从预定的吸入性皮质类固醇 (ICS) 加上随需要的快速起作用的β-抗原剂 (FABA) 下降到随需要的ICS/FABA:系统性审查和元分析
Ricardo J Estrada-Mendizabal1, John B Hagan1, Alex Wonnaparhown1
1Mayo Clinic, Scottsdale, Ariz.
概括
根据需要降低吸入性皮质类固醇/快速起作用的β-激动剂 (ICS/FABA) 治疗稳定的喘,可以保持喘控制和生活质量,同时减少ICS暴露. 这种方法可与标准护理相比,有计划的ICS加按需要的FABA.
科学领域:
- 肺部病理学 肺部病理学
- 临床医学 临床医学
- 药理学 药理学是指药理学的学科.
背景情况:
- 标准的喘治疗包括计划的吸入性皮质类固醇 (ICS) 和根据需要的快速起作用的β-激动剂 (FABA).
- 通过逐步减少治疗来降低ICS剂量的比较疗效和安全性仍在研究中.
研究的目的:
- 在稳定的喘患者中,评估从预定的ICS加按需要的FABA降低到按需要的ICS/FABA的有效性和安全性.
- 为了比较包括恶化,喘控制,生活质量,肺功能和不良事件在内的结果.
主要方法:
- 在主要数据库 (MEDLINE,EMBASE,Cochrane Central,WHO ICTRP) 进行随机对照试验 (RCT) 的系统文献搜索.
- 使用随机效应模型进行元分析,以综合关键喘结果的数据.
- 使用推,评估,开发和评估 (GRADE) 方法评估证据的确定性.
主要成果:
- 包括7个涉及2485名患者的RCT.
- 两组之间在严重恶化,喘生活质量,肺功能或严重不良事件方面没有发现显著差异.
- 控制喘稍微有利于预定ICS,但效果微不足道;在按需ICS组中,累计ICS剂量显著较低.
结论:
- 与标准护理相比,在稳定的喘中降低到必要的ICS/FABA对于喘控制和生活质量是不劣的.
- 这一策略导致累积吸入性皮质类固醇暴露的减少.
- 对这些结果的证据被评为具有中等确定性.
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