{"title":"青少年和成人哮喘患者运动性支气管痉挛维持方案的有效性和安全性：系统评价和网络荟萃分析","authors":"Irin Vichara-anont MD , Lalita Lumkul MSc , Phichayut Phinyo MD, PhD , Chamard Wongsa MD , Torpong Thongngarm MD","doi":"10.1016/j.jaip.2025.02.018","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Exercise-induced bronchospasm (EIB) commonly coexists with asthma. However, the data on the efficacy of maintenance therapies for asthma with EIB are scarce.</div></div><div><h3>Objective</h3><div>This network meta-analysis assessed the comparative efficacy and safety of maintenance regimens for asthmatics with EIB.</div></div><div><h3>Methods</h3><div>We searched PubMed, Scopus, Embase, the Cochrane Center of Controlled Trials, and Google Scholar for randomized controlled trials (RCTs) that addressed the efficacy and safety of maintenance treatments in adolescent and adult asthmatics with EIB from inception to April 2024. The primary outcome was the change in forced expiratory volume in 1 second postexercise after maintenance therapy. The secondary outcome focused on treatment-related adverse events (AEs).</div></div><div><h3>Results</h3><div>Eleven RCTs involving 1054 patients were included. Low-dose inhaled corticosteroid (ICS)-montelukast significantly improved EIB with a mean difference (95% confidence interval) of 14.96% (9.61, 20.31), followed by low- to medium-dose (LM-dose) ICS-salmeterol 13.7% (8.68, 18.72), high-dose ICS 13.30% (1.34, 25.26), montelukast 11.35% (5.76, 16.95), ICS-vilanterol 9.24% (4.41, 14.07), zafirlukast 8.80% (2.28, 15.32), LM-dose ICS 7.55% (3.48, 11.63), and as-needed ICS-formoterol 6.91% (2.07, 11.75). Low-dose ICS-montelukast and LM-dose ICS-salmeterol were comparably effective. There were no significant efficacy differences among ICS monotherapy, as-needed ICS-formoterol, and antileukotrienes. Antileukotrienes were inferior to ICS monotherapy in reducing asthma exacerbation. Long-acting β<sub>2</sub>-agonist (LABA)-induced tachyphylaxis may occur despite using alongside ICS.</div></div><div><h3>Conclusion</h3><div>Low-dose ICS and as-needed ICS-formoterol were equally effective in managing asthmatics with EIB. The addition of antileukotrienes or LABA to ICS should be considered for more severe cases, with close monitoring to assess treatment response and detect potential tachyphylaxis or AEs.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 7","pages":"Pages 1755-1767.e3"},"PeriodicalIF":6.6000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Efficacy and Safety of Maintenance Regimens for Adolescent and Adult Asthmatics With Exercise-Induced Bronchospasm: Systematic Review and Network Meta-Analysis\",\"authors\":\"Irin Vichara-anont MD , Lalita Lumkul MSc , Phichayut Phinyo MD, PhD , Chamard Wongsa MD , Torpong Thongngarm MD\",\"doi\":\"10.1016/j.jaip.2025.02.018\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Exercise-induced bronchospasm (EIB) commonly coexists with asthma. However, the data on the efficacy of maintenance therapies for asthma with EIB are scarce.</div></div><div><h3>Objective</h3><div>This network meta-analysis assessed the comparative efficacy and safety of maintenance regimens for asthmatics with EIB.</div></div><div><h3>Methods</h3><div>We searched PubMed, Scopus, Embase, the Cochrane Center of Controlled Trials, and Google Scholar for randomized controlled trials (RCTs) that addressed the efficacy and safety of maintenance treatments in adolescent and adult asthmatics with EIB from inception to April 2024. The primary outcome was the change in forced expiratory volume in 1 second postexercise after maintenance therapy. The secondary outcome focused on treatment-related adverse events (AEs).