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首页> 外文期刊>Drugs and aging >Is combination therapy with inhaled anticholinergics and beta2-adrenoceptor agonists justified for chronic obstructive pulmonary disease?
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Is combination therapy with inhaled anticholinergics and beta2-adrenoceptor agonists justified for chronic obstructive pulmonary disease?

机译：吸入抗胆碱能药和β2-肾上腺素能受体激动剂联合治疗对慢性阻塞性肺疾病是否合理？

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Chronic obstructive pulmonary disease (COPD) is a debilitating condition characterised by progressive, irreversible airflow limitation. The economic and social burden of the disease is enormous. The treatment of COPD is guided by the stage of the disease and is aimed primarily at control of symptoms. Bronchodilators are the cornerstone of pharmacological management of COPD. Short-acting bronchodilators (beta(2)-adrenoceptor agonists and anticholinergics) have been available for many years and have been extensively studied as individual agents and in combination. When administered in combination, short-acting bronchodilators provide superior bronchodilation compared with individual agents given alone. However, the improvement in bronchodilation does not translate into an improvement in quality-of-life (QOL) indices. More recently, long-acting beta(2)-adrenoceptor agonists (LABAs) and anticholinergics have been introduced, and current guidelines recommend regular use of these agents in COPD of Global initiative for chronic Obstructive Lung Disease (GOLD) stage II or more. Combining short-acting anticholinergics with LABAs for daily use has been evaluated, but this combination does not confer any advantage in terms of subjective improvement or prevention of exacerbations. Combining the long-acting anticholinergic tiotropium bromide with formoterol given once or twice daily improves airway obstruction and hyperinflation. However, the effects of combinations of long-acting bronchodilators on patients' symptom scores, QOL and exacerbations remain to be studied. Ultra-LABAs, which are in development, may enable use of a combination of long-acting bronchodilators in a single inhaler for once-daily use, thus simplifying the regimen. This article discusses the results of various clinical trials comparing the efficacy of bronchodilators given alone or in combination to patients with COPD, with emphasis on the effects of these agents on bronchodilation, symptomatic and objective improvements in QOL and prevention of exacerbations.
机译：慢性阻塞性肺疾病（COPD）是一种令人衰弱的疾病，其特征是进行性，不可逆的气流受限。该疾病的经济和社会负担是巨大的。 COPD的治疗以疾病的阶段为指导，主要目的是控制症状。支气管扩张剂是COPD药理学管理的基石。短效支气管扩张剂（β（2）-肾上腺素能受体激动剂和抗胆碱能药）已经问世多年，并且已作为单独的药物或联合应用进行了广泛的研究。与单独使用的单独药物相比，短效支气管扩张药联合使用时，支气管扩张作用更强。但是，支气管扩张的改善并未转化为生活质量（QOL）指数的改善。最近，已经引入了长效β（2）-肾上腺素受体激动剂（LABA）和抗胆碱能药，目前的指南建议在慢性阻塞性肺病（GOLD）II期或以上的全球计划的COPD中定期使用这些药物。已经评估了将短效抗胆碱药与LABA日常组合使用，但是这种组合在主观改善或预防加重方面没有任何优势。长效抗胆碱能噻托溴铵与福莫特罗的组合每天一次或两次，可以改善气道阻塞和过度充气。然而，长效支气管扩张剂联合使用对患者症状评分，生活质量和病情加重的影响仍有待研究。正在开发中的Ultra-LABA可将长效支气管扩张剂的组合用于单个吸入器中，每天使用一次，从而简化了治疗方案。本文讨论了各种临床试验的结果，这些试验比较了单独或联合给予COPD患者的支气管扩张药的疗效，重点是这些药物对支气管扩张，生活质量改善的症状和客观改善以及预防加重的影响。

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