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首页> 外文期刊>Pulmonary pharmacology & therapeutics >The impact of inhaled corticosteroid and long-acting beta-agonist combination therapy on outcomes in COPD.
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The impact of inhaled corticosteroid and long-acting beta-agonist combination therapy on outcomes in COPD.

机译：吸入糖皮质激素和长效β-激动剂联合治疗对COPD结局的影响。

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摘要

Chronic obstructive pulmonary disease (COPD) is an under-recognized cause of morbidity and mortality worldwide that imposes an ever increasing burden on the patient and society alike. The disease encompasses multiple structural and functional components of which inflammation is at the core of the disease, affecting the lungs and other organs. Consequently, current treatment strategies are aimed at treating both the symptoms and the pulmonary inflammation underlying the complex pathophysiology of COPD. Smoking cessation is the only intervention currently shown to slow disease progression in COPD and decrease all-cause mortality, aside from lung transplant, lung-volume reduction surgery and oxygen therapy in selective patients. However, this intervention is difficult to achieve and sustain because of the addictive and chronic relapsing nature of cigarette smoking. Pharmacotherapy with bronchodilating agents, including the beta(2)-agonists, anticholinergics and methylxanthines, is central to the symptomatic management of all stages of COPD. While inhaled corticosteroids (ICS) are employed to reduce inflammation in more severe patients, their role as stand alone medication in COPD is not well defined. However, increasing evidence suggests that long-acting beta(2)-agonists (LABAs) and ICS have complementary and synergistic effects, when delivered as combination therapy from a single inhaler. In this respect, two preparations comprising combinations of salmeterol+fluticasone propionate (SFC) and formoterol+budesonide (FBC) are currently available and employed for treatment of more severe disease. Several large-scale studies in patients with moderate-to-severe COPD have demonstrated that treatment with SFC and FBC leads to significantly greater improvements in lung function, exacerbations, health status and breathlessness, compared with placebo or monotherapy with the component drugs. In the recently published landmark study, Towards a Revolution in COPD Health (TORCH), regular treatment with SFC narrowly missed demonstrating a statistically significant benefit on the reduction in all-cause mortality over 3 years (17.5% reduction in risk, P=0.052), further emphasizing the clinical usefulness of LABA+ICS therapy in COPD. In view of this increasing evidence for the additional effectiveness of LABA+ICS combinations compared with the individual components, and the potential benefits of LABA+ICS on lung function, disease progression and potentially on all-cause mortality, initiation of LABA+ICS combination treatment early in the COPD disease process may be warranted. SEARCH STRATEGY: The studies discussed in this review were identified from systematic searches of Medline and the Cochrane Database, up to October 2007, for articles in English or with English abstracts describing randomized, double-blind, parallel-group/crossover trials of at least 24 weeks' duration. All searches were performed using the terms: chronic obstructive pulmonary disease, COPD, chronic obstructive airway disease, or COAD AND either salmeterol, formoterol, long-acting beta(2)-adrenoceptor agonist, fluticasone propionate, budesonide, inhaled corticosteroids, or inhaled glucocorticosteroids. Additional relevant references were identified from the reference lists of selected papers. Only studies that compared a combined LABA+ICS therapy with its monotherapy components were selected for inclusion in this manuscript.
机译：慢性阻塞性肺疾病（COPD）是世界范围内发病率和死亡率公认不足的病因，给患者和社会带来了越来越大的负担。该疾病包含多种结构和功能成分，其炎症是该疾病的核心，影响肺和其他器官。因此，当前的治疗策略旨在治疗COPD复杂病理生理学基础的症状和肺部炎症。戒烟是目前唯一能减缓COPD疾病进展并降低全因死亡率的干预措施，除了选择性移植患者的肺移植，肺减容手术和氧气疗法外。但是，由于吸烟具有成瘾性和慢性复发性，这种干预措施难以实现和维持。支气管扩张剂（包括β（2）-激动剂，抗胆碱能药和甲基黄嘌呤）的药物治疗对于COPD所有阶段的症状管理至关重要。虽然吸入性糖皮质激素（ICS）用于减轻更严重患者的炎症，但它们在COPD中作为独立药物的作用尚不清楚。但是，越来越多的证据表明，当从单个吸入器中以联合疗法的形式提供时，长效β（2）-激动剂（LABA）和ICS具有互补和协同作用。在这方面，目前可获得包含沙美特罗+丙酸氟替卡松（SFC）和福莫特罗+布地奈德（FBC）的组合的两种制剂，并用于治疗更严重的疾病。几项针对中度至重度COPD患者的大规模研究表明，与安慰剂或单一药物联合治疗相比，SFC和FBC的治疗可显着改善肺功能，恶化，健康状况和呼吸困难。在最近发表的具有里程碑意义的研究中，《走向COPD健康的革命》（TORCH）中，常规使用SFC的治疗差点被漏掉了，这表明在三年内降低全因死亡率具有统计学上的显着益处（风险降低了17.5％，P = 0.052）。 ，进一步强调了LABA + ICS疗法在COPD中的临床实用性。鉴于越来越多的证据表明，LABA + ICS联合治疗与单个成分相比具有更高的有效性，以及LABA + ICS对肺功能，疾病进展以及潜在的全因死亡率的潜在益处，因此开始LABA + ICS联合治疗可能需要在COPD疾病早期进行。搜索策略：本综述中讨论的研究是从截至2007年10月的Medline和Cochrane数据库的系统搜索中找到的，以英文或英文摘要描述了至少包含以下内容的随机，双盲，平行组/交叉试验的文章持续24周。所有搜索均使用以下术语进行：慢性阻塞性肺疾病，COPD，慢性阻塞性气道疾病或COAD和沙美特罗，福莫特罗，长效β（2）-肾上腺素受体激动剂，丙酸氟替卡松，布地奈德，吸入糖皮质激素或吸入糖皮质激素。从所选论文的参考文献列表中确定了其他相关参考文献。仅选择将LABA + ICS联合疗法与其单一疗法成分进行比较的研究，以纳入本手稿。

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