Mammen Manoj J, Sethi Sanjay
University at Buffalo, State University of New York at Buffalo, United States.
Pol Arch Med Wewn. 2012;122(1-2):54-9.
Acute exacerbations are a major contributor to health care costs and a leading cause of death in patients with chronic obstructive pulmonary disease (COPD). A reduction in acute exacerbations of COPD (AECOPD) would lead to significant improvements in patient well-being and survival. Bacterial and viral infections cause a majority of AECOPD episodes; however, with the exception of influenza and pneumococcal vaccines, preventative therapies for exacerbations do not directly address these infectious causes of AECOPD. Antibiotics were shown to have marginal benefit in preventing AECOPD several decades ago; however, since then, pathogens and antibiotics have changed substantially. Macrolides display immunomodulatory and anti-inflammatory effects in addition to their direct antibacterial effect. Several studies have examined macrolides in AECOPD prevention, with a recent landmark study by Albert et al. clearly demonstrating the efficacy of azithromycin in preventing AECOPD. Unfortunately, the rate of isolation of macrolide-resistant pathogens does increase with such treatment. Macrolides could also suppress bacterial colonization and thus decrease airway inflammation, thereby interrupting the vicious cycle of inflammation and infection in COPD. COPD patients with two or more exacerbations a year in spite of appropriate standard therapy are potential candidates for this therapeutic approach. However, optimal duration and dosing of macrolide prophylaxis for AECOPD remains uncertain.
急性加重是慢性阻塞性肺疾病(COPD)患者医疗费用的主要构成因素及死亡的主要原因。减少慢性阻塞性肺疾病急性加重(AECOPD)将显著改善患者的健康状况和生存率。细菌和病毒感染导致了大多数AECOPD发作;然而,除流感疫苗和肺炎球菌疫苗外,针对加重的预防性治疗并未直接针对这些导致AECOPD的感染病因。几十年前就已表明抗生素在预防AECOPD方面益处不大;然而,从那时起,病原体和抗生素都已发生了很大变化。大环内酯类药物除了具有直接抗菌作用外,还具有免疫调节和抗炎作用。多项研究已对大环内酯类药物在预防AECOPD方面进行了考察,最近Albert等人的一项具有里程碑意义的研究清楚地证明了阿奇霉素在预防AECOPD方面的疗效。不幸的是,接受此类治疗时,对大环内酯类耐药病原体的分离率确实会增加。大环内酯类药物还可抑制细菌定植,从而减轻气道炎症,进而打断COPD中炎症和感染的恶性循环。尽管接受了适当的标准治疗,但每年仍有两次或更多次加重发作的COPD患者是这种治疗方法的潜在适用对象。然而,用于AECOPD的大环内酯类药物预防性治疗的最佳疗程和剂量仍不确定。