Tariq Syed Mohammad, Thomas Enson C
Department of Respiratory Medicine, Luton and Dunstable University Hospital, Luton.
Respiratory Unit, Bedford Hospital, Bedford, UK.
Int J Chron Obstruct Pulmon Dis. 2017 Jun 23;12:1877-1882. doi: 10.2147/COPD.S138006. eCollection 2017.
Long-term maintenance therapy for COPD is evolving rapidly. Dual bronchodilation with new long-acting muscarinic antagonist and long-acting beta-agonist (LAMA/LABA) fixed dose combination inhalers were introduced over the past 2 years. In clinical trials, these inhalers significantly improved lung function (trough forced expiratory volume in 1 second), patient-reported outcomes, and quality of life measures compared with placebo, their respective monocomponents, and tiotropium. The recorded adverse events of these new inhalers were also similar to those of their monocomponents or placebo. There are concerns regarding long-term complications (weight gain, osteoporosis, cataract) and increased risk of community-acquired pneumonia with the use of inhaled corticosteroids (ICS). The new LAMA/LABA inhalers could potentially reduce the use of ICS as part and parcel of maintenance therapy in COPD. Recent studies compared these LAMA/LABA inhalers with ICS/LABA combination inhalers in moderate-to-severe COPD. The results are promising and favor the LAMA/LABA inhalers, especially in the longer duration trials. Furthermore, there is a clearer picture emerging as to the subgroup of COPD patients who may be able to successfully switch from their current ICS/LABA therapy to these new LAMA/LABA inhalers.
慢性阻塞性肺疾病(COPD)的长期维持治疗正在迅速发展。在过去两年中,新型长效毒蕈碱拮抗剂与长效β受体激动剂(LAMA/LABA)固定剂量联合吸入器的双重支气管扩张疗法被引入。在临床试验中,与安慰剂、各自的单一组分以及噻托溴铵相比,这些吸入器显著改善了肺功能(一秒用力呼气容积谷值)、患者报告的结局以及生活质量指标。这些新型吸入器记录的不良事件也与它们的单一组分或安慰剂相似。使用吸入性糖皮质激素(ICS)存在对长期并发症(体重增加、骨质疏松、白内障)以及社区获得性肺炎风险增加的担忧。新型LAMA/LABA吸入器有可能减少作为COPD维持治疗一部分的ICS的使用。最近的研究在中重度COPD患者中将这些LAMA/LABA吸入器与ICS/LABA联合吸入器进行了比较。结果很有前景,且更有利于LAMA/LABA吸入器,尤其是在更长疗程的试验中。此外,对于哪些COPD患者亚组可能能够成功地从当前ICS/LABA治疗转换为这些新型LAMA/LABA吸入器,情况也越来越清晰。