van der Molen Thys, Cazzola Mario
Department of General Practice, University Medical Center Groningen, Groningen, The Netherlands.
Prim Care Respir J. 2012 Mar;21(1):101-8. doi: 10.4104/pcrj.2011.00102.
Bronchodilators are central to the management of chronic obstructive pulmonary disease (COPD). Clinical studies combining different classes of bronchodilators, in particular a long-acting muscarinic antagonist (LAMA) and a long-acting β2-agonist (LABA), have demonstrated greater improvements in lung function (forced expiratory volume in 1 second, FEV1) in patients with COPD than monotherapy. FEV1 has served as an important diagnostic measurement of COPD, and the majority of clinical studies of currently available pharmacotherapies grade effectiveness of treatment regimens based on improvements in FEV1. However, FEV1 alone may not adequately reflect the overall health status of the patient. Published evidence suggests that LABA/LAMA combination therapies demonstrate greater improvements in patient-centred outcomes such as dyspnoea, symptoms, rescue medication use, and quality of life than individual drugs used alone. Evaluating patient-centred outcomes associated with COPD is likely to play an important role in future research as a measure of overall treatment effectiveness. Raising awareness of the importance of outcomes beyond lung function alone, particularly in primary care where most patients initially present themselves for medical evaluation, should form a fundamental part of a more holistic approach to COPD management.
支气管扩张剂是慢性阻塞性肺疾病（COPD）管理的核心。将不同类别的支气管扩张剂，特别是长效毒蕈碱拮抗剂（LAMA）和长效β2受体激动剂（LABA）联合使用的临床研究表明，与单一疗法相比，COPD患者的肺功能（一秒用力呼气容积，FEV1）有更大改善。FEV1一直是COPD的重要诊断指标，目前大多数现有药物治疗的临床研究都是根据FEV1的改善情况来评估治疗方案的有效性。然而，仅FEV1可能无法充分反映患者的整体健康状况。已发表的证据表明，与单独使用单一药物相比，LABA/LAMA联合疗法在以患者为中心的结局方面表现出更大改善，如呼吸困难、症状、急救药物使用和生活质量。评估与COPD相关的以患者为中心的结局，作为衡量整体治疗效果的指标，可能在未来研究中发挥重要作用。提高对仅肺功能以外结局重要性的认识，特别是在大多数患者最初前来接受医学评估的初级保健中，应该成为更全面的COPD管理方法的基本组成部分。
