Insaf Respiratory Research Institute, Wiesbaden, Germany.
Adv Ther. 2010 Mar;27(3):150-9. doi: 10.1007/s12325-010-0017-6. Epub 2010 Apr 19.
Bronchodilators are the cornerstone of symptomatic treatment for all chronic obstructive pulmonary disease (COPD) severity stages when administered on a regular basis to prevent or reduce symptoms and exacerbations. The principal inhaled bronchodilator treatments are beta-2 agonists and anticholinergics, used singularly or in combination. There is good evidence that regular treatment with long-acting bronchodilators is more effective and convenient than treatment with short-acting bronchodilators. Long-acting agents include the twice-daily beta-2 agonists formoterol and salmeterol, the once-daily anticholinergic tiotropium, and, more recently, the once-daily beta-2 agonist indacaterol. Long-acting bronchodilators have been shown to improve multiple clinical outcomes in COPD in comparison to short-acting agents including lung function, symptoms, dyspnea, quality of life, and exacerbations. Studies of head-to-head comparisons of long-acting bronchodilators are scant but indicate superior bronchodilation of tiotropium over salmeterol, while preliminary data from trials with the novel once-daily beta-2 agonist indacaterol indicate superior bronchodilation and clinical efficacy over twice-daily long-acting beta-2 agonists and at least equipotent bronchodilation as once-daily tiotropium. These recent therapeutic developments in COPD represent a change of paradigm with a shift from short-acting bronchodilators with multiple dosing per day to reduced dosing frequency and prolonged duration of action including once-daily treatment. This review summarizes relevant data and landmark studies comparing the efficacy of short-acting versus longer-acting bronchodilators in COPD, including new data for once-daily indacaterol, and discusses potential mechanism underlying the improved efficacy of long-acting versus short-acting bronchodilators.
支气管扩张剂是所有慢性阻塞性肺疾病（COPD）严重程度阶段的症状治疗基石，当定期使用以预防或减少症状和加重时。主要的吸入性支气管扩张剂治疗是β2 激动剂和抗胆碱能药物，单独使用或联合使用。有充分的证据表明，长效支气管扩张剂的常规治疗比短效支气管扩张剂更有效和方便。长效药物包括每天两次的β2 激动剂福莫特罗和沙美特罗、每天一次的抗胆碱能药物噻托溴铵，以及最近的每天一次的β2 激动剂茚达特罗。长效支气管扩张剂已被证明在与短效药物相比，可改善 COPD 的多种临床结局，包括肺功能、症状、呼吸困难、生活质量和加重。长效支气管扩张剂头对头比较的研究很少，但表明噻托溴铵对沙美特罗的支气管扩张作用更优，而新型每天一次的β2 激动剂茚达特罗的试验初步数据表明，与每天两次的长效β2 激动剂相比，其支气管扩张和临床疗效更优，与每天一次的噻托溴铵相比，支气管扩张作用至少相当。COPD 最近的这些治疗进展代表了一种范式的转变，从每天多次给药的短效支气管扩张剂转变为减少给药频率和延长作用持续时间，包括每天一次的治疗。本综述总结了比较 COPD 中短效与长效支气管扩张剂疗效的相关数据和里程碑研究，包括每天一次的茚达特罗的新数据，并讨论了长效与短效支气管扩张剂疗效提高的潜在机制。
