慢性肺炎的逐步管理:支气管扩张后的下一步是什么?
Marc Miravitlles1, Kazuto Matsunaga2, Michael Dreher3
1Pneumology Department, University Hospital Vall d'Hebron/Vall d'Hebron Research Institute (VHIR, Vall d'Hebron Barcelona Hospital Campus; CIBER de Enfermedades Respiratorias [CIBERES]), P. Vall d'Hebron 119-129, Barcelona 08035, Spain.
Therapeutic advances in respiratory disease
|November 8, 2023
概括
长期作用的肌肉抗剂 (LAMA) 和长期作用的β2-激动剂 (LABA) 是COPD的标准药物. 吸入性皮质类固醇 (ICS) 在临床实践中经常被过度使用,尽管指南建议它们只适用于特定的患者群体.
科学领域:
- 肺部病理学 肺部病理学
- 药理学 药理学是指药理学的学科.
背景情况:
- 长效肌抗体 (LAMAs) 和长效β2抗体 (LABAs) 构成了慢性阻塞性肺病 (COPD) 管理的基石.
- 目前的指导方针限制了吸入性皮质类固醇 (ICS) 添加到LABA/LAMA治疗中的患者,这些患者经常出现恶化,血液中高氨基酸或同时存在的喘.
研究的目的:
- 审查全球和特定国家 (德国,西班牙,日本) 的COPD治疗指南.
- 将指南建议与LABA/LAMA和ICS利用的现实数据进行比较.
- 根据患者表型,为LABA/LAMA提供附加治疗的临床指南.
主要方法:
- 对治疗指南和现实世界的数据进行叙述性审查.
- 对指南建议与临床实践进行比较分析.
- 作为辅助治疗指导的表型分类.
主要成果:
- 实际数据表明,在不符合指导标准的COPD患者中,ICS经常被过度使用.
- 关于ICS添加的建议和实际临床实践之间存在差异.
- 指导方针和现实数据显示不同国家的差异.
结论:
- 临床人员遵守COPD的ICS处方指南需要改进.
- 过度使用ICS可能源于对治疗升级途径的误解.
- 基于表型的方法对于优化COPD管理中的附加疗法至关重要.
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