Lu C C
Chest Department, Division of Clinical Pulmonary Physiology, Veterans General Hospital-Taipei, Taiwan.
Respirology. 1997 Dec;2(4):317-22. doi: 10.1111/j.1440-1843.1997.tb00096.x.
Chronic obstructive pulmonary disease (COPD) is a heterogeneous group of diseases characterized by cough, sputum production, dyspnoea, airflow limitation and bronchial hyperreactivity. The airflow limitation declines progressively and is irreversible or partially reversible. Bronchodilator therapy is prescribed to relieve the symptoms, reverse airway obstruction and hopefully slow the rate of disease progression and decelerate the decline in pulmonary function. During acute exacerbation, inhalation of beta2-agonists remain the therapy of choice. The usefulness of anticholinergic inhalation in acute attacks is investigated in order to determine if a higher dose and more frequent administration have same benefit as beta2-agonists inhalation. Theophylline is usually given orally as a sustained release formulation for chronic maintenance therapy. Some patients may benefit from theophylline infusion during an acute phase when appropriately used; however, sympathomimetic agents fail to produce adequate bronchodilation. During interim periods of stability, inhalation of ipratropium bromide has increased in popularity as a regular long-term bronchodilator therapy. Although ipratropium and beta2-agonists are equally efficacious when the dosage is adequate enough, a combination of both provides a rapid onset of action of the adrenergic agents and a prolonged action of the anticholinergic. Furthermore, this combination can be given in a reduced dose, thereby avoiding side-effects. Inhalation techniques can influence the efficacy of bronchodilator therapy. For severe dyspnoeic patients or patients with poor technique of co-ordination with metered-dose inhaler (MDI), attachment of a spacer to the MDI or using a nebulizer will overcome these difficulties. Bronchodilator therapy can not prevent the development of COPD or slow down the decline of pulmonary function, other interventions should be included in a comprehensive management programme.
慢性阻塞性肺疾病（COPD）是一组异质性疾病，其特征为咳嗽、咳痰、呼吸困难、气流受限和支气管高反应性。气流受限呈进行性下降，且不可逆或部分可逆。开具支气管扩张剂治疗以缓解症状、逆转气道阻塞，并有望减缓疾病进展速度和降低肺功能下降速率。在急性加重期，吸入β2受体激动剂仍然是首选治疗方法。对急性发作时吸入抗胆碱能药物的有效性进行了研究，以确定更高剂量和更频繁给药是否与吸入β2受体激动剂具有相同的益处。茶碱通常以缓释制剂口服用于慢性维持治疗。一些患者在急性期适当使用茶碱静脉输注可能会受益；然而，拟交感神经药未能产生足够的支气管扩张作用。在病情稳定的间歇期，吸入异丙托溴铵作为常规长期支气管扩张剂治疗越来越受欢迎。虽然异丙托溴铵和β2受体激动剂在剂量足够时疗效相当，但两者联合使用可使肾上腺素能药物起效迅速且抗胆碱能药物作用持久。此外，这种联合用药可以降低剂量，从而避免副作用。吸入技术会影响支气管扩张剂治疗的疗效。对于重度呼吸困难患者或使用定量吸入器（MDI）时协调技术不佳的患者，在MDI上连接储物罐或使用雾化器将克服这些困难。支气管扩张剂治疗无法预防COPD的发生或减缓肺功能下降，综合管理方案应包括其他干预措施。
