Schachter E N
Mount Sinai Medical School of Medicine, New York, NY, USA.
Drugs Today (Barc). 2013 Jul;49(7):437-46. doi: 10.1358/dot.2013.49.7.1980496.
Chronic obstructive pulmonary disease (COPD) is a worldwide problem causing prolonged and progressive morbidity as well as premature mortality. Pharmacologic treatment consists primarily in the relief of symptoms and preventing or minimizing the consequences of exacerbations. Central to the pharmacologic management of COPD is the use of bronchodilator therapy. Two major classes of agents are frequently used: β-adrenoceptor agonists and antimuscarinic agents. These drugs are used mainly in the inhalational form, primarily as rescue medication, but occasionally for maintenance in combination therapy. The availability of "ultra-long"-acting β-adrenoceptor agonists and long-acting antimuscarinic agents opens the way for combinations of these agents to be used in maintenance therapy. Such a combination offers the potential of enhanced efficacy due to additive effects and better compliance as the result of once-daily treatment. This article reviews the rationale for current bronchodilator therapy of COPD as well as the current status of a fixed-dose combined inhaler using two novel long-acting agents: glycopyrronium bromide and indacaterol maleate.
慢性阻塞性肺疾病（COPD）是一个全球性问题，会导致长期且渐进性的发病以及过早死亡。药物治疗主要在于缓解症状以及预防或尽量减少急性加重的后果。COPD药物治疗的核心是使用支气管扩张剂疗法。常用的两大类药物是：β-肾上腺素能受体激动剂和抗毒蕈碱药物。这些药物主要以吸入形式使用，主要作为急救药物，但偶尔也用于联合治疗中的维持治疗。“超长效”β-肾上腺素能受体激动剂和长效抗毒蕈碱药物的出现为这些药物联合用于维持治疗开辟了道路。这种联合使用由于具有相加效应而有可能提高疗效，并且由于每日一次给药而具有更好的依从性。本文综述了目前COPD支气管扩张剂治疗的理论依据以及一种使用两种新型长效药物：格隆溴铵和马来酸茚达特罗的固定剂量联合吸入器的现状。
