Mahler Donald A
Section of Pulmonary and Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
J Allergy Clin Immunol. 2002 Dec;110(6 Suppl):S298-303. doi: 10.1067/mai.2002.129703.
The major clinical outcomes measured in evaluating the responses to pharmacotherapy in patients with chronic obstructive pulmonary disease (COPD) include the severity of dyspnea, exercise capacity, exacerbations, and health status. Various studies have demonstrated that testing for acute bronchodilator reversibility in the pulmonary function laboratory does not predict the clinical responses to a trial of bronchodilator therapy in patients with COPD. Separate studies have shown that inhaled albuterol, both a single dose (300 microg) and 2 weeks of therapy (200 microg/4x/day), reduces dyspnea. There is more published information available about the effects of long-acting (>/=12 hours' duration of action) inhaled beta(2)-agonists because of greater interest in considering clinical outcomes at the time of drug testing. In one randomized clinical trial, formoterol reduced symptoms (as recorded in a home diary) and improved health status. Nine clinical studies have examined the effects of salmeterol on clinical outcomes. Salmeterol reduced the perception of breathlessness (in 6 of 9 studies) and improved health status (in 3 of 4 studies). These results collectively demonstrate that long-acting inhaled beta(2)-agonists not only relax bronchial smooth muscle but also provide important clinical benefits in symptomatic patients with COPD.
评估慢性阻塞性肺疾病（COPD）患者药物治疗反应的主要临床指标包括呼吸困难的严重程度、运动能力、急性加重情况和健康状况。多项研究表明，在肺功能实验室进行急性支气管扩张剂可逆性检测并不能预测COPD患者支气管扩张剂治疗试验的临床反应。另有研究显示，吸入沙丁胺醇，无论是单次剂量（300微克）还是治疗2周（200微克/每日4次），均可减轻呼吸困难。由于在药物试验时对临床结局的关注更多，因此关于长效（作用持续时间≥12小时）吸入β2受体激动剂效果的已发表信息更多。在一项随机临床试验中，福莫特罗减轻了症状（如家庭日记所记录）并改善了健康状况。九项临床研究考察了沙美特罗对临床结局的影响。沙美特罗减轻了呼吸困难的感觉（9项研究中有6项）并改善了健康状况（4项研究中有3项）。这些结果共同表明，长效吸入β2受体激动剂不仅能舒张支气管平滑肌，还能为有症状的COPD患者带来重要的临床益处。
