慢性阻塞性肺病患者的吸入性皮质类固醇:一个古老的,未完成的历史
Andrea S Melani1, Sara Croce1, Gaia Fabbri1
1Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy.
Biomolecules
|February 24, 2024
概括
吸入性皮质类固醇 (ICS) 在COPD治疗中被广泛使用,但指南建议在稳定的患者中谨慎使用. 虽然三重疗法可能会降低死亡率,但潜在的副作用需要仔细评估.
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:
- 慢性阻塞性肺病 (COPD) 显著导致全球发病率和死亡率.
- 维持性支气管扩展剂是标准的COPD治疗方法,常常添加吸入性皮质类固醇 (ICS).
研究的目的:
- 审查ICS在稳定的COPD患者的维持治疗中的作用,特别是与支气管扩展剂结合使用.
- 为了比较指南建议与真实世界使用的三重吸入疗法.
主要方法:
- 对现有文献和指导方针进行叙述性审查.
- 讨论近期随机对照试验的三重吸入疗法与双重支气管扩展剂治疗.
主要成果:
- 指导方针建议ICS用于特定的COPD亚组 (例如,喘病史,频繁恶化与高乙酸盐).
- 在现实世界中,三重疗法的使用是广泛的,通常超过指南指示.
- 在最近的试验中,与双重支气管扩展剂治疗相比,三重疗法显示所有原因死亡率降低.
- ICS的使用与局部不良事件 (失声症,角膜炎,肺炎) 和潜在的系统性影响有关.
结论:
- 在稳定的COPD中使用ICS需要仔细考虑,这与常见的临床实践有所不同.
- 在降低死亡率方面,三重疗法的益处必须与潜在的不良事件和特定的患者个人资料进行权衡.
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