Mantero Marco, Radovanovic Dejan, Santus Pierachille, Blasi Francesco
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy,
Internal Medicine Department, Respiratory Unit and Regional Adult Cystic Fibrosis Center, IRCCS Fondazione Ca' Granda Ospedale Policlinico, Milan, Italy,
Int J Chron Obstruct Pulmon Dis. 2018 Jul 30;13:2319-2333. doi: 10.2147/COPD.S147484. eCollection 2018.
The major determinant of the decline in lung function, quality of life, and the increased mortality risk in patients with COPD is represented by severe acute exacerbations of the disease, that is, those requiring patients' hospitalization, constituting a substantial social and health care burden in terms of morbidity and medical resource utilization. Different long-term therapeutic strategies have been proposed so far in order to prevent and/or reduce the clinical and social impact of these events, the majority of which were extrapolated from trials initially focused on the effect of long-acting muscarinic antagonist and subsequently on the efficacy of long-acting β2-agonists in combination or not with inhaled corticosteroids. The option to employ all three classes of molecules combined, despite the limited amount of evidence in our possession, represents a choice currently proposed by international guidelines; however, current recommendations are often based mainly on observational studies or on the results of secondary outcomes in randomized controlled trials. The present narrative review evaluates the available trials that investigated the efficacy of inhaled therapy to prevent COPD exacerbations and especially severe ones, with a particular focus on beclomethasone dipropionate/formoterol/glycopyrronium bromide fixed dose combination, which is the first treatment that comprises all the three drug classes, specifically tested for the prevention of moderate and severe COPD exacerbations.
慢性阻塞性肺疾病（COPD）患者肺功能下降、生活质量降低以及死亡风险增加的主要决定因素是该疾病的严重急性加重，即那些需要患者住院治疗的情况，这在发病率和医疗资源利用方面构成了巨大的社会和医疗负担。迄今为止，已经提出了不同的长期治疗策略，以预防和/或减少这些事件的临床和社会影响，其中大多数是从最初关注长效毒蕈碱拮抗剂作用、随后关注长效β2受体激动剂联合或不联合吸入性糖皮质激素疗效的试验中推断出来的。尽管我们掌握的证据有限，但采用这三类分子联合使用的方案是目前国际指南提出的一种选择；然而，当前的建议往往主要基于观察性研究或随机对照试验的次要结局结果。本叙述性综述评估了那些研究吸入疗法预防COPD加重尤其是严重加重疗效的现有试验，特别关注丙酸倍氯米松/福莫特罗/格隆溴铵固定剂量组合，这是第一种包含所有三类药物的治疗方法，专门用于预防中度和重度COPD加重。
