used in the diagnosis of lung disease. Although small airways dysfunction is a feature of asthma and COPD, physiological tests of small airways are not included in guidelines for BDR testing. This systematic review assessed the current evidence of BDR using small airways function in asthma and COPD. The systematic review used standard methodology with the protocol prospectively registered on PROSPERO (CRD42020164140). Electronic medical databases (EMBASE and Medline) were searched using related keywords. Abstracts and full texts were screened independently by two reviewers. Studies that reported the change of physiological small airways function and FEV1 were included in the review. The revised Cochrane risk of bias tool for RCT and NIH quality assessment tool for cohort and cross-sectional studies were used to evaluate the studies. A total of 934 articles were identified, with 12 meeting the inclusion criteria. Ten studies included asthma patients, 1 study included COPD patients and 1 study included both asthma and COPD. A total of 1104 participants were included, of whom 941 were asthmatic, 64 had COPD and 109 were healthy controls. Studies were heterogeneous in design including the device, dose and time intervals for BDR assessment. A small airway BDR was seen for most tests in asthma and COPD, including oscillometry (R5-20, reactance (X5), area of reactance (AX) and resonant frequency (Fres)) and Maximal Mid Expiratory Flow. There is a measurable BDR in the small airways. However, with no consensus on how to assess BDR, studies were heterogeneous. Further research is needed to inform how BDR should be assessed, its clinical impact and place in routine clinical practice.