Pharmacotherapeutic approaches to preventing acute exacerbations of chronic obstructive pulmonary disease.
Pharmacotherapeutic approaches to preventing acute exacerbations of chronic obstructive pulmonary disease.
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DOI：
10.1513/pats.201102-016rm
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发表时间：
2011-08-01
期刊：
影响因子：
--
通讯作者：
Martinez, Fernando J
中科院分区：
文献类型：
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作者：
Han, Meilan K;Martinez, Fernando J
慢性阻塞性肺疾病（AECOPD）急性加重的重要性日益受到重视。AECOPD导致显著的发病率和死亡率，并且是医疗保健成本的重要驱动因素。频繁的AECOPD与生活质量差和肺功能下降更快相关。因此，降低其频率或严重程度是COPD治疗的关键范例。单独使用支气管扩张剂和与吸入性皮质类固醇联合使用是目前的标准治疗，可减少AECOPD。用慢性大环内酯类抗生素或脉冲喹诺酮类药物预防感染已显示出一些希望。接种链球菌肺炎和流感疫苗可能是有益的。具有抗氧化特性的治疗药物，包括磷酸二酯酶4抑制剂和HMG-CoA还原酶抑制剂，可能会降低AECOPD的发生率。人们还研究了抑制反应性氧化剂物质的形成，并得出了不同的结果。抗氧化剂，包括N-乙酰半胱氨酸和S-羧甲基半胱氨酸，可能会减少加重频率，但需要进一步研究。随着新疗法的开发，了解它们在哪些患者表型中最有效以及它们与吸入皮质类固醇、支气管扩张剂或其组合的疗效和副作用特征如何比较将是有帮助的。
The significance of acute exacerbations in chronic obstructive pulmonary disease (AECOPDs) is increasingly appreciated. AECOPDs result in significant morbidity and mortality and are a significant driver of health care costs. Frequent AECOPDs are associated with poor quality of life and more rapid decline in lung function. As such, reducing their frequency or severity is a key paradigm of COPD therapy. Bronchodilators alone and in combination with inhaled corticosteroids are the current standards of care and decrease AECOPDs. Prevention of infection with chronic macrolide antibiotics or pulsed quinolones has demonstrated some promise. Vaccination against Streptococcus pneumonia and influenza is likely beneficial. Therapeutics with antiinflammatory properties, including phosphodiesterase enzyme 4 inhibitors and HMG-CoA reductase inhibitors, may reduce AECOPD frequency. Inhibiting the formation of reactive oxidant species has also been studied, with varying results. Antioxidants, including N-acetylcysteine and S-carbomethylcysteine, may reduce exacerbation frequency, but further investigation is needed. As new therapies are developed, it will be helpful to know in which patient phenotypes they are most effective and how they compare in efficacy and side-effect profiles with inhaled coricosteroids, bronchodilators, or their combination.