喘息缓解疗法:一个系统的审查和分析
Daniel G Rayner1, Dario M Ferri2, Gordon H Guyatt1
1Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
JAMA
|October 28, 2024
概括
与单独使用SABA相比,吸入性皮质类固醇 (ICS) 与formoterol或短效β- 激动剂 (SABA) 相结合显著减少喘恶化并改善症状控制. 这些含有ICS的疗法为患者提供更好的喘治疗.
科学领域:
- 肺病学
- 临床药理学
- 基于证据的医学
背景情况:
- 治疗喘的最佳吸入缓解剂策略尚未确定.
- 目前的指导方针提出了各种方法,导致临床实践的不确定性.
- 比较不同的缓解疗法对于优化患者的结果至关重要.
研究的目的:
- 为了比较单独使用短效β激素剂 (SABA) 与与吸入性皮质类固醇 (ICS) 结合使用的SABA的疗效和安全性.
- 为了评估与ICS结合的快速起作用的长效β-激动剂 (formoterol) 作为缓解疗法.
- 确定最好的吸入缓解剂策略来控制喘和预防恶化.
主要方法:
- 在2020年1月至2024年9月期间,对MEDLINE,Embase和CENTRAL数据库进行了系统搜索.
- 包括随机临床试验,比较单独的SABA,ICS与formoterol以及ICS与SABA.
- 使用随机效应元分析和GRADE评估来综合有关喘控制,生活质量和恶化风险的数据.
主要成果:
- 与单独使用SABA相比,两种含有ICS的缓解剂策略 (ICS-formoterol和ICS-SABA) 显著减少了严重的喘恶化 (高确定性).
- 在间接比较中,ICS-formoterol显示出比ICS-SABA更大的恶化减少 (中等确定性).
- 与单独的SABA相比,两种含有ICS的疗法都改善了喘症状控制 (高确定性),但没有增加严重的不良事件.
结论:
- 吸入性皮质类固醇 (ICS) 与formoterol或SABA相结合,在减少喘恶化方面优于单独的SABA.
- 这些含有ICS的缓解疗法显著改善了喘症状的控制.
- 与ICS-SABA相比,ICS-formoterol可能是一个更有效的减轻恶化策略.
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