Falk Jeremy A, Minai Omar A, Mosenifar Zab
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cedars-Sinai Medical Center for the David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
Proc Am Thorac Soc. 2008 May 1;5(4):506-12. doi: 10.1513/pats.200707-096ET.
Systemic and local inflammation is central to the pathophysiology of chronic obstructive pulmonary disease (COPD). Increased levels of inflammation have been linked to a more progressive course in COPD and have been shown to be present during an exacerbation. Decreases in inflammatory cytokines, C-reactive protein, and inflammatory cells have been observed with corticosteroid use, suggesting a possible mechanism for a therapeutic benefit of steroids. No available data support the routine use of systemic corticosteroids in stable COPD; however, short courses during exacerbations are likely to improve length of hospitalization, lung function, and relapse rate. Inhaled corticosteroids (ICS) decrease the rate of exacerbation and may improve the response to bronchodilators and decrease dyspnea in stable COPD. No study shows that ICS reduce the loss of lung function; however, recent data suggest a possible survival benefit when combined with long-acting beta agonists. There are limited data on the use of ICS in the treatment of acute exacerbations of COPD, and its role in this setting must be more clearly defined. The empiric use of systemic corticosteroids perioperatively represents another area of uncertainty. The role of pharmacogenetics in the metabolism of corticosteroids in COPD is evolving but may be partially responsible for the observed variability in patient responsiveness. The potential benefits of systemic or inhaled corticosteroid use must be weighed against the risk of known toxicities.
全身和局部炎症是慢性阻塞性肺疾病（COPD）病理生理学的核心。炎症水平升高与COPD更进展性的病程相关，并且已证实在病情加重期间炎症水平会升高。使用皮质类固醇后观察到炎症细胞因子、C反应蛋白和炎症细胞水平降低，提示类固醇具有治疗益处的一种可能机制。目前尚无可用数据支持在稳定期COPD常规使用全身皮质类固醇；然而，在病情加重期间短期使用可能会缩短住院时间、改善肺功能并降低复发率。吸入性皮质类固醇（ICS）可降低病情加重率，并可能改善稳定期COPD患者对支气管扩张剂的反应并减轻呼吸困难。尚无研究表明ICS可减少肺功能丧失；然而，近期数据提示与长效β受体激动剂联合使用时可能具有生存获益。关于ICS用于治疗COPD急性加重的数据有限，其在这种情况下的作用必须更明确地界定。围手术期经验性使用全身皮质类固醇是另一个存在不确定性的领域。药物遗传学在COPD中皮质类固醇代谢中的作用正在不断发展，但可能部分解释了观察到患者反应性存在差异的原因。使用全身或吸入性皮质类固醇的潜在益处必须与已知毒性风险相权衡
