Mitigating systemic corticosteroid risks in COPD: A call for earlier triple therapy initiation

IF 2.8 3区 医学 Q2 PHARMACOLOGY & PHARMACY
Luis J. Nannini
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引用次数: 0

Abstract

Current GOLD guidelines recommend initial dual therapy with a LABA and LAMA for COPD patients with a high risk of exacerbations (at least two moderate or one severe exacerbation in the previous 12 months), with Inhaled Corticosteroids (ICS) added for specific phenotypes or continued exacerbations. Systemic corticosteroids (SCS) are advised for severe exacerbations, but cumulative SCS exposure is linked to significant adverse outcomes such as endocrine disorders and pneumonia. Studies suggest that after limited exacerbations, COPD patients may exhaust their “SCS credit,” increasing their risk of severe comorbidities. Earlier initiation of triple therapy in high-risk, symptomatic patients shows substantial benefits, including improved quality of life, compared to standard care. Like asthma management, SCS exposure in COPD should be minimised, and precision medicine should guide early triple therapy to preserve SCS use for future exacerbations.
减轻慢性阻塞性肺病的全身皮质类固醇风险:呼吁尽早开始三联治疗
目前的GOLD指南推荐对急性加重高风险(过去12个月内至少有两次中度或一次严重加重)的COPD患者进行LABA和LAMA的初始双重治疗,并针对特定表型或持续加重添加吸入皮质类固醇(ICS)。对于严重的恶化,建议使用全身性皮质类固醇(SCS),但累积的SCS暴露与内分泌紊乱和肺炎等重大不良后果有关。研究表明,在有限的加重后,COPD患者可能耗尽其“SCS信用”,增加其严重合并症的风险。与标准治疗相比,在高风险、有症状的患者中早期开始三联疗法显示出实质性的益处,包括改善生活质量。与哮喘治疗一样,慢性阻塞性肺病患者的SCS暴露应最小化,精准医学应指导早期三联治疗,以保留SCS在未来恶化时的使用。
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来源期刊
CiteScore
6.20
自引率
0.00%
发文量
41
审稿时长
42 days
期刊介绍: Pulmonary Pharmacology and Therapeutics (formerly Pulmonary Pharmacology) is concerned with lung pharmacology from molecular to clinical aspects. The subject matter encompasses the major diseases of the lung including asthma, cystic fibrosis, pulmonary circulation, ARDS, carcinoma, bronchitis, emphysema and drug delivery. Laboratory and clinical research on man and animals will be considered including studies related to chemotherapy of cancer, tuberculosis and infection. In addition to original research papers the journal will include review articles and book reviews. Research Areas Include: • All major diseases of the lung • Physiology • Pathology • Drug delivery • Metabolism • Pulmonary Toxicology.
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