Fenton Caroline, Keating Gillian M
Adis International Limited, Auckland, New Zealand.
Drugs. 2004;64(17):1975-96. doi: 10.2165/00003495-200464170-00014.
The salmeterol/fluticasone propionate dry powder inhaler (DPI) [Advair Diskus, Seretide Accuhaler] contains the long-acting beta2-adrenoceptor agonist salmeterol and the inhaled corticosteroid fluticasone propionate. In the US, twice-daily salmeterol/fluticasone propionate 50/250 microg is approved for use in adults with chronic obstructive pulmonary disease (COPD) associated with chronic bronchitis, and in the EU, the twice-daily 50/500 microg dosage is approved for use in patients with severe COPD, repeat exacerbations and significant symptoms despite bronchodilator therapy. In patients with moderate-to-severe COPD, twice-daily inhaled salmeterol/fluticasone propionate 50/250 or 50/500 microg for 24-52 weeks improves predose forced expiratory volume in 1 second (FEV1) significantly more than salmeterol monotherapy, improves postdose or postbronchodilator FEV1 significantly more than fluticasone propionate monotherapy and results in clinically significant improvements in health-related quality of life. Salmeterol/fluticasone propionate 50/500 microg significantly reduced annual COPD exacerbations, especially in severe COPD. Some corticosteroid-related adverse events were increased in recipients of fluticasone propionate with or without salmeterol versus salmeterol monotherapy or placebo; withdrawal from fluticasone propionate, including combination therapy, needs careful management to minimise COPD exacerbations. The DPI combining a corticosteroid and long-acting beta2-agonist provides benefits over monotherapy and may encourage patient compliance in COPD.
沙美特罗/丙酸氟替卡松干粉吸入器（DPI）[舒利迭准纳器、信必可都保] 含有长效β2肾上腺素能受体激动剂沙美特罗和吸入性糖皮质激素丙酸氟替卡松。在美国，每日两次吸入50/250微克沙美特罗/丙酸氟替卡松被批准用于患有与慢性支气管炎相关的慢性阻塞性肺疾病（COPD）的成人；在欧盟，每日两次吸入50/500微克的剂量被批准用于患有严重COPD、尽管接受了支气管扩张剂治疗仍反复急性加重且有明显症状的患者。在中重度COPD患者中，每日两次吸入50/250或50/500微克沙美特罗/丙酸氟替卡松，持续24 - 52周，与沙美特罗单药治疗相比，能显著提高给药前1秒用力呼气容积（FEV1）；与丙酸氟替卡松单药治疗相比，能显著提高给药后或使用支气管扩张剂后的FEV1，并能在临床上显著改善与健康相关的生活质量。50/500微克沙美特罗/丙酸氟替卡松能显著减少COPD的年度急性加重次数，尤其是在严重COPD患者中。与沙美特罗单药治疗或安慰剂相比，接受丙酸氟替卡松（无论是否与沙美特罗联用）的患者中，一些与糖皮质激素相关的不良事件有所增加；停用丙酸氟替卡松，包括联合治疗，需要谨慎处理，以尽量减少COPD急性加重。将糖皮质激素和长效β2激动剂联合使用的DPI比单药治疗更具优势，可能会提高COPD患者的依从性。
