哮喘患者持续输注特布他林---综述
2011/11/23
摘要
背景:自从沙美特罗多中心哮喘临床试验提出有关哮喘药物治疗的安全性以来,药物长期刺激β肾上腺受体的安全性一直受到关注。因此,我们对持续皮下输注特布他林(CSIT)进行综述分析,因为该治疗常常用于重度哮喘和难治性哮喘患者。
结果:20世纪80年代的早期试验对26例患者进行了研究,结果显示,尽管采用较高血清剂量的特布他林皮下治疗,患者仍能很好耐受,主要副作用为皮肤副反应。CSIT能改善75%患者的疾病转归,包括每日最低呼气峰值流速(PEFR)增加、昼夜变异缩小、对其他药物治疗的需求下降和主观感觉症状缓解。几乎所有哮喘改善的患者在治疗前都存在较大的PEFR变异。然而,在对42例患者进行的回顾性研究中,平均住院次数下降是CSIT治疗后唯一显著改善的疾病转归指标(P=0.031)。理论上,CSIT 能间断性刺激β受体,而该作用未见于常规药物吸入治疗,在皮下治疗联合雾化吸入治疗后,表现为第一秒用力呼气流量(FEV1)进一步增加。
结论:虽然一些研究结果令人鼓舞,但这些研究结果来自于小样本的观察性研究,而且当时的哮喘标准处理方法与当前的方法也有很大区别。目前尚无随机对照临床试验对CSIT进行研究,英国卫生部门也仍未批准该方法用于哮喘治疗。显然,我们需要有前瞻性的研究来证实该治疗的疗效及其安全性——在CSIT应用较少甚至还有进一步减少趋势的情况下,即使有安全性问题也不太可能显现。
(林江涛 审校)
J Asthma. 2011 Oct;48(8):753-6.
Continuous infusions of terbutaline in asthma - a review.
Jones GH, Scott SJ.
Source
Respiratory Department, Countess of Chester Hospital , Chester , UK .
Abstract
BACKGROUND:After the safety issues raised by the Salmeterol Multicenter Asthma Research Trial, concerns persist about the safety of agents that cause prolonged β-adrenoceptor stimulation in asthmatic patients. We therefore decided to revisit and review the use of continuous subcutaneous infusions of terbutaline (CSIT)-a treatment often reserved for those with severe and refractory disease.
RESULTS:Original studies from the 1980s included 26 patients and showed that CSIT was well tolerated with predominately cutaneous side effects despite maintaining very high serum levels of terbutaline. CSIT led to improved outcomes in approximately 75% of patients which included rises in lowest daily peak expiratory flow rate (PEFR), diminution in diurnal variation, reduction in other medication requirements, and subjective opinion of symptoms. Almost all patients demonstrating an improvement had a wide variation in their pretreatment PEFRs. However, in a retrospective follow-up of 42 patients, the only outcome to be significantly improved by CSIT was that of mean hospital admissions (p = .031). CSIT is theorized to stimulate a discrete set of β-receptors not accessible by the inhaled route as further increases in Forced expiratory volume in one second (FEV(1)) occur with concurrent nebulized therapy.
CONCLUSION:Although some findings are encouraging, they are drawn from small observational studies done at a time when the standard management of asthma was quite different from today. No randomized controlled trials exist for the use of CSIT, which remains off-license for the treatment of asthma in the United Kingdom. Clearly, prospective well-powered studies are required to fully ascertain its potential benefits and safety profile-something that is unlikely to occur given that the use of CSIT remains low and appears to be declining.
J Asthma. 2011 Oct;48(8):753-6.
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