Department of Clinical and Experimental Sciences, Respiratory Medicine Unit, University of Brescia, Brescia, Italy.
Int J Chron Obstruct Pulmon Dis. 2020 Apr 20;15:821-829. doi: 10.2147/COPD.S233462. eCollection 2020.
The use of inhaled corticosteroids (ICSs) in long-term treatment of COPD has been a debated topic for a long time. According to the evidence produced till now, ICSs are presently advocated in combination with long-acting bronchodilators for high-risk symptomatic COPD patients with a history of frequent COPD exacerbations. However, the heterogeneity of COPD patients in terms of prevalent underlying disease, with its associated biological and functional characteristics, and different types of exacerbation makes this recommendation highly questionable. This review aims to discuss the usefulness of ICSs in the pharmacological management of COPD and trys to detect those aspects that may likely anticipate a beneficial response following their therapeutic use related to respiratory function, functional decline, prevention of exacerbation, and quality of life. In this respect, the BERN acronym, meaning Bronchiolitis, Eosinophilia, Responsiveness to bronchodilator, and Non-smoker, may be of practical utility to select among COPD patients those that can take more advantage from ICS adoption when positive and vice versa when negative.
吸入性皮质类固醇（ICSs）在 COPD 的长期治疗中的应用一直是一个备受争议的话题。根据目前所产生的证据，ICSs 目前被提倡与长效支气管扩张剂联合用于具有频繁 COPD 恶化病史的高危症状性 COPD 患者。然而，COPD 患者在常见基础疾病、相关生物学和功能特征以及不同类型的恶化方面存在异质性，这使得这一建议受到高度质疑。本综述旨在讨论 ICSs 在 COPD 药物治疗中的有用性，并试图发现与呼吸功能、功能下降、预防恶化和生活质量相关的治疗使用后可能产生有益反应的方面。在这方面，BERN 缩写词，意思是细支气管炎、嗜酸性粒细胞增多症、对支气管扩张剂的反应性和非吸烟者，可能对 COPD 患者具有实用价值，可以根据阳性结果选择那些可以从 ICS 应用中获益更多的患者，反之亦然。
