Ingenito Edward P
Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Semin Thorac Cardiovasc Surg. 2007 Summer;19(2):142-50. doi: 10.1053/j.semtcvs.2007.06.003.
Medical treatment for patients with stable chronic obstructive pulmonary disease (COPD) has evolved significantly over the past 2 decades. Current World Health Organization recommendations suggest a stepwise approach to therapy depending upon disease severity. As-needed use of short-acting bronchodilators is recommended for patients with mild disease. Scheduled dosing of bronchodilators is recommended for patients with more advanced disease. Inhaled beta-agonists and anti-cholinergic agents in combination have proved to be more effective than either agent alone. Long-acting preparations are associated with better disease control and have not been associated with tachyphylaxis. Inhaled corticosteroids are useful for reducing the frequency of exacerbations in patients who experience one or more episodes per year. Oxygen therapy is clearly beneficial in patients with advanced COPD and chronic respiratory failure, and its potential benefits in less severe disease are currently being studied. Pulmonary rehabilitation benefits patients with mild-to-severe disease, although the greatest benefits have been demonstrated in those with moderate COPD. New ultra-long-acting inhaled bronchodilators, phosphodiesterase inhibitors, protease inhibitors, and retinoids intended to promote tissue regeneration are currently being evaluated in clinical trials as future therapeutic agents.
在过去20年中，稳定期慢性阻塞性肺疾病（COPD）患者的医学治疗有了显著进展。世界卫生组织目前的建议是根据疾病严重程度采取逐步治疗方法。对于轻度疾病患者，建议按需使用短效支气管扩张剂。对于病情更严重的患者，建议定期使用支气管扩张剂。事实证明，吸入性β受体激动剂和抗胆碱能药物联合使用比单独使用任何一种药物都更有效。长效制剂与更好的疾病控制相关，且未出现快速耐受现象。吸入性糖皮质激素有助于减少每年发作一次或多次的患者的病情加重频率。氧疗对晚期COPD和慢性呼吸衰竭患者显然有益，目前正在研究其在病情较轻患者中的潜在益处。肺康复对轻至重度疾病患者有益，尽管在中度COPD患者中已证明获益最大。新型超长效吸入性支气管扩张剂、磷酸二酯酶抑制剂、蛋白酶抑制剂以及旨在促进组织再生的类视黄醇目前正在临床试验中作为未来治疗药物进行评估。
