哮喘联盟

    既往的有研究认为长效β受体激动剂能够增加COPD患者的呼吸道的不良反应事件的发生率及死亡率。然而，2008年5月Chest上的一篇报道提出不同的观点。这个研究表明长效β受体激动剂对中重度COPD的患者是有益的，它并没有增加呼吸系统的致死率。在研究中，Rodrigo及其同事分析了27个随机临床对照病例，他们将2种长效β受体激动剂与安慰剂相对比，或者与2种长效抗胆碱能药物相对比。与安慰剂组相比，长效β受体激动剂降低了重度COPD的急性发作率，并且没有增加COPD的死亡率。长效β受体激动剂的治疗可以改善肺功能，提高生活质量。同时，Malcolm R. Sears博士强调在临床中应用这个研究结果时要谨慎。因为在COPD的研究试验中，患者的入选标准很严格，并且有仔细的监测，哮喘患者是排除在外的。而在实际临床中，哮喘和COPD是很难区分的，尤其是老年患者。因此Sears强调：单一长效β受体激动剂的应用对COPD的患者是有效并且安全的，这可能会给部分误诊为COPD的哮喘患者带来危险。Rodrigo及其研究成员发现：长效β受体激动剂联合吸入激素治疗与单纯应用长效β受体激动剂相比死亡率较低。因此，强调在COPD的治疗中推荐长效β受体激动剂与吸入激素联合治疗。

（苏新明 中国医科大学附属一院呼吸科 110001  摘译）
（Chest. 2008 May;133(5):1079-1087.）

Rodrigo GJ, Nannini LJ, Rodríguez-Roisin R. Safety of long-acting beta-agonists in stable COPD: a systematic review.

 
Chest. 2008 May;133(5):1079-87.

BACKGROUND: Some studies have suggested that use of long-acting beta(2)-agonists (LABAs) leads to an increased risk for adverse events in patients with stable COPD. The purpose of this review was to assess the safety, and secondarily the efficacy of LABAs. 
METHODS: The authors conducted a systematic review with metaanalysis of randomized clinical trials (> or = 1 month in duration) in the published literature that have compared LABAs with placebo or anticholinergics in stable poorly reversible and reversible COPD.
RESULTS: MEDLINE, EMBASE, CINAHL, and the Cochrane Controlled Trials Register were searched to identify 27 studies. LABAs reduced severe exacerbations compared with placebo (relative risk [RR], 0.78; 95% confidence interval [CI], 0.67 to 0.91). There was no significant difference between LABA and placebo groups in terms of respiratory deaths (RR, 1.09; 95% CI, 0.45 to 2.64). Use of LABAs with inhaled corticosteroids reduced the risk of respiratory death compared with LABAs alone (RR, 0.35; 95% CI, 0.14 to 0.93). Patients receiving LABAs showed significant benefits in airflow limitation measures, health-related quality of life, and use of rescue medication. Finally, tiotropium decreased the incidence of severe COPD exacerbations compared with LABAs (RR, 0.52; 95% CI, 0.31 to 0.87). 
CONCLUSION: This review supports the beneficial effects of the use of LABAs in patients with stable moderate-to-severe COPD, and did not confirm previous data about an increased risk for respiratory deaths. Also, our analysis suggests the superiority of tiotropium over LABAs for the treatment of stable COPD patients.