Corticosteroid plus β(2)-agonist in a single inhaler as reliever therapy in intermittent and mild asthma: a proof-of-concept systematic review and meta-analysis.
Corticosteroid plus β(2)-agonist in a single inhaler as reliever therapy in intermittent and mild asthma: a proof-of-concept systematic review and meta-analysis.
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皮质类固醇加 β2 激动剂在单一吸入器中作为间歇性和轻度哮喘的缓解疗法：系统评价和荟萃分析
DOI：
10.1186/s12931-017-0687-6
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发表时间：
2017-12-06
影响因子：
5.8
通讯作者：
Wang G
中科院分区：
文献类型：
--
作者：
Wang G;Zhang X;Zhang HP;Wang L;Kang Y;Barnes PJ;Wang G
目前的指南建议对中度至重度哮喘采用单一吸入剂维持和缓解治疗（SMART）方案。然而，缺乏吸入性皮质类固醇加速效β2-受体激动剂（ICS/FABA）作为间歇性和轻度哮喘患者缓解治疗的证据。系统地探索ICS + FABA方案在单一吸入器中作为间歇性和轻度持续性哮喘儿童和成人缓解治疗的概念验证的有效性和安全性。我们检索了在线文献数据库中关于间歇性或轻度哮喘患者按需使用ICS/FABA单药治疗的随机对照试验（RCT）。主要结局为急性加重和至首次急性加重时间的风险比（HR）。6项RCT（n = 1300）符合纳入标准。与按需FABA方案相比，按需使用ICS/FABA作为单药治疗在统计学上减少了急性加重（RR = 0.56，P = 0.001）。与常规ICS方案相比，按需ICS/FABA治疗的急性加重风险略高（RR = 1.39，P = 0.011）。ICS/FABA方案至首次急性加重时间的HR显著低于FABA方案（HR = 0.52，P = 0.002），但与ICS方案无差异（HR = 1.30，P = 0.286）。每日ICS方案的皮质类固醇暴露量是按需使用ICS/FABA方案的2- 5倍。我们的分析表明，ICS/FABA作为一种药物驱动的治疗方案可能是间歇性或轻度哮喘患者的一种有前途的替代方案，但需要进一步的真实世界RCT来证实这些发现。本文的在线版本（10.1186/s12931-017-0687-6）包含补充材料，可供授权用户使用。
Current guidelines recommend a single inhaler maintenance and reliever therapy (SMART) regimen for moderate to severe asthma. However, evidence for the inhaled corticosteroid plus fast-onset-acting β2-agonist (ICS/FABA) as reliever therapy in management of intermittent and mild asthma patients is lacking. To systematically explore efficacy and safety of the proof-of-concept of the ICS plus FABA regimen in a single inhaler as reliever therapy across children and adults with intermittent and mild persistent asthma. We searched online bibliographic databases for randomized controlled trials (RCTs) involving the as-needed use of ICS/FABA as monotherapy in intermittent or mild asthma patients. The primary outcomes were exacerbations and the hazard ratio (HR) of the time to first exacerbation. Six RCTs (n = 1300) met the inclusion criteria. Compared with the as-needed FABA regimen, the as-needed use of ICS/FABA as monotherapy statistically reduced exacerbations (RR = 0.56, P = 0.001). Compared with regular ICS regimen, the as-needed ICS/FABA therapy had slightly higher risk of exacerbations (RR = 1.39, P = 0.011). The HR for time to first exacerbations in the ICS/FABA regimen was significant lower when compared with FABA regimen (HR = 0.52, P = 0.002) but had no difference when compared with ICS regimen (HR = 1.30, P = 0.286). The corticosteroid exposure in the daily ICS regimen was 2- to 5-fold compared with as-needed use of ICS/FABA regimen. Our analysis shows that the ICS/FABA as a symptom-driven therapy may be a promising alternative regimen for the patients with intermittent or mild asthma, but it needs further real-world RCTs to confirm these findings. The online version of this article (10.1186/s12931-017-0687-6) contains supplementary material, which is available to authorized users.
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影响因子：
3.8
作者：
Ding B;Small M
通讯作者：
Small M
DOI：
10.1164/rccm.201107-1317pp
发表时间：
2012-02-15
影响因子：
24.7
作者：
Jarjour, Nizar N.;Erzurum, Serpil C.;Busse, William W.
通讯作者：
Busse, William W.
影响因子：
24.3
作者：
Chung, Kian Fan;Wenzel, Sally E.;Teague, W. Gerald
通讯作者：
Teague, W. Gerald
影响因子：
2.2
作者：
DerSimonian R;Laird N
通讯作者：
Laird N
影响因子：
14.2
作者：
BIRKHEAD, G;ATTAWAY, NJ;TEUTSCH, S
通讯作者：
TEUTSCH, S