合理使用吸入性皮质类固醇治疗COPD
Jennifer K Quint1, Amnon Ariel2, Peter J Barnes3
1National Heart and Lung Institute, Imperial College London, London, UK. j.quint@imperial.ac.uk.
NPJ primary care respiratory medicine
|July 24, 2023
概括
吸入性皮质类固醇 (ICS) 对经常恶化COPD患者有好处,但过度使用. 指南建议ICS仅适用于特定的患者群体,以避免风险和成本.
科学领域:
- 肺部病理学 肺部病理学
- 呼吸系统医学 呼吸系统医学
- 药物治疗 药物治疗
背景情况:
- 吸入性皮质类固醇 (ICS) 是喘的标准,但它们在慢性阻塞性肺病 (COPD) 中的使用仍在争论中.
- 虽然ICS与双重支气管扩展剂 (三重疗法) 结合减少严重COPD的恶化,但死亡率益处尚未证明.
研究的目的:
- 审查COPD中ICS的益处和风险.
- 根据全球指导方针,提供有关初级保健中适当的ICS处方的指导.
主要方法:
- 随机对照试验 (RCT) 和COPD患者的观察性研究的综述.
- 分析来自常规临床实践和初级保健机构的证据.
主要成果:
- 三重疗法显著减少了COPD患者的恶化频繁/严重的恶化.
- 双支支气管扩张在较广泛的COPD患者群体中显示出更好的结果,而COPD患者群体中不经常出现恶化.
- 过度使用ICS很普遍 (50-80%),导致肺炎等风险,增加成本,但对许多患者没有明显的好处.
结论:
- ICS应保留给患有频繁/严重恶化的慢性慢性病患者,高血红蛋白细胞,或同时存在的喘.
- 适当的ICS选择平衡了益处与肺炎和不良事件的风险.
- 遵守指导方针可以优化ICS的使用,并降低COPD管理中的医疗保健成本.
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