合理使用吸入性皮质类固醇治疗COPD:一个简单的语言摘要
Amnon Ariel1, Peter J Barnes2, Tiago Maricoto3,4,5
1Lung Unit, Emek Medical Center, Afula, Israel.
Journal of comparative effectiveness research
|November 27, 2023
概括
吸入性皮质类固醇 (ICS) 在慢性阻塞性肺病 (COPD) 中经常被过度处方,增加了对大多数患者没有证明的益处的风险. 指南建议ICS仅用于频繁恶化,但目前的做法偏离,需要审查COPD中适当的ICS使用.
科学领域:
- 呼吸系统医学 呼吸系统医学
- 药理学 药理学是指药理学的学科.
- 临床实践指南 临床实践指南
背景情况:
- 吸入性皮质类固醇 (ICS) 是标准的喘治疗方法,但在慢性阻塞性肺病 (COPD) 中具有有限的疗效和显著的副作用,如肺炎.
- 目前的COPD指导方针主张ICS仅在经历频繁恶化的患者中使用.
- 尽管有指导方针,但ICS经常被处方给慢性慢性病患者,没有经常的恶化,可能是由于组合吸入器疗法.
研究的目的:
- 审查吸入性皮质类固醇 (ICS) 在慢性阻塞性肺病 (COPD) 管理中的益处和风险.
- 为了确定从COPD的ICS治疗中受益的患者子组.
- 在COPD管理中提供有关适当的ICS处方和戒断的指导.
主要方法:
- 随机对照试验 (RCT) 和关于ICS在COPD中使用的观察性研究的系统审查.
- 分析数据以确定不同COPD患者群体的ICS疗效和安全概况.
- 根据既定的临床指南评估当前的处方实践.
主要成果:
- ICS仅在一小部分COPD患者中有效,主要是那些频繁恶化患者.
- 在COPD中观察到广泛的过度处方ICS,使患者面临诸如肺炎之类的风险,没有明显的益处.
- 有证据表明,ICS在一般COPD患者中不会提高生存率.
结论:
- 在COPD中,应仔细考虑ICS的处方,并将其限制在符合特定标准的患者身上,主要是频繁恶化.
- 医疗保健专业人员和患者需要明确的指导来优化ICS的使用,并减轻COPD的风险.
- 趋向于单吸入器组合疗法的趋势可能会在COPD中促进不适当的ICS使用.
相关概念视频
01:26COPD: Management Using Bronchodilators and Corticosteroids
214
Chronic obstructive pulmonary isease (COPD) involves a group of progressive lung disorders characterized by persistent airflow limitation and chronic respiratory symptoms. Asthma-COPD Overlap Syndrome (ACOS), encompassing features of both asthma and Chronic obstructive pulmonary disease (COPD), is a group of progressive lung disorders that includes chronic bronchitis, emphysema, and refractory (non-reversible) asthma. ACOS leads to complex clinical presentations that combine the inflammatory...
214
01:25Antiasthma Drugs: Inhaled Corticosteroids and Glucocorticoids
270
Inhaled corticosteroids (ICS) are anti-inflammatory drugs used primarily in treating persistent asthma and providing long-term maintenance. They target the bronchial mucosa, the lining of the airways, to control inflammation, a critical factor in asthma progression and exacerbation.
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
270
01:23Inhaled Medications
280
Inhaled medications are crucial for managing chronic obstructive pulmonary disease (COPD) and asthma. They are essential for effective treatment and control, ensuring optimal respiratory health and well-being. Inhaled medication delivers drugs directly to the lungs, providing a rapid onset of action and reducing systemic side effects compared to oral or injectable medications. Three primary types of inhalation devices are used to administer these medications: nebulizers, metered-dose inhalers...
280
01:17Drugs Used in Lower Respiratory Disorders: Overview
451
Lower respiratory tract disorders present challenges that often require skilled and nuanced approaches for effective management. Common ailments, such as asthma and chronic obstructive pulmonary disease (COPD), have prompted the development of intricate treatment strategies involving bronchodilators and anti-inflammatory drugs, each tailored to ease breathing and revitalize the lungs.
Bronchodilators, the first step of respiration enhancement, come in various forms, each with its own mechanism...
Bronchodilators, the first step of respiration enhancement, come in various forms, each with its own mechanism...
451
01:29Chronic Obstructive Pulmonary Disease-V: Management
2.5K
Managing Chronic Obstructive Pulmonary Disease (COPD) involves a multifaceted approach to reduce symptoms, prevent exacerbations, improve overall health status, and slow disease progression. Key strategies include lifestyle modifications, pharmacotherapy, supportive therapies, and, in some cases, surgery. Here is an overview of the primary COPD management strategies:
Smoking Cessation
Smoking Cessation
2.5K
01:21Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
121
Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2...
121