Stockley Robert A
University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
Curr Med Res Opin. 2009 May;25(5):1235-45. doi: 10.1185/03007990902868971.
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, and through under-diagnosis, is often inappropriately treated. This multicomponent disease involves both airway and systemic inflammation at all stages and may influence the progression of disease and the pathophysiology of comorbidities. This review examines evidence linking inflammation, disease progression and comorbidities in COPD, and the potential role of anti-inflammatory therapies.
Systematic searches of Medline and Cochrane Reviews databases from 1976 to March 2008 using the terms: chronic obstructive pulmonary disease, disease progression, inflammation, inflammatory, comorbid condition, comorbidity, treatment, therapy, bronchodilator, inhaled corticosteroid.
Increased levels of interleukin-8, tumour necrosis factor-alpha and systemic C-reactive protein correlate with worse disease severity, exacerbation rates and lung function decline. Increased systemic C-reactive protein is also associated with poorer health status and comorbidities (e.g. cardiovascular disease, cancer and skeletal muscle dysfunction). The pivotal role of inflammation in the pathogenesis of COPD and its comorbidities suggests anti-inflammatory therapies will be important in the overall management of COPD. Long-term studies indicate that combination therapies consisting of a long-acting beta-agonist plus an inhaled corticosteroid in one inhaler have the potential to modify disease progression through positive effects on lung function, exacerbations, symptoms and health status. The TOwards a Revolution in COPD Health (TORCH) study is the first to demonstrate that a COPD pharmacotherapy (combination salmeterol plus fluticasone propionate) significantly decreased the rate of lung function decline versus placebo.
Better understanding of the specific inflammatory mechanisms underlying COPD disease progression and associated comorbidities will likely lead to more effective management of the disease.
慢性阻塞性肺疾病（COPD）是发病和死亡的主要原因，由于诊断不足，其治疗往往并不恰当。这种多因素疾病在所有阶段均涉及气道和全身炎症，可能影响疾病进展及合并症的病理生理学。本综述探讨了COPD中炎症、疾病进展和合并症之间的关联证据，以及抗炎治疗的潜在作用。
使用以下术语对1976年至2008年3月的Medline和Cochrane综述数据库进行系统检索：慢性阻塞性肺疾病、疾病进展、炎症、炎性、合并病症、合并症、治疗、疗法、支气管扩张剂、吸入性糖皮质激素。
白细胞介素-8、肿瘤坏死因子-α和全身C反应蛋白水平升高与更严重的疾病严重程度、急性加重率及肺功能下降相关。全身C反应蛋白水平升高还与较差的健康状况和合并症（如心血管疾病、癌症和骨骼肌功能障碍）有关。炎症在COPD及其合并症发病机制中的关键作用表明，抗炎治疗在COPD的整体管理中至关重要。长期研究表明，一种吸入器中含长效β受体激动剂加吸入性糖皮质激素的联合疗法有可能通过对肺功能、急性加重、症状和健康状况的积极影响来改变疾病进展。迈向COPD健康革命（TORCH）研究首次证明，一种COPD药物疗法（沙美特罗加丙酸氟替卡松联合用药）与安慰剂相比，显著降低了肺功能下降率。
更好地了解COPD疾病进展及相关合并症背后的特定炎症机制可能会带来更有效的疾病管理。
