慢性阻塞性肺疾病患者的支气管扩张剂治疗:在临床实践中选择给药方案时应考虑什么?

Q4 Medicine

Pulmonologiya Pub Date : 2023-02-10 DOI:10.18093/0869-0189-2023-33-1-44-50

O. Titova, N. Kuzubova, A. Kozyrev, A. A. Shumilov

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引用次数: 0

摘要

使用长效支气管扩张剂是慢性阻塞性肺疾病(COPD)治疗的核心。支气管扩张的目标之一是减少与更严重疾病和加重风险增加相关的早晨COPD症状。本研究的目的是评估合并长效支气管扩张剂QD的严重晨间症状COPD患者转换为固定剂量联合使用溴化阿克啶(AB)和富马酸福莫特罗(FF) bid的临床疗效。我们检查了联合使用长效β2-激动剂和m -抗胆碱能药物(但不包括AB和FF)治疗的COPD患者，这些患者尽管接受了治疗，但仍在早晨抱怨症状严重。经检查，患者改用AB 0.4 mg和FF 0.012 mg (AB/FF) BID的固定剂量组合，以计量粉状吸入器的形式使用。在基线和6个月的随访中对患者进行检查。在115名COPD患者中，有90人完成了研究。治疗6个月后，他们在咳嗽强度、痰量、远端喘息严重程度和早晨呼吸短促方面表现出显著下降(4分制-0.88、-0.38、-0.29、-0.58，平均得分-0.44;P < 0.001)。COPD评估测试的结果从28 (24;34)至24 (20);28) (p = 0.011)， 6分钟步行距离从319±72 m增加到354±67 m (p < 0.001)。AB/FF固定剂量联合用药未发生严重不良事件。固定剂量AB/FF联合治疗COPD患者可显著改善临床症状，且耐受性良好。AB/FF联合每日两次给药方案适用于晨间症状持续的患者，尽管使用其他长效支气管扩张剂联合每日一次给药方案治疗。

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Bronchodilator therapy in patients with chronic obstructive pulmonary disease: what should be considered in clinical practice when choosing a dosing regimen?

The use of long-acting bronchodilators is central to the chronic obstructive pulmonary disease (COPD) therapy. One of the goals of bronchodilation is to reduce the morning COPD symptoms that are associated with a more severe disease and an increased risk of exacerbations.The aim of the study was to evaluate the clinical efficacy of switching COPD patients with severe morning symptoms who received combinations of long-acting bronchodilators QD to a fixed-dose combination of aclidinium bromide (AB) and formoterol fumarate (FF) BID.Methods. We examined COPD patients treated with combinations of long-acting β2-agonists and M-anticholinergics (but not AB and FF), who continued to complain of severe symptoms in the morning despite the treatment. After examination, the patients were switched to the fixed-dose combination of AB 0.4 mg and FF 0.012 mg (AB/FF) BID in the form of a metered-dose powder inhaler. The patients were examined at baseline and at 6-month follow-up.Results. Of the 115 included COPD patients, 90 completed the study. After 6 months of treatment, they showed a significant decrease in the intensity of cough, sputum amount, severity of distant wheezing, and shortness of breath in the morning (–0.88, –0.38, –0.29, –0.58 on a 4-point scale, the mean score –0.44; p < 0.001). The result of the COPD Assessment test decreased from 28 (24; 34) to 24 (20; 28) (p = 0.011), the distance of a 6-minute walk increased from 319 ± 72 to 354 ± 67 m (p < 0.001). The fixed-dose combination of AB/FF did not cause serious adverse events.Conclusion. The fixed-dose AB/FF combination in COPD patients resulted in a significant clinical improvement and was well tolerated. The AB/FF combination with twice daily dosing regimen is advisable for the patients with morning symptoms persisting despite therapy with other combinations of long-acting bronchodilators with once daily dosing regimen.

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来源期刊

Pulmonologiya Medicine-Pulmonary and Respiratory Medicine

CiteScore

1.40

自引率

0.00%

发文量

期刊介绍： The aim of this journal is to state a scientific position of the Russian Respiratory Society (RRS) on diagnosis and treatment of respiratory diseases based on recent evidence-based clinical trial publications and international consensuses. The most important tasks of the journal are: -improvement proficiency qualifications of respiratory specialists; -education in pulmonology; -prompt publication of original studies on diagnosis and treatment of respiratory diseases; -sharing clinical experience and information about pulmonology service organization in different regions of Russia; -information on current protocols, standards and recommendations of international respiratory societies; -discussion and consequent publication Russian consensus documents and announcement of RRS activities; -publication and comments of regulatory documents of Russian Ministry of Health; -historical review of Russian pulmonology development. The scientific concept of the journal includes publication of current evidence-based studies on respiratory medicine and their discussion with the participation of Russian and foreign experts and development of national consensus documents on respiratory medicine. Russian and foreign respiratory specialists including pneumologists, TB specialists, thoracic surgeons, allergists, clinical immunologists, pediatricians, oncologists, physiologists, and therapeutists are invited to publish article in the journal.