Ikeda A, Nishimura K, Izumi T
Chest Disease Research Institute, Kyoto University, Japan.
Drugs Aging. 1998 Feb;12(2):129-37. doi: 10.2165/00002512-199812020-00005.
Exacerbations of chronic obstructive pulmonary disease (COPD) are usually treated with bronchodilator therapy, glucocorticoids and antibiotics. However, there are few experimental data on the effects of these agents in patients with acute COPD. A beta(2)-adrenoceptor agonist is usually given first because it can be expected to produce a rapid response. An anticholinergic agent should also be given when the patient is severely ill or responds inadequately to the beta(2) agonist. These agents can be administered via a nebuliser or using a metered-dose inhaler in conjunction with a spacer device. Glucocorticoids can accelerate recovery if the standard empirical regimens for acute exacerbations of asthma are used, although a longer treatment duration appears to be required. Theophylline provides little additional benefit in patients who receive frequent doses of inhaled bronchodilators and an adequate dosage of a glucocorticoid. Although the role of bacterial infections is not completely understood, the use of antibiotics is justified in patients with severe airflow limitation who have febrile tracheobronchitis.
慢性阻塞性肺疾病（COPD）急性加重期通常采用支气管扩张剂治疗、糖皮质激素及抗生素治疗。然而，关于这些药物对急性COPD患者疗效的实验数据较少。通常首先给予β₂肾上腺素能受体激动剂，因为预期其能产生快速反应。当患者病情严重或对β₂激动剂反应不佳时，也应给予抗胆碱能药物。这些药物可通过雾化器给药，或与储物罐装置一起使用定量吸入器给药。如果采用哮喘急性加重期的标准经验性治疗方案，糖皮质激素可加速恢复，尽管似乎需要更长的治疗时间。对于频繁使用吸入性支气管扩张剂且糖皮质激素剂量充足的患者，茶碱几乎没有额外益处。尽管细菌感染的作用尚未完全明确，但对于患有发热性气管支气管炎且气流严重受限的患者，使用抗生素是合理的。
