Moitra Subhabrata, Bhome Arvind B, Brashier Bill B
Chest Research Foundation, Pune, Maharashtra, India.
Indian Coalition of Obstructive Lung Diseases (ICOLD) Network, Pune, Maharashtra, India.
Drug Des Devel Ther. 2015 Apr 7;9:1989-99. doi: 10.2147/DDDT.S53150. eCollection 2015.
The quest for the right combination of bronchodilators with different mechanisms of action such as long-acting muscarinic antagonists and long-acting β-agonists in the management of stable moderate-to-severe chronic obstructive pulmonary disease (COPD) is a topic of intense research activity currently, given the rising morbidity and mortality due to this disease. The fixed-dose combination of aclidinium bromide and formoterol fumarate in a single inhaler seems to offer superior advantages over either drugs given alone or as separate inhalers concurrently. Since the fixed-dose combination needs to be given twice daily, it is likely to achieve control of symptoms most crucial to the quality of life in COPD, namely, the morning hours. This is reflected in significant trough FEV1 (forced expiratory volume in 1 second) improvements after the dose. This paper reviews the various studies related to this combination put in the perspective of its safety and efficacy and potential benefits over other therapeutic options. However, there is a dearth of data on the long-term safety and efficacy in terms of improvement in lung function. This combination could emerge as an excellent option in the management of stable COPD if data on exacerbation rates and patient-reported outcomes become available from longer-term studies. Moreover, we need some more studies to define the ideal phenotype of COPD best suited for the use of this combination.
鉴于稳定期中度至重度慢性阻塞性肺疾病（COPD）的发病率和死亡率不断上升，寻求长效毒蕈碱拮抗剂和长效β受体激动剂等不同作用机制的支气管扩张剂的正确组合，是目前一项深入研究的课题。单吸入器中阿地溴铵和富马酸福莫特罗的固定剂量组合似乎比单独使用任何一种药物或同时单独吸入器给药具有更大优势。由于固定剂量组合需要每日给药两次，因此可能最能控制对COPD患者生活质量至关重要的症状，即早晨时段的症状。这在给药后的显著谷值第一秒用力呼气量（FEV1）改善中得到体现。本文从安全性、有效性以及相对于其他治疗选择的潜在益处等方面综述了与该组合相关的各种研究。然而，关于肺功能改善方面的长期安全性和有效性的数据匮乏。如果长期研究能提供关于急性加重率和患者报告结局的数据，那么这种组合可能成为稳定期COPD管理的一个极佳选择。此外，我们还需要更多研究来确定最适合使用这种组合的COPD理想表型。
