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【医学】研究表明使用Beta激动剂吸入器COPD(肺慢
A new analysis that compares two common inhalers for patients suffering from chronic obstructive pulmonary disease (COPD) finds that one reduces respiratory-related hospitalizations and respiratory deaths, but the other -- which is prescribed in the majority of cases -- increases respiratory deaths.
The Cornell and Stanford universities' statistical analysis of 22 trials with 15,276 participants found that common bronchodilators known as anticholinergics (generically named tiotropium and ipratropium) reduced severe respiratory events by 33 percent and respiratory-related deaths by 73 percent, compared with a placebo.
However, the same meta-analysis (which combines the results of the numerous studies) found that regularly inhaled beta-agonists (metaproterenol [Alupent], formoterol [Foradil], salmeterol [Serevent, Advair] and albuterol [Proventil, Ventolin, Volmax and others]) increased the risk of respiratory death more than twofold, compared with a placebo.
Yet only 5 percent of all prescriptions for COPD are anticholinergics, with beta-agonists dominating what doctors prescribe, the researchers report.
The study, now online, will be published in an upcoming issue of the Journal of General Internal Medicine.
COPD is a progressive lung disease characterized by difficulty breathing, wheezing and a chronic cough. Complications include bronchitis and pneumonia. It is often associated with smoking.
"When patients used the anticholinergics, they experienced fewer severe exacerbations requiring hospitalizations and fewer respiratory deaths than those taking only a placebo," said Edwin Salpeter, the J.G. White Distinguished Professor of Physical Sciences Emeritus at Cornell, who led the statistical analysis in the study. An eminent astrophysicist, Salpeter has more recently focused his attention on medical statistics. "With the beta-agonists, it's the other way around, where the number of respiratory deaths increased when compared with those who took only the placebo."
"These results suggest that anticholinergics should be the bronchodilator of choice in COPD," said Shelley Salpeter, M.D., Edwin Salpeter's daughter and the lead author. She is a clinical professor of medicine at Stanford's School of Medicine and a physician at Santa Clara Valley Medical Center in San Jose, Calif. "The long-term safety of beta-agonists in patients with COPD should be addressed."
A recent meta-analysis by the Salpeters also revealed that beta-agonist inhalers increased both hospitalizations and deaths in asthma sufferers of all ages.
Previous studies have shown that patients with COPD build up tolerance to beta-agonists' bronchodilator and bronchoprotective effects after regular treatment compared with the first dose.
While beta-agonists may reduce symptoms through bronchodilation, the researchers believe they also promote bronchial inflammation and sensitivity by reducing bronchial protection without any warning of increased symptoms, which can then lead to a life-threatening response.
In the trials that were analyzed, only two patients out of 4,036 who took anticholinergics died of respiratory causes, while 12 of 3,845 participants in the placebo group died of respiratory ailments. When patients inhaled beta-agonists, there were 21 respiratory deaths out of 1,320 patients and eight respiratory deaths out of 1,084 participants in the placebo group. 呵呵，这么好的文章没有人认领翻译？
β受体激动剂在哮喘和COPD中是应用最广泛的药物，居然有这样的临床分析结果？
我认领了。不是本人的专业领域，有错误，请指正。
对COPD患者中两类吸入治疗人群所做的一项新的分析发现，一类降低了呼吸障碍相关的住院率和死亡率，而另一类，大多数的处方病例，则死亡率增加。
The Cornell and Stanford universities' statistical analysis of 22 trials with 15,276 participants found
康乃尔大学和斯坦福大学分析了涉及15276名受试者的22个临床试验，发现与安慰剂相比，常用的抗胆碱类支气管扩张剂（‘噻托溴铵’和‘异丙托溴铵’）能够使得严重发病和死亡分别降低33%和73%。
然而，这一meta分析（综合多项临床研究的结果）还发现，与安慰剂相比，规律性地吸入β受体激动剂（奥西那林、福莫特罗、沙美特罗和奥布特罗）却使得死亡的风险增加了两成。
研究者报道说，只有5%的COPD处方使用抗胆碱药物，而β受体激动剂在医生的处方中占绝对的多数。
这项研究，即将发表在最近出版的Journal of General Internal Medicine，其网络版已经可以参阅。
COPD是一种肺部进行性疾病，其特征是呼吸困难、喘息、慢性持续咳嗽，并发症包括支气管炎和肺炎，常常伴随吸烟而发生。
J.G. White 奖获得者、这项研究的负责人康乃尔大学物理学退休教授Edwin Salpeter，曾是一位著名的天体物理学家，最近却关注起了医学统计，他说：“同吸入安慰剂的患者比较，使用抗胆碱药物的病人，病情恶化减轻，住院少，死亡少。而β受体激动剂，却是另一回事，比吸入安慰剂死亡得更多。”
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作者:admin@医学,生命科学 2011-03-05 05:25
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