哮喘联盟

   摘要
   背景：了解对不明原因或难治性咳嗽治疗的疗效比较结果，对于增强该类特殊人群对已知疗法及其副作用的认知是至关重要的。
   方法：检索至2012年6月已发表的、比较慢性咳嗽对症治疗的英文研究。由两名研究者对每篇摘要和全文（包括结论、摘要和质量评分）进行筛选。使用Meta分析的随机效应模型来总结治疗效果。
   结果：本研究纳入了49项研究(3067例患者)，比较了68种疗法。这些研究已证实了阿片类和某些非阿片类/非麻醉镇咳药在治疗成人慢性咳嗽中的疗效。与对照组比较，阿片类药物的效应值(咳嗽严重程度的标准平均差[SMDs]和咳嗽频率的率比 [RRs])分别为0.55 (95%CI：0.38-0.72，p=0.0001)和0.57 (95% CI, 0.36-0.91; p=0.0260)。右美沙芬的效应值分别为0.37 (95% CI, 0.19-0.56; p=0.0008)和0.40 (95% CI, 0.18-0.85; p=0.0248)。证据的总强度受限于结果的不一致和不精确，以及直接比较的小样本量。有关儿童咳嗽的非药物疗法和管理的研究很少。
   结论：虽然证据有限，但阿片类和某些非阿片类/非麻醉镇咳药已证明了在成人慢性咳嗽治疗中的效果。对于不明原因或难治性咳嗽患者需要进一步的研究，以及更多的系统研究设计、以患者为中心的结果评估和报告。

 

（刘国梁 审校）
Chest. 2013 Aug 8. doi: 10.1378/chest.13-0490. [Epub ahead of print]

 

Efficacy and tolerability of treatments for chronic cough: a systematic review and meta-analysis.
 

Yancy WS, McCrory DC, Coeytaux RR, Schmit KM, Kemper AR, Goode A, Hasselblad V, Heidenfelder BL, Sanders GD.
 

Abstract
ABSTRACT BACKGROUND: Understanding the comparative effectiveness of treatments for patients with unexplained or refractory cough is important to increase awareness of proven therapies and their potential adverse effects in this unique population.
METHODS: We performed a literature search for English-language studies published up to June 2012 that compared symptomatic therapies for chronic cough. Two investigators screened each abstract and full-text article for inclusion, abstracted data, and rated quality. Meta-analysis with random-effects models was used to summarize effects of treatments.
RESULTS: We identified 49 studies (3067 patients), comprising 68 therapeutic comparisons. Of the studied agents, opioid and certain nonopioid/nonanesthetic antitussives demonstrated efficacy for chronic cough in adults. Compared with placebo, effect sizes (standardized mean differences [SMDs] for cough severity and rate ratios [RRs] for cough frequency) for opioids were 0.55 (95% confidence interval [CI], 0.38 to 0.72; p=0.0001) and 0.57 (95% CI, 0.36 to 0.91; p=0.0260), respectively. For dextromethorphan, effect sizes were 0.37 (95% CI, 0.19 to 0.56; p=0.0008) and 0.40 (95% CI, 0.18 to 0.85; p=0.0248), respectively. The overall strength of evidence was limited by inconsistency and imprecision of results, and by small numbers of direct comparisons. Nonpharmacological therapies and the management of cough in children were infrequently studied.
CONCLUSIONS: Although evidence is limited, opioid and certain nonopioid/nonanesthetic antitussives demonstrated efficacy for treating chronic cough in adults. There is a need for further studies in patients with unexplained or refractory cough, as well as more systematic study design, assessment of patient-centered outcomes, and reporting.
 

Chest. 2013 Aug 8. doi: 10.1378/chest.13-0490. [Epub ahead of print]