Highland Kristin B
Division of Pulmonary, Critical Care, Allergy and Clinical Immunology, Medical University of South Carolina, Charleston, South Carolina, USA.
Curr Opin Pulm Med. 2004 Mar;10(2):113-9. doi: 10.1097/00063198-200403000-00005.
The use of inhaled corticosteroids is one of the most controversial issues in COPD pharmacotherapy. Experts disagree about the benefits and harms of ICS for patients with COPD, yet a majority of patients with COPD are being treated with inhaled corticosteroids. This is a review of the most recent literature on this subject.
Evidence suggests that ICS, with or without a long-acting beta2-agonist, are cost-effective in reducing exacerbation rates and retarding the decline in health status of COPD patients, although they do not significantly modify the rate of decline in FEV1 or change mortality. This discrepancy is likely related to the differences in pathology of COPD when compared with asthma. Evidence also suggests that ICS may be safe regarding the effects on adrenals and bone mineral density. We have yet to identify reliable criteria for predicting a response to ICS in COPD, but it has become clear that in mild disease, no beneficial effect has been demonstrated.
In contrast to asthma, inhaled corticosteroids should not be used as a first-line medication in patients with COPD. Identification of patients with COPD who might benefit from long-term treatment with ICS remains paramount.
吸入性糖皮质激素的使用是慢性阻塞性肺疾病（COPD）药物治疗中最具争议的问题之一。专家们对于COPD患者使用吸入性糖皮质激素（ICS）的利弊存在分歧，但大多数COPD患者仍在接受吸入性糖皮质激素治疗。本文对该主题的最新文献进行综述。
有证据表明，无论是否联用长效β2受体激动剂，ICS在降低COPD患者急性加重率和延缓健康状况恶化方面具有成本效益，尽管它们不会显著改变第一秒用力呼气容积（FEV1）的下降速率或降低死亡率。与哮喘相比，这种差异可能与COPD的病理差异有关。有证据还表明，ICS对肾上腺和骨密度的影响可能是安全的。我们尚未确定预测COPD患者对ICS反应的可靠标准，但很明显，在轻度疾病中，尚未证明其有益作用。
与哮喘不同，吸入性糖皮质激素不应作为COPD患者的一线用药。确定可能从长期ICS治疗中获益的COPD患者仍然至关重要。
