Sin Don D, Man S F Paul
The James Hogg iCAPTURE Center for Cardiovascular and Pulmonary Research, St. Paul's Hospital, Room 368A, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6 Canada.
Proc Am Thorac Soc. 2006 Sep;3(7):624-9. doi: 10.1513/pats.200603-096SS.
Despite rapid advances in our understanding of its pathophysiology, chronic obstructive pulmonary disease (COPD) remains incurable. Although bronchodilators and theophyllines are commonly used to treat symptoms of dyspnea and cough and to acutely improve lung function, they do not modify the long-term decline in FEV(1). The principal goals of current COPD pharmacotherapy are to reduce exacerbations, improve health status, and prolong survival. There is strong evidence, including data from randomized clinical trials, that indicates inhaled corticosteroids alone, or in combination with a long-acting beta(2)-adrenoceptor agonist, improve patient symptoms, reduce morbidity, and perhaps even prolong survival in COPD. A recent individual patient-based meta-analysis of randomized, placebo-controlled trials of inhaled corticosteroids in COPD indicated that mortality over 3-4 yr was 27% lower in the group that received inhaled corticosteroids compared with the group that received placebo. Several short-term follow-up trials have also suggested a reduction in mortality with a combination of long-acting beta(2)-agonist and inhaled corticosteroids, and a large, long-term study that is currently ongoing (the Toward a Revolution in COPD Health [TORCH] study) will provide data on the effects of fluticasone propionate and salmeterol in combination on all-cause mortality. This article reviews some of the relevant epidemiologic and pathophysiologic processes that affect mortality in COPD and critically examines the effect of current COPD therapies on mortality.
尽管我们对慢性阻塞性肺疾病（COPD）病理生理学的理解取得了快速进展，但该疾病仍然无法治愈。虽然支气管扩张剂和茶碱类药物常用于治疗呼吸困难和咳嗽症状，并能急性改善肺功能，但它们并不能改变第一秒用力呼气容积（FEV₁）的长期下降趋势。当前COPD药物治疗的主要目标是减少急性加重、改善健康状况并延长生存期。有充分的证据，包括来自随机临床试验的数据，表明单独使用吸入性糖皮质激素或与长效β₂肾上腺素受体激动剂联合使用，可改善COPD患者的症状、降低发病率，甚至可能延长生存期。最近一项基于个体患者的对COPD患者吸入性糖皮质激素随机、安慰剂对照试验的荟萃分析表明，在3至4年的时间里，接受吸入性糖皮质激素治疗的组比接受安慰剂治疗的组死亡率低27%。几项短期随访试验也表明，长效β₂激动剂与吸入性糖皮质激素联合使用可降低死亡率，目前正在进行的一项大型长期研究（慢性阻塞性肺疾病健康革命研究 [TORCH]）将提供丙酸氟替卡松和沙美特罗联合使用对全因死亡率影响的数据。本文回顾了一些影响COPD死亡率的相关流行病学和病理生理过程，并批判性地审视了当前COPD治疗方法对死亡率的影响。
