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联合支气管扩张剂治疗慢性阻塞性肺疾病。

Combination bronchodilator therapy in the management of chronic obstructive pulmonary disease.

机构信息

Department of Medicine, David Geffen School of Medicine at UCLA, 405 Hilgard Avenue, Los Angeles, CA 90095, USA.

出版信息

Respir Res. 2013 May 8;14(1):49. doi: 10.1186/1465-9921-14-49.

Abstract

Chronic obstructive pulmonary disease (COPD) represents a significant cause of global morbidity and mortality, with a substantial economic impact. Recent changes in the Global initiative for chronic Obstructive Lung Disease (GOLD) guidance refined the classification of patients for treatment using a combination of spirometry, assessment of symptoms, and/or frequency of exacerbations. The aim of treatment remains to reduce existing symptoms while decreasing the risk of future adverse health events. Long-acting bronchodilators are the mainstay of therapy due to their proven efficacy. GOLD guidelines recommend combining long-acting bronchodilators with differing mechanisms of action if the control of COPD is insufficient with monotherapy, and recent years have seen growing interest in the additional benefits that combination of long-acting muscarinic antagonists (LAMAs), typified by tiotropium, with long-acting β(2)-agonists (LABAs), such as formoterol and salmeterol. Most studies have examined free combinations of currently available LAMAs and LABAs, broadly showing a benefit in terms of lung function and other patient-reported outcomes, although evidence is limited at present. Several once- or twice-daily fixed-dose LAMA/LABA combinations are under development, most involving newly developed monotherapy components. This review outlines the existing data for LAMA/LABA combinations in the treatment of COPD, summarizes the ongoing trials, and considers the evidence required to inform the role of LAMA/LABA combinations in treatment of this disease.

摘要

慢性阻塞性肺疾病(COPD)是全球发病率和死亡率的重要原因,具有重大的经济影响。全球慢性阻塞性肺病倡议(GOLD)指南的最新变化通过结合肺活量测定、症状评估和/或加重频率,对患者的治疗进行了分类。治疗的目的仍然是减轻现有症状,同时降低未来不良健康事件的风险。长效支气管扩张剂是治疗的主要手段,因为它们具有已证实的疗效。GOLD 指南建议,如果 COPD 的控制不足,联合使用长效支气管扩张剂,并且具有不同的作用机制,如果单药治疗不足,近年来,长效毒蕈碱拮抗剂(LAMA)与长效β(2)-激动剂(LABA)的联合应用引起了越来越多的关注,以噻托溴铵为代表。大多数研究都考察了目前可用的 LAMA 和 LABA 的自由联合应用,尽管目前证据有限,但广泛显示在肺功能和其他患者报告的结果方面有获益。目前正在开发几种每日一次或两次的固定剂量 LAMA/LABA 联合制剂,大多数涉及新开发的单药成分。这篇综述概述了 LAMA/LABA 联合治疗 COPD 的现有数据,总结了正在进行的试验,并考虑了确定 LAMA/LABA 联合治疗这种疾病的作用所需的证据。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d520/3651866/516cc5fc5db5/1465-9921-14-49-1.jpg

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