Schuurbiers O C J, Schermer T R J, Dekhuijzen P N R, van Weel C
Universitair Medisch Centrum St Radboud, Nijmegen.
Ned Tijdschr Geneeskd. 2006 Jun 3;150(22):1227-32.
The goals of COPD management according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline are: prevention of disease progression, relief of symptoms, improvement of exercise tolerance and the quality of life, prevention and treatment of exacerbations and complications, and reduction of mortality and adverse effects. These correspond to the goals formulated in the Dutch 'National transmural agreements on COPD'. Bronchodilators play a key role in the pharmacological treatment and with the availability of tiotropium, a long-acting anticholinergic bronchodilator, it has become important to decide at what moment this is indicated in COPD management. In comparative studies, tiotropium was an effective long-acting bronchodilator that had a favourable effect not only on lung function but also on the other parameters indicated in the GOLD guideline. When maintenance treatment with bronchodilators is needed, one should consider a long-acting bronchodilator. In view of the additive positive effects, tiotropium is the bronchodilator of choice. In case of severe symptoms, a combination of tiotropium with a long-acting beta2-sympathicomimetic agent is recommended.
根据慢性阻塞性肺疾病全球倡议（GOLD）指南，慢性阻塞性肺疾病（COPD）管理的目标是：预防疾病进展、缓解症状、提高运动耐量和生活质量、预防和治疗急性加重及并发症，以及降低死亡率和不良反应。这些目标与荷兰“COPD国家跨部门协议”中制定的目标一致。支气管扩张剂在药物治疗中起关键作用，随着长效抗胆碱能支气管扩张剂噻托溴铵的出现，决定在COPD管理中的何时使用它变得很重要。在比较研究中，噻托溴铵是一种有效的长效支气管扩张剂，不仅对肺功能有良好影响，而且对GOLD指南中指出的其他参数也有良好影响。当需要使用支气管扩张剂进行维持治疗时，应考虑使用长效支气管扩张剂。鉴于其相加的积极作用，噻托溴铵是首选的支气管扩张剂。对于严重症状，建议将噻托溴铵与长效β2-肾上腺素能激动剂联合使用。