</div></div><div><h3>Results</h3><div>Eleven RCTs involving 1054 patients were included. Low-dose inhaled corticosteroid (ICS)-montelukast significantly improved EIB with a mean difference (95% confidence interval) of 14.96% (9.61, 20.31), followed by low- to medium-dose (LM-dose) ICS-salmeterol 13.7% (8.68, 18.72), high-dose ICS 13.30% (1.34, 25.26), montelukast 11.35% (5.76, 16.95), ICS-vilanterol 9.24% (4.41, 14.07), zafirlukast 8.80% (2.28, 15.32), LM-dose ICS 7.55% (3.48, 11.63), and as-needed ICS-formoterol 6.91% (2.07, 11.75). Low-dose ICS-montelukast and LM-dose ICS-salmeterol were comparably effective. There were no significant efficacy differences among ICS monotherapy, as-needed ICS-formoterol, and antileukotrienes. Antileukotrienes were inferior to ICS monotherapy in reducing asthma exacerbation. Long-acting β<sub>2</sub>-agonist (LABA)-induced tachyphylaxis may occur despite using alongside ICS.</div></div><div><h3>Conclusion</h3><div>Low-dose ICS and as-needed ICS-formoterol were equally effective in managing asthmatics with EIB. The addition of antileukotrienes or LABA to ICS should be considered for more severe cases, with close monitoring to assess treatment response and detect potential tachyphylaxis or AEs.</div></div>\",\"PeriodicalId\":51323,\"journal\":{\"name\":\"Journal of Allergy and Clinical Immunology-In Practice\",\"volume\":\"13 7\",\"pages\":\"Pages 1755-1767.e3\"},\"PeriodicalIF\":6.6000,\"publicationDate\":\"2025-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Allergy and Clinical Immunology-In Practice\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2213219825001898\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/2/26 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"ALLERGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Allergy and Clinical Immunology-In Practice","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2213219825001898","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/26 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"ALLERGY","Score":null,"Total":0}
Efficacy and Safety of Maintenance Regimens for Adolescent and Adult Asthmatics With Exercise-Induced Bronchospasm: Systematic Review and Network Meta-Analysis
Background
Exercise-induced bronchospasm (EIB) commonly coexists with asthma. However, the data on the efficacy of maintenance therapies for asthma with EIB are scarce.
Objective
This network meta-analysis assessed the comparative efficacy and safety of maintenance regimens for asthmatics with EIB.
Methods
We searched PubMed, Scopus, Embase, the Cochrane Center of Controlled Trials, and Google Scholar for randomized controlled trials (RCTs) that addressed the efficacy and safety of maintenance treatments in adolescent and adult asthmatics with EIB from inception to April 2024. The primary outcome was the change in forced expiratory volume in 1 second postexercise after maintenance therapy. The secondary outcome focused on treatment-related adverse events (AEs).
Results
Eleven RCTs involving 1054 patients were included. Low-dose inhaled corticosteroid (ICS)-montelukast significantly improved EIB with a mean difference (95% confidence interval) of 14.96% (9.61, 20.31), followed by low- to medium-dose (LM-dose) ICS-salmeterol 13.7% (8.68, 18.72), high-dose ICS 13.30% (1.34, 25.26), montelukast 11.35% (5.76, 16.95), ICS-vilanterol 9.24% (4.41, 14.07), zafirlukast 8.80% (2.28, 15.32), LM-dose ICS 7.55% (3.48, 11.63), and as-needed ICS-formoterol 6.91% (2.07, 11.75). Low-dose ICS-montelukast and LM-dose ICS-salmeterol were comparably effective. There were no significant efficacy differences among ICS monotherapy, as-needed ICS-formoterol, and antileukotrienes. Antileukotrienes were inferior to ICS monotherapy in reducing asthma exacerbation. Long-acting β2-agonist (LABA)-induced tachyphylaxis may occur despite using alongside ICS.
Conclusion
Low-dose ICS and as-needed ICS-formoterol were equally effective in managing asthmatics with EIB. The addition of antileukotrienes or LABA to ICS should be considered for more severe cases, with close monitoring to assess treatment response and detect potential tachyphylaxis or AEs.
期刊介绍：
JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases.
This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders.
The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.
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