Long-Acting β-Agonists in Asthma Management What is the Current Status?
Long-Acting β-Agonists in Asthma Management What is the Current Status?
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DOI：
10.2165/11596260-000000000-00000
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发表时间：
2011-01-01
期刊：
影响因子：
11.5
通讯作者：
Ruffin, Richard E.
中科院分区：
文献类型：
--
作者：
Mysore, Satya;Ruffin, Richard E.
在使用不同剂量（从零到常规）吸入性皮质类固醇（ICS）的哮喘患者中进行的长效β受体激动剂（LA BA）与安慰剂相比的大型监测研究或IV期临床研究提出了定期服用LABA的哮喘患者的死亡风险问题。已经有一些荟萃分析和系统性综述检查了LABA在哮喘患者中的风险，一般结论是，与单独使用ICS相比，在ICS基础上添加LA BA可减少哮喘相关的住院治疗，且死亡率无统计学增加。然而，不使用ICS的LABA确实会增加哮喘的死亡风险。所有审查和分析均显示LABA死亡人数较多，但并非所有病例均具有统计学显著性。最近的一项荟萃分析发现，LABA联合ICS治疗哮喘的死亡率高于单独使用ICS。该研究的缺陷在于对照组中ICS的剂量较高，但隐含的信息仍然存在：对足够的ICS控制气道炎症的基本需求。我们建议，务实的解决方案是LABA仅可用于与ICS相同的哮喘治疗器械。我们认为没有必要进行比较LABA + ICS与ICS单药治疗哮喘的安全性的研究。如果进行这样的研究，测量ICS剂量增加的发病率是一个重要的设计考虑因素。此外，不应忘记哮喘管理的关键重点-教育卫生专业人员和社区ICS的关键作用，以及卫生专业人员和哮喘患者之间良好沟通的必要性，以促进良好的哮喘控制。同样的论点也适用于老年患者的哮喘与慢性阻塞性肺疾病重叠综合征。迫切需要向医务人员提供诊断重叠综合征的能力。
Large surveillance studies or phase IV clinical studies of long-acting beta-agonists (LA BA) compared with placebo in asthma patients using variable (from nil to regular) doses of inhaled corticosteroids (ICS) have raised the issue of mortality risk in patients with asthma taking regular LABA. There have been a number of meta-analyses and systematic reviews that have examined the risk of LABA in asthma patients, and the general conclusion is that LA BA added to ICS reduces asthma-related hospitalizations compared with ICS alone and there is no statistical increase in mortality. However, LABA without ICS do increase mortality risk in asthma. All reviews and analyses show a greater number of LABA deaths, but not all are statistically significant. A recent meta-analysis found LABA with concomitant ICS had a higher mortality rate in asthma than ICS alone. The flaw in the study is the higher doses of ICS in the control arms, but the implicit message remains: the essential need for enough ICS to control airway inflammation. We suggest that the pragmatic solution is to have LABA only available in the same device as ICS for asthma treatment. We do not think that a study comparing the safety of LABA plus ICS versus ICS alone in asthma is necessary. If such a study is conducted, the measurement of morbidity from increased doses of ICS is an essential design consideration. Furthermore, the critical focus in asthma management should not be forgotten - education of health professionals and the community of the critical role of ICS, and the need for good communication between health professionals and the asthma patient to facilitate good asthma control. The same arguments apply to the asthma-with-chronic obstructive pulmonary disease overlap syndrome in older patients. There is an urgent need to provide medical practitioners with the capability to diagnose the overlap syndrome.