Long-acting β2 agonists in the management of stable chronic obstructive pulmonary disease
Long-acting β2 agonists in the management of stable chronic obstructive pulmonary disease
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DOI：
10.2165/00003495-200060020-00005
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发表时间：
2000-08-01
期刊：
影响因子：
11.5
通讯作者：
Donner, CF
中科院分区：
文献类型：
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作者：
Cazzola, M;Donner, CF
长效β(2)激动剂支气管扩张剂（如福莫特罗、沙美特罗）是一种新的治疗慢性阻塞性肺疾病（COPD）的有趣选择。在短期内，沙美特罗和福莫特罗似乎都比短效β(2)激动剂更有效，并且在稳定型COPD患者中，它们比抗胆碱能药物和茶碱更有效。慢性阻塞性肺病患者定期使用长效β(2)激动剂治疗可诱导呼吸功能和某些方面生活质量的改善。此外，在长期治疗后，在推荐剂量下，沙美特罗似乎比异丙托品和茶碱更能改善肺功能。长期吸入β(2)激动剂与抗胆碱能剂或茶碱联合治疗COPD患者的研究还不够充分。通常剂量的异丙托品或奥硝托品与通常剂量的沙美特罗或福莫特罗联合用药似乎不能改善肺功能，但联合用药缺乏改善本身不应阻止对抗胆碱能药物和/或单独给药沙美特罗或福莫特罗有反应的患者实施进一步的治疗措施。福莫特罗和沙美特罗在健康个体和可逆性气道阻塞患者中均不会引起显著的心血管影响。然而，慢性阻塞性肺病合并心律失常和低氧血症的患者如果使用长效β(2)激动剂，可能会发生不良心脏事件，尽管推荐单剂量沙美特罗50 μ g或福莫特罗12 μ g比福莫特罗24 μ g具有相对较高的安全范围。经这些支气管扩张剂常规治疗后，长效β(2)激动剂的支气管扩张作用似乎相当稳定。此外，在部分可逆性COPD患者中，常规剂量的福莫特罗或沙美特罗治疗前不能排除沙丁胺醇进一步诱导支气管扩张的可能性。所有这些发现都支持使用长效β(2)受体激动剂支气管扩张剂作为慢性阻塞性肺病患者气流阻塞长期治疗的一线支气管扩张剂治疗。然而，由于医生必须始终选择一种高效、耐受性好且价格低廉的药物，因此对乙醚支气管扩张剂的成本-效果分析将决定长效β(2)受体激动剂在稳定期COPD长期治疗中的合适位置。
Long-acting beta(2) agonist bronchodilators (e.g. formoterol, salmeterol) are a new interesting therapeutic option for patients with chronic obstructive pulmonary disease (COPD).In the short term, both salmeterol and formoterol appear to be more effective than short-acting beta(2) agonists, and in patients with stable COPD they are more effective than anticholinergic agents and theophylline.Regular treatment of patients with COPD with long-acting beta(2) agonists can induce an improvement in the respiratory function and certain aspects of quality of life. Moreover, salmeterol seems to be better than ipratropium and theophylline in improving lung function at the recommended doses after a long term treatment.Use of combination therapy of a long-acting inhaled beta(2) agonist and an anticholinergic agent or theophylline in patients with COPD has not been sufficiently studied. Combination of usual doses of ipratropium or oxitropium with usual doses of salmeterol or formoterol does not appear to improve pulmonary function, but this lack of improvement with the combination should not, in itself, prevent implementation of further therapeutic steps in patients responsive to an anticholinergic agent and/or salmeterol or formoterol administered singly.Neither formoterol nor salmeterol elicit significant cardiovascular effects in healthy individuals and patients with reversible airway obstruction. However adverse cardiac events might occur in patients with COPD with pre-existing cardiac arrhythmias and hypoxaemia if they use long-acting beta(2) agonists, although the recommended single dose of salmeterol 50 mu g or formoterol 12 mu g ensures a relatively higher safety margin than formoterol 24 mu g.The bronchodilatory effect of long-acting beta(2) agonists seems to be fairly stable after regular treatment with these bronchodilators. Moreover, pre-treatment with a conventional dose of formoterol or salmeterol does not preclude the possibility of inducing further bronchodilation with salbutamol in patients with partially reversible COPD.All these findings support the use of long-acting beta(2) agonist bronchodilators as first-line bronchodilator therapy for the long term treatment of airflow obstruction in patients with COPD. However, since physicians must always choose a drug that is highly efficacious, well tolerated and inexpensive, the cost-effectiveness analysis in relation to Ether bronchodilators will determine the proper place of long-acting beta(2) agonists in the long term therapy of stable COPD.