Prakash Anoop, Babu K Suresh, Morjaria Jaymin B
Department of Respiratory Medicine, Castle Hill Hospital, Cottingham, UK.
Department of Respiratory Medicine, Queen Alexandra Hospital, Cosham, Portsmouth, UK.
Int J Chron Obstruct Pulmon Dis. 2015 Jan 7;10:111-23. doi: 10.2147/COPD.S67758. eCollection 2015.
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. The cornerstone of pharmacological treatment for COPD is bronchodilation. Inhaled glycopyrronium bromide is a long-acting muscarinic antagonist developed as a maintenance treatment for patients with COPD. Phase III trials have shown that glycopyrronium produces rapid and sustained bronchodilation with an efficacy similar to tiotropium and is well tolerated, with a low incidence of muscarinic side effects in patients with moderate to severe COPD. A combination of glycopyrronium bromide with indacaterol maleate (QVA149) has recently been approved as a once-daily maintenance therapy in adult patients with COPD. Phase III trials (the IGNITE program) with QVA149 have demonstrated significant improvements in lung function versus placebo, glycopyrronium, and tiotropium in patients with moderate to severe COPD, with no safety concerns of note. Hence QVA149 is a safe treatment option for moderate to severe COPD patients in whom long-acting muscarinic antagonist monotherapy is inadequate.
慢性阻塞性肺疾病（COPD）是发病和死亡的主要原因。COPD药物治疗的基石是支气管扩张。吸入用格隆溴铵是一种长效毒蕈碱拮抗剂，开发用于COPD患者的维持治疗。III期试验表明，格隆溴铵可产生快速且持续的支气管扩张作用，疗效与噻托溴铵相似，耐受性良好，在中重度COPD患者中，毒蕈碱副作用发生率较低。格隆溴铵与马来酸茚达特罗（QVA149）的联合用药最近已被批准作为COPD成年患者的每日一次维持治疗药物。QVA149的III期试验（IGNITE项目）已证明，与安慰剂、格隆溴铵和噻托溴铵相比，中重度COPD患者的肺功能有显著改善，且无明显安全问题。因此，对于长效毒蕈碱拮抗剂单药治疗不足的中重度COPD患者，QVA149是一种安全的治疗选择。
