哮喘患者过度使用短效β₂受体激动剂的不良结局：一项系统评价与荟萃分析
2025/08/01
摘要
背景：2019年全球哮喘防治倡议（GINA）指南不再推荐短效β₂受体激动剂（SABA）单药治疗哮喘，因其缺乏抗炎作用且可能引发相关并发症。本系统评价与荟萃分析旨在评估哮喘患者过度使用SABA（定义为≥3罐/年）与不良结局的关联。
方法： 系统检索PubMed、Cochrane Library、EMBASE及Web of Science数据库（1981年至2023年11月），纳入探讨哮喘患者SABA过度使用（≥3罐/年）的随机对照试验（RCT）、队列研究及横断面研究。采用随机效应模型和Mantel-Haenszel加权法计算全因死亡率与急性发作的合并风险比（RR）。根据研究设计进行亚组分析。
结果: 共纳入27项研究（2项RCT、1项前瞻性队列研究、12项回顾性队列研究及12项横断面研究）。SABA过度使用组（130,629例患者中2,743例）的全因死亡率显著高于对照组（300,451例患者中3,534例；RR=2.04，95%置信区间[CI] 1.37-3.04；p<0.001），急性发作率亦显著升高（过度使用组165,271例中60,320例 vs. 对照组376,845例中84,439例；RR=1.93，95% CI 1.24-3.03；p<0.001）。回顾性队列研究（RR=1.88，95% CI 1.43-2.47；p<0.001）和横断面研究（RR=2.23，95% CI 1.04-4.77；p<0.001）均显示急性发作风险增加。
结论：SABA过度使用与哮喘患者死亡率及急性发作率升高显著相关，这一结果支持现行指南反对SABA单药治疗哮喘的推荐。
Chia-Ling, Tsao; Shu-Yen,
Abstrast
Introduction: The 2019 Global Initiative for Asthma (GINA) report no longer recommended short-acting beta-agonists (SABA) monotherapy due to associated complications and a lack of anti-inflammatory properties. This systematic review and meta-analysis aimed to evaluate adverse outcomes associated with SABA overuse in patients with asthma.
Methods: PubMed, Cochrane Library, EMBASE, and Web of Science databases were searched for studies on SABA overuse (≥ 3 SABA canisters/year) in patients with asthma, from 1981 to November 2023. Randomized controlled trials (RCTs), cohort studies, and cross-sectional studies were included. Pooled risk ratios (RRs) were calculated for dichotomous measures of all-cause mortality and acute exacerbations using random-effects models and Mantel-Haenszel weighting. Subgroup analyses were conducted based on study design.
Results: Out of 626 records, 27 studies (2 RCTs, 1 prospective cohort study, 12 retrospective cohort studies, and 12 cross-sectional studies) were included. SABA overuse (≥ 3 SABA canisters/year) was associated with significantly higher mortality (2743 of 130,629 in the overuse group versus 3534 of 300,451 in controls; RR = 2.04, 95% confidence interval, CI = 1.37-3.04; p < 0.001) and a significantly higher rate of acute exacerbations (60,320 of 165,271 in the overuse group versus 84,439 of 376,845 in controls; RR = 1.93, 95% CI = 1.24-3.03; p < 0.001). An increased risk of acute exacerbations was observed in retrospective cohort studies (RR = 1.88, 95% CI = 1.43-2.47; p < 0.001) and cross-sectional studies (RR = 2.23, 95% CI = 1.04-4.77; p < 0.001).
Conclusion: SABA overuse was associated with increased rates of mortality and acute exacerbations in patients with asthma, supporting guidelines that advise against SABA monotherapy in asthma management.t.
背景：2019年全球哮喘防治倡议（GINA）指南不再推荐短效β₂受体激动剂（SABA）单药治疗哮喘，因其缺乏抗炎作用且可能引发相关并发症。本系统评价与荟萃分析旨在评估哮喘患者过度使用SABA（定义为≥3罐/年）与不良结局的关联。
方法： 系统检索PubMed、Cochrane Library、EMBASE及Web of Science数据库（1981年至2023年11月），纳入探讨哮喘患者SABA过度使用（≥3罐/年）的随机对照试验（RCT）、队列研究及横断面研究。采用随机效应模型和Mantel-Haenszel加权法计算全因死亡率与急性发作的合并风险比（RR）。根据研究设计进行亚组分析。
结果: 共纳入27项研究（2项RCT、1项前瞻性队列研究、12项回顾性队列研究及12项横断面研究）。SABA过度使用组（130,629例患者中2,743例）的全因死亡率显著高于对照组（300,451例患者中3,534例；RR=2.04，95%置信区间[CI] 1.37-3.04；p<0.001），急性发作率亦显著升高（过度使用组165,271例中60,320例 vs. 对照组376,845例中84,439例；RR=1.93，95% CI 1.24-3.03；p<0.001）。回顾性队列研究（RR=1.88，95% CI 1.43-2.47；p<0.001）和横断面研究（RR=2.23，95% CI 1.04-4.77；p<0.001）均显示急性发作风险增加。
结论：SABA过度使用与哮喘患者死亡率及急性发作率升高显著相关，这一结果支持现行指南反对SABA单药治疗哮喘的推荐。
(中日友好医院呼吸与危重症医学科 万静萱 摘译 林江涛 审校)
（Allergy 2025 Jun;80(6):1629-1646.DOI:10.1111/all.16538.IF: 8.706）
Adverse Outcomes Associated With Short-Acting Beta-Agonist Overuse in Asthma: A Systematic Review and Meta-Analysis.Chia-Ling, Tsao; Shu-Yen,
Abstrast
Introduction: The 2019 Global Initiative for Asthma (GINA) report no longer recommended short-acting beta-agonists (SABA) monotherapy due to associated complications and a lack of anti-inflammatory properties. This systematic review and meta-analysis aimed to evaluate adverse outcomes associated with SABA overuse in patients with asthma.
Methods: PubMed, Cochrane Library, EMBASE, and Web of Science databases were searched for studies on SABA overuse (≥ 3 SABA canisters/year) in patients with asthma, from 1981 to November 2023. Randomized controlled trials (RCTs), cohort studies, and cross-sectional studies were included. Pooled risk ratios (RRs) were calculated for dichotomous measures of all-cause mortality and acute exacerbations using random-effects models and Mantel-Haenszel weighting. Subgroup analyses were conducted based on study design.
Results: Out of 626 records, 27 studies (2 RCTs, 1 prospective cohort study, 12 retrospective cohort studies, and 12 cross-sectional studies) were included. SABA overuse (≥ 3 SABA canisters/year) was associated with significantly higher mortality (2743 of 130,629 in the overuse group versus 3534 of 300,451 in controls; RR = 2.04, 95% confidence interval, CI = 1.37-3.04; p < 0.001) and a significantly higher rate of acute exacerbations (60,320 of 165,271 in the overuse group versus 84,439 of 376,845 in controls; RR = 1.93, 95% CI = 1.24-3.03; p < 0.001). An increased risk of acute exacerbations was observed in retrospective cohort studies (RR = 1.88, 95% CI = 1.43-2.47; p < 0.001) and cross-sectional studies (RR = 2.23, 95% CI = 1.04-4.77; p < 0.001).
Conclusion: SABA overuse was associated with increased rates of mortality and acute exacerbations in patients with asthma, supporting guidelines that advise against SABA monotherapy in asthma management.t.
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哮喘患者使用度普利尤单抗与淋巴瘤风险：一项基于人群的队列研究
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