Szmidt Mirosław
Oddział Kliniczny Chorób Wewnętrznych i Alergologii, Katedra Nauk Klinicznych, Wydział Nauk Biomedycznych i Kształcenia Podyplomowego Uniwersytetu Medycznego w Łodzi.
Pneumonol Alergol Pol. 2012;80(3):255-62.
Bronchodilators - long-acting b2-adrenergic agonists (formoterol and salmeterol) and a long-acting antimuscarinic drug (tiotropium), are the main drugs applied in symptomatic treatment of COPD. In patients with COPD, dyspnea is frequently associated with simple everyday activities. Two questionnaires have been published recently as a means of assessing the patients' ability to perform morning activities and symptoms. Dynamic hyperinflation is the pathophysiological disorder responsible for dyspnea and decreased exercise tolerance in COPD. Formoterol is faster than salmeterol in diminishing air-trapping. It has been shown that treatment with formoterol and tiotropium in COPD patients improves FEV(1), FVC, IC, symptoms score and quality of life in comparison with tiotropium applied alone. Among LABA and inhaled glucocorticosteroids combinations, those containing formoterol have a more beneficial effect on the ability to perform simple morning activities (budesonide/formoterol was better than fluticasone/salmeterol). Beclomethasone/formoterol - 400/24 mcg/die, in comparison with fluticasone/salmeterol - 500/100 mcg/die significantly reduced air-trapping and dyspnea in COPD patients. The comparison of budesonide/formoterol - 400/12 mcg 2 x die with beclomethasone/ /formoterol - 200/12 mcg 2 x die has shown similar influence of both combinations on FEV(1), dyspnea, 6-minute walk test, symptoms score and quality of life. The addition of budesonide and formoterol combination to tiotropium gives further benefits: reduces number of exacerbations, improves FEV1, symptoms score and performance of simple morning routines. Doctors should pay more attention to symptoms and limitations in simple activities in the morning and adequately adjust the treatment.
支气管扩张剂——长效β2肾上腺素能激动剂（福莫特罗和沙美特罗）以及长效抗胆碱能药物（噻托溴铵），是慢性阻塞性肺疾病（COPD）症状性治疗的主要药物。在COPD患者中，呼吸困难常常与日常简单活动相关。最近发表了两份问卷，作为评估患者进行晨间活动能力和症状的手段。动态肺过度充气是导致COPD患者呼吸困难和运动耐力下降的病理生理紊乱。福莫特罗在减少气体陷闭方面比沙美特罗更快。研究表明，与单独使用噻托溴铵相比，COPD患者使用福莫特罗和噻托溴铵治疗可改善第1秒用力呼气容积（FEV1）、用力肺活量（FVC）、吸气量（IC）、症状评分和生活质量。在长效β2肾上腺素能激动剂（LABA）与吸入性糖皮质激素的联合制剂中，含福莫特罗的制剂对进行简单晨间活动的能力有更有益的影响（布地奈德/福莫特罗优于氟替卡松/沙美特罗）。与氟替卡松/沙美特罗500/100微克/日相比，倍氯米松/福莫特罗400/24微克/日显著降低了COPD患者的气体陷闭和呼吸困难。布地奈德/福莫特罗400/12微克每日2次与倍氯米松/福莫特罗200/12微克每日2次的比较显示，两种联合制剂对FEV1、呼吸困难、6分钟步行试验、症状评分和生活质量的影响相似。在噻托溴铵基础上加用布地奈德和福莫特罗联合制剂有更多益处：减少急性加重次数，改善FEV1、症状评分和简单晨间日常活动表现。医生应更多关注晨间简单活动中的症状和限制，并适当调整治疗。
