Ridolo Erminia, Pellicelli Irene, Gritti Bruna, Incorvaia Cristoforo
Allergy and Clinical Immunology, Medicine and Surgery Department, University of Parma, Parma, Italy,
Cardiac/Pulmonary Rehabilitation Unit, ASST Pini-CTO, Milan, Italy.
Patient Prefer Adherence. 2019 Jan 14;13:145-150. doi: 10.2147/PPA.S166704. eCollection 2019.
Dual bronchodilation with long-acting beta-2 agonists and muscarinic antagonists is recommended in patients with severe to very severe COPD. Among dual bronchodilator combinations, indacaterol/glycopyrronium combination (IGC) received evidence of higher efficacy and good safety compared with monotherapy with either drug as well as with tiotropium. In randomized controlled trials, the primary outcome is usually the change in mean FEV resulting from treatment. However, the functional aspects that influence the physician's choice of the type of management may not be considered important by the patient, based on his perception of the disease. To address such issue, patient-reported outcomes (PROs) were assessed in recent studies. They include patient's perception of breathlessness, physical functioning, global health status, quality of life, use of rescue medications, and patient's report of COPD exacerbations. PRO data from the studies showed a clear improvement in patients' awareness of a better control of the disease in patients treated with IGC. In addition, the latest literature on two important issues influencing patient's preference and adherence, ie, the once-daily administration and the device to be used, confirmed the effectiveness of IGC and the ability of its device (Breezhaler) to result in patient's satisfaction, ease of use, less handling errors, and self-assurance to have inhaled the entire dose.
对于重度至极重度慢性阻塞性肺疾病（COPD）患者，推荐使用长效β2受体激动剂与毒蕈碱拮抗剂联合进行双重支气管扩张治疗。在双重支气管扩张剂组合中，与单独使用两种药物中的任何一种以及噻托溴铵单药治疗相比，茚达特罗/格隆溴铵组合（IGC）显示出更高的疗效和良好的安全性。在随机对照试验中，主要结局通常是治疗导致的平均第一秒用力呼气容积（FEV）的变化。然而，基于患者对疾病的认知，那些影响医生选择治疗方式的功能方面问题，患者可能并不认为重要。为解决此类问题，近期研究对患者报告结局（PROs）进行了评估。这些结局包括患者对呼吸急促的感受、身体功能、整体健康状况、生活质量、急救药物的使用情况以及患者报告的COPD急性加重情况。研究中的PRO数据显示，接受IGC治疗的患者对疾病控制改善的认知有明显提高。此外，关于影响患者偏好和依从性的两个重要问题，即每日一次给药和使用的装置的最新文献，证实了IGC的有效性及其装置（Breezhaler）能使患者满意、使用方便、减少操作失误并让患者确信吸入了全部剂量。
