哮喘联盟

   摘要
   综述的目的：抗胆碱能支气管扩张剂诸如噻托溴铵，是一种强力长效药物，是慢性阻塞性肺疾病对症治疗中的关键性药物。最近它在哮喘治疗中的作用被研究。本综述批判性地评价了临床试验的文献证据，评估了哮喘治疗中抗胆碱药物治疗的影响。
   最新发现：近期发表了10项长达4 到52 周的II期和III期随机对照研究，评价了在中重度哮喘的治疗中添加噻托溴铵的效果。这些 RCTs包括3368例患有中度哮喘和1019例患有重度哮喘的受试者。并且，一项系统评价和6项meta分析已评价了发表及未发表的研究噻托溴铵在哮喘中作用的RCTs结果。中度哮喘的RCTs 结果表明添加噻托溴铵到ICS的效果不逊于添加LABA。 另外，噻托溴铵的安全性和功效也与沙美特罗类似。重度哮喘的研究结果显示添加噻托溴铵到高剂量ICS加LABA治疗中会使肺功能进一步改善，延长了距首次哮喘急性发作和哮喘恶化的时间，改善哮喘控制。除了口腔干燥，在中度和重度哮喘中，噻托溴铵的安全性均与安慰剂组类似。
   总结：添加噻托溴铵到ICS或ICS加LABA中改善肺功能，症状和哮喘控制，在重度哮喘中延长了距首次急性发作的时间，并具有好的安全性。其效果似乎独立于基线特征，诸如年龄，阻塞程度，吸烟状况，过敏状况和可逆性特征。
 

（杨冬 审校）
Pol Arch Med Wewn. 2015 Oct 30. pii: AOP_15_095. [Epub ahead of print]

 

Current role of anticholinergic drugs in the treatment of asthma - key messages for clinical practice.
 

Pizzichini MM, Kerstjens HA, Pizzichini E.
 

Abstract
PURPOSE OF THE REVIEW：Anticholinergic bronchodilators such as tiotropium, a potent long acting drug, are central in the symptomatic treatment of chronic obstructive pulmonary disease. Its role in asthmatreatment has been recently investigated. This review critically evaluates documented evidence of clinical trials and assesses the therapeutic implications of anticholinergic drugs in asthma management.
RECENT FINDINGS：Currently, 10 Phases II and III randomized controlled trials (RCTs), with a duration of 4 to 52 weeks evaluating the effect of adding tiotropium to treatment of moderate or of severe asthma, are published. These RCTs involved 3368 subjects with moderate asthma and 1019 subjects with severe asthma. Also, one systematic review and six meta-analyses have appraised the results of published and unpublished RCTs investigating the role of tiotropium in asthma. The results of the RCTs in moderate asthma showed that adding tiotropium to ICS was not inferior to adding LABA. In addition, the safety and efficacy of tiotropium were similar to those of salmeterol. The results of studies on severe asthma showed that adding tiotropium to a treatment of high doses of ICS plus LABA results in further improvement in lung function, increases the time to first severe exacerbation of asthma and to worsening of asthma, and improves asthma control. Except for dry mouth, the safety profile of tiotropium was similar to placebo both in moderate and in severe asthma.
SUMMARY：Adding tiotropium to ICS or to ICS plus LABA improves lung function, symptoms and asthmacontrol and in severe asthma, increases the time to exacerbations, with good safety profile. The effect seems independent of baseline characteristics such as age, level of obstruction, smoking status, allergic status and reversibility.
 

Pol Arch Med Wewn. 2015 Oct 30. pii: AOP_15_095. [Epub ahead of print]