COCHRANE

CORNER

By Chunhu Shi, BSc

Editors note: This is a summary of a nursing carerelated systematic review from the Cochrane Library.

2-Agonists for the Prevention of

Exercise-Induced Asthma
REVIEW QUESTION
What are the effects of inhaled short- and longacting 2-agonists in the pretreatment of
children and adults with exercise-induced
asthma and exercise-induced
bronchoconstriction?

TYPE OF REVIEW
This is a Cochrane systematic review of 53
random-ized, double-blind, placebo-controlled
trials (including 48 with crossover and five with
parallel-group designs) comparing short-acting
2-agonists (SABA) and long-acting 2-agonists
(LABA) with placebo in the pretreat ment of
children and adults with exercise-induced asthma
or exercise-induced bronchoconstriction.

RELEVANCE FOR NURSING

Physical exercise can trigger symptoms such as
cough, chest tightness, and shortness of breath in
people with asthma and induce bronchial
obstruction in people without clinical asthma. 2agonists are recommended for the management of
asthma because they can open up the airways,
making it easier for people to breathe. As there is
still no consensus about the efficacy and safety of
2-agonists, however, a systematic review was
warranted.

CHARACTERISTICS OF THE
EVIDENCE
A total of 1,139 children and adults were
included in the review. Participants had a
history of exercise-induced asthma and/or a
positive response to a stan-dardized exercise
challenge. Inhaling 2-agonists at any dose was
the intervention of interest. They could be
SABA or LABA, but they had to be
administered be-fore an exercise challenge.
Interventions were com-pared with placebo.
The primary outcomes were mean maximal percent fall in forced expiratory volume in one

sec-ond (FEV1), mean percent protection afforded by 2agonists, and mean area under the curve (AUC) of time course
changes in FEV1 after treatment. The secondary outcomes
included the number of people with a maximal fall in FEV 1 of
less than 10% (com-plete protection), less than 15%, and less
than 20%; a mean maximal percent fall in other pulmonary
func-tion parameters; onset of tolerance; and adverse effects.
The evidence was considered to be of low to
ajn@wolterskluwer.com

moderate quality. Meta-analysis was undertaken where

possible.
Single administration. Forty-five studies evaluated single 2agonist administration (77 arms of active treatment [49 SABA and
28 LABA]) compared with placebo. Both SABA and LABA had a
statistically significant protective effect regarding maximal fall in
FEV1 compared with placebo (mean difference, -17.67%) and the
mean percent protection was 66%. LABA administration at
different time points showed a FEV1 percent fall AUC that favored
the active treat-ment. 2-agonists also demonstrated a positive and
protective effect on exercise-induced asthma compared with
placebo in the number of people with a maximal percent fall in
FEV1 of less than 10%, less than 15%, and less than 20%. There
was no significant difference in adverse effects between
interventions and placebo.
Long-term administration. Eight studies (five cross over and
three parallel-group studies) evaluated long-term administration,
with treatment ranging from seven to 29 days. Meta-analysis could
not be under-taken because of the heterogeneity of the study designs. Generally, the first dose of 2-agonists had a bronchoprotective effect. However, long-term use of both SABA and
LABA led to onset of tolerance and decreased the duration of the
drugs effect.

BEST PRACTICE RECOMMENDATIONS

When administered in a single dose before exercise, both
SABA and LABA can effectively and safely pre - vent
exercise-induced asthma. However, long-term administration
of inhaled 2-agonists can induce tol-erance, and there is
currently a lack of sufficient safety data.

RESEARCH RECOMMENDATIONS
Further trials that examine long-term 2-agonist admin-istration in
exercise-induced asthma are warranted.
Chunhu Shi is a faculty member in the School of Basic Medical Sciences,

Evidence-Based Medicine Centre of Lanzhou University,

Lanzhou City, Gansu Province, China, and a member of the
Co-chrane Nursing Care Field.

SOURCE DOCUMENT
Bonini M, et al. Beta2-agonists for exercise-induced asthma.
Cochrane Database Syst Rev 2013;10:CD003564.

dada, dan sesak napas pada penderita

asma dan menginduksi obstruksi
bronkus pada orang tanpa asma klinis.
2-agonis dianjurkan untuk manajemen
asma karena mereka dapat membuka
saluran udara, sehingga lebih mudah
bagi orang untuk bernapas. Karena
masih ada konsensus tentang
kemanjuran dan keamanan 2-agonis,
namun, tinjauan sistematis telah
dibenarkan.
2-Agonis untuk Pencegahan
Asma Latihan-Induced
REVIEW PERTANYAAN
Apa efek dari dihirup pendek
dan long-acting 2-agonis
dalam pretreatment anakanak dan orang dewasa
dengan asma akibat olahraga
dan latihan-induced
bronkokonstriksi?
JENIS REVIEW

KARAKTERISTIK BUKTI YANG

Sebanyak 1.139 anak-anak dan orang
dewasa dimasukkan dalam review.
Peserta memiliki riwayat asma akibat
olahraga dan / atau respon positif
terhadap tantangan latihan standardized. Menghirup 2-agonis dengan
dosis setiap adalah intervensi
kepentingan. Mereka bisa menjadi
SABA atau LABA, tetapi mereka harus
diberikan be-kedepan tantangan
olahraga. Intervensi yang com-dikupas
dengan plasebo.

