D'Urzo Anthony, Chapman Kenneth R, Donohue James F, Kardos Peter, Maleki-Yazdi M Reza, Price David
Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
Asthma and Airway Centre, University Health Network, University of Toronto, Toronto, ON, Canada.
Pulm Ther. 2019 Jun;5(1):23-41. doi: 10.1007/s41030-019-0090-1. Epub 2019 Mar 13.
Inhaled fixed-dose combinations (FDCs) of a long-acting β-agonist (LABA) and a long-acting muscarinic antagonist (LAMA) have become the cornerstone for the maintenance treatment of symptomatic COPD patients. In this regard, global COPD treatment guidelines have recognized the importance of inhaler devices as integral contributors to the effectiveness of LABA/LAMA FDCs and recommend regular assessment of inhaler device use by the patients in order to improve long-term clinical outcomes. Optimal disease control is also highly dependent upon patient preferences and adherence to inhaler devices. This review objectively examines and compares the major inhaler devices used to deliver different LABA/LAMA FDCs, discusses the inhaler device characteristics that determine drug deposition in the airways, real-life preference for inhaler devices, and handling of inhaler devices that impact the results of the long-term management of COPD. The introduction of new LABA/LAMA FDCs, new inhaler devices, and more clinical studies have created confusion among physicians in choosing the optimal inhaled therapy for COPD patients; in this context, this review attempts to provide an evidence-based framework for informed decision-making with a particular focus on the inhaler devices.Funding. The preparation of this manuscript was funded by Novartis Pharma AG.
长效β受体激动剂（LABA）与长效毒蕈碱拮抗剂（LAMA）的吸入性固定剂量组合（FDC）已成为有症状慢性阻塞性肺疾病（COPD）患者维持治疗的基石。在这方面，全球COPD治疗指南已认识到吸入装置作为LABA/LAMA FDC有效性的重要组成部分的重要性，并建议对患者的吸入装置使用情况进行定期评估，以改善长期临床结局。最佳疾病控制也高度依赖于患者的偏好和对吸入装置的依从性。本综述客观地检查和比较了用于递送不同LABA/LAMA FDC的主要吸入装置，讨论了决定药物在气道中沉积的吸入装置特性、吸入装置的实际使用偏好以及影响COPD长期管理结果的吸入装置操作。新的LABA/LAMA FDC、新的吸入装置以及更多临床研究的出现，在为COPD患者选择最佳吸入治疗方案时给医生造成了困惑；在此背景下，本综述试图提供一个基于证据的框架，以便做出明智的决策，特别关注吸入装置。资助。本稿件的编写由诺华制药有限公司资助。
