Department of Thoracic Medicine, National Heart and Lung Institute, Imperial College, London, UK.
Int J Chron Obstruct Pulmon Dis. 2011 Jan 10;6:47-61. doi: 10.2147/COPD.S13758.
Chronic obstructive pulmonary disease (COPD) is a leading cause of disability and mortality. Caring for patients with COPD, particularly those with advanced disease who experience frequent exacerbations, places a significant burden on health care budgets, and there is a global need to reduce the financial and personal burden of COPD. Evolving scientific evidence on the natural history and clinical course of COPD has fuelled a fundamental shift in our approach to the disease. The emergence of data highlighting the heterogeneity in rate of lung function decline has altered our perception of disease progression in COPD and our understanding of appropriate strategies for the management of stable disease. These data have demonstrated that early, effective, and prolonged bronchodilation has the potential to slow the rate of decline in lung function and to reduce the frequency of exacerbations that contribute to functional decline. The goals of therapy for COPD are no longer confined to controlling symptoms, reducing exacerbations, and maintaining quality of life, and slowing disease progression is now becoming an achievable aim. A challenge for the future will be to capitalize on these observations by improving the identification and diagnosis of patients with COPD early in the course of their disease, so that effective interventions can be introduced before the more advanced, disabling, and costly stages of the disease. Here we critically review emerging data that underpin the advances in our understanding of the clinical course and management of COPD, and evaluate both current and emerging pharmacologic options for effective maintenance treatment.
慢性阻塞性肺疾病（COPD）是导致残疾和死亡的主要原因。照顾 COPD 患者，特别是那些经常发生急性加重的晚期疾病患者，给医疗保健预算带来了巨大的负担，因此全球需要减轻 COPD 的经济和个人负担。关于 COPD 自然史和临床过程的不断发展的科学证据推动了我们对该疾病治疗方法的根本性转变。强调肺功能下降率异质性的数据的出现改变了我们对 COPD 疾病进展的看法，以及我们对稳定疾病管理的适当策略的理解。这些数据表明，早期、有效和持久的支气管扩张有可能减缓肺功能下降的速度，并减少导致功能下降的急性加重的频率。COPD 治疗的目标不再仅限于控制症状、减少急性加重和维持生活质量，减缓疾病进展现在成为一个可实现的目标。未来的挑战将是通过在疾病早期识别和诊断 COPD 患者，利用这些观察结果，在疾病更晚期、更具致残性和更高成本阶段之前引入有效的干预措施。在这里，我们批判性地回顾了支持我们对 COPD 临床过程和管理理解的最新数据，并评估了有效的维持治疗的当前和新兴药物选择。