Ini adalah Cochrane review

sistematis dari 53, doubleblind, uji coba terkontrol
plasebo acak-ized (termasuk
48 dengan crossover dan
lima dengan desain
kelompok paralel)
membandingkan short-acting
2-agonis (SABA) dan longacting 2-agonis (LABA)
dengan plasebo dalam ment
pretreat anak-anak dan orang
dewasa dengan asma akibat
olahraga atau latihaninduced bronkokonstriksi.

Hasil utama yang berarti maksimal

persen penurunan volume ekspirasi
paksa dalam satu detik-ond (FEV1),
berarti perlindungan persen diberikan
oleh 2-agonis, dan berarti area di
bawah kurva (AUC) perubahan tentu
saja waktu di FEV1 setelah perawatan.
Hasil sekunder termasuk jumlah orang
dengan penurunan maksimal dalam
FEV1 kurang dari 10% (perlindungan
com-plete), kurang dari 15%, dan
kurang dari 20%; a berarti maksimal
persen penurunan parameter func-tion
paru lainnya; timbulnya toleransi; dan
efek samping. Bukti itu dianggap
rendah sampai

RELEVANSI UNTUK
KEPERAWATAN

ajn@wolterskluwer.com

latihan fisik dapat memicu

gejala seperti batuk, sesak

kualitas moderat. Meta-analisis

dilakukan di mana mungkin.

administrasi tunggal. Empat
puluh lima studi dievaluasi
administrasi 2-agonis
tunggal (77 lengan
pengobatan aktif [49 SABA
dan 28 LABA]) dibandingkan
dengan plasebo. Kedua SABA
dan LABA memiliki efek
perlindungan yang signifikan
secara statistik mengenai
jatuhnya maksimal dalam
FEV1 dibandingkan dengan
plasebo (rata-rata
perbedaan, -17,67%) dan
persen rata perlindungan
adalah 66%. administrasi
LABA pada titik waktu yang
berbeda menunjukkan FEV1
persen penurunan AUC yang
disukai aktif mengobatiment. 2-agonis juga
menunjukkan efek positif dan
pelindung pada asma akibat
olahraga dibandingkan
dengan plasebo pada jumlah
orang dengan persen
penurunan maksimal dalam
FEV1 kurang dari 10%,
kurang dari 15%, dan kurang
dari 20%. Tidak ada
perbedaan yang signifikan
dalam efek samping antara
intervensi dan plasebo.
pemberian jangka panjang.
Delapan studi (lima cross
over dan tiga studi kelompok
paralel) dievaluasi
administrasi jangka panjang,
dengan pengobatan mulai
dari tujuh sampai 29 hari.
Meta-analisis tidak bisa
berada di bawah-diambil
karena heterogenitas studi
de-tanda. Umumnya, dosis
pertama 2-agonis memiliki
efek bronchoprotective.
Namun, penggunaan jangka
panjang dari kedua SABA dan
LABA menyebabkan

timbulnya toleransi dan penurunan

durasi efek obat.
REKOMENDASI PRAKTEK TERBAIK
Bila diberikan dalam dosis tunggal
sebelum latihan, baik SABA dan LABA
dapat efektif dan aman pra melampiaskan asma akibat olahraga.
Namun, administrasi jangka panjang
inhalasi 2-agonis dapat menginduksi
tol-erance, dan saat ini ada kurangnya
data keselamatan yang memadai.
REKOMENDASI PENELITIAN
uji coba lebih lanjut yang meneliti 2agonis jangka panjang adminAdministration di asma akibat olahraga
dijamin.
Chunhu Shi adalah anggota staf
pengajar di Sekolah Ilmu Kedokteran
Dasar, Bukti-Based Medicine Centre
dari Universitas Lanzhou, Lanzhou City,
Provinsi Gansu, Cina, dan anggota dari
Co-chrane Keperawatan Perawatan
Field.
SUMBER DOKUMEN
Bonini M, et al. Beta2-agonis untuk
asma akibat olahraga.
Cochrane database Syst Rev 2013; 10:
CD003564.
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September 2014

Vol. 114, No. 9