Vogelmeier Claus, Worth Heinrich, Buhl Roland, Criée Carl-Peter, Lossi Nadine S, Mailänder Claudia, Kardos Peter
Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Marburg.
Facharzt Forum Fürth, Fürth.
Int J Chron Obstruct Pulmon Dis. 2017 Feb 1;12:487-494. doi: 10.2147/COPD.S125616. eCollection 2017.
Many patients with chronic obstructive pulmonary disease (COPD) receive inhaled corticosteroids (ICSs) without a clear indication, and thus, the impact of ICS withdrawal on disease control is of great interest. DACCORD is a prospective, noninterventional 2-year study in the primary and secondary care throughout Germany. A subgroup of patients were taking ICS prior to entry - 1,022 patients continued to receive ICS for 2 years; physicians withdrew ICS on entry in 236 patients. Data from these two subgroups were analyzed to evaluate the impact of ICS withdrawal. Patients aged ≥40 years with COPD, initiating or changing COPD maintenance medication were recruited, excluding patients with asthma. Demographic and disease characteristics, prescribed COPD medication, COPD Assessment Test, exacerbations, and lung function were recorded. There were few differences in baseline characteristics; ICS withdrawn patients had shorter disease duration and better lung function, with 74.2% of ICS withdrawn patients not exacerbating, compared with 70.7% ICS-continued patients. During Year 1, exacerbation rates were 0.414 in the withdrawn group and 0.433 in the continued group. COPD Assessment Test total score improved from baseline in both groups. These data suggest that ICS withdrawal is possible with no increased risk of exacerbations in patients with COPD managed in the primary and secondary care.
许多慢性阻塞性肺疾病（COPD）患者在没有明确指征的情况下接受吸入性糖皮质激素（ICS）治疗，因此，停用ICS对疾病控制的影响备受关注。DACCORD是一项在德国全国初级和二级医疗保健机构中进行的为期2年的前瞻性非干预性研究。一部分患者在入组前正在使用ICS——1022名患者持续接受ICS治疗2年；236名患者在入组时停用了ICS。对这两个亚组的数据进行分析，以评估停用ICS的影响。招募年龄≥40岁、开始或改变COPD维持治疗药物的COPD患者，排除哮喘患者。记录人口统计学和疾病特征、开具的COPD药物、COPD评估测试、急性加重情况和肺功能。基线特征差异不大；停用ICS的患者病程较短，肺功能较好，74.2%停用ICS的患者未出现急性加重，而持续使用ICS的患者这一比例为70.7%。在第1年，停用组的急性加重率为0.414，持续使用组为0.433。两组的COPD评估测试总分均较基线有所改善。这些数据表明，在初级和二级医疗保健机构管理的COPD患者中，停用ICS是可行的，且不会增加急性加重风险。
