噻托溴铵在哮喘中的演变作用
2017/09/29
摘要
噻托溴铵是通过阻断气道中的内源性乙酰胆碱受体发挥其支气管扩张作用的长效M受体拮抗剂（LAMA）。它的安全性和有效性在治疗COPD的疗效方面已被证实，并且其在改善肺功能及控制哮喘方面的作用现在正在被认可。此篇综述旨在探讨了噻托溴铵通过雾化吸入的方式在哮喘严重程度和年龄范围内的患者中的演变作用,并且提供了其安全性及有效性数据的概述。噻托溴铵是目前唯一的批准用于治疗哮喘的长效M受体拮抗剂，并且来自大规模临床试验方案的证据，包括对成年人进行的几项III期研究，已经证明噻托溴铵改善了肺功能和哮喘控制，其安全性与安慰剂相当。青少年患者（12-17岁）的临床试验也显示出肺功能的改善和改善哮喘控制的趋势。值得注意的是，无论基线特征和表型如何其功效和安全性是一致的。鉴于庞大且不断增长的证据体系，很可能随着噻托溴铵的临床试验的增加，这种治疗在将来可能成为吸入性糖皮质激素/长效ß受体拮抗剂的附加治疗中以及在不耐受长效支气管扩张剂或其他药物的患者的关键选择。
The Evolving Role of Tiotropium in Asthma
Abstract
Tiotropium is a long-acting muscarinic antagonist (LAMA) that exerts its bronchodilatoryeffect by blocking endogenous acetylcholine receptors in the airways. Its safety andefficacy are well established for the treatment of COPD, and it is now being recognized for its role in improving lung function and control in asthma. This review discusses the evolving role oftiotropium delivered by the Respimat in patients across the range of asthma severities and ages,and provides an overview of safety and efficacy data. Tiotropium is the only LAMA currentlyapproved for the treatment of asthma, and evidence from a large-scale clinical trial program,including several Phase III studies in adults, has demonstrated that tiotropium improves lungfunction and asthma control, with a safety profile comparable with that of placebo. Clinical trials in adolescent patients (aged 12–17 years) have also shown improvements in lung functionand trends towardimproved asthma control. Of note, the efficacy and safety profiles areconsistent regardless of baseline characteristics and phenotype. Given the large and growingbody of evidence, it is likely that as clinical experience with tiotropium increases, this treatmentmay possibly emerge as the key choice for add-on therapy to inhaledcorticosteroids/long-acting2-agonists, and in patients who do not tolerate long-acting bronchodilators or other medications,in the future.
噻托溴铵是通过阻断气道中的内源性乙酰胆碱受体发挥其支气管扩张作用的长效M受体拮抗剂（LAMA）。它的安全性和有效性在治疗COPD的疗效方面已被证实，并且其在改善肺功能及控制哮喘方面的作用现在正在被认可。此篇综述旨在探讨了噻托溴铵通过雾化吸入的方式在哮喘严重程度和年龄范围内的患者中的演变作用,并且提供了其安全性及有效性数据的概述。噻托溴铵是目前唯一的批准用于治疗哮喘的长效M受体拮抗剂，并且来自大规模临床试验方案的证据，包括对成年人进行的几项III期研究，已经证明噻托溴铵改善了肺功能和哮喘控制，其安全性与安慰剂相当。青少年患者（12-17岁）的临床试验也显示出肺功能的改善和改善哮喘控制的趋势。值得注意的是，无论基线特征和表型如何其功效和安全性是一致的。鉴于庞大且不断增长的证据体系，很可能随着噻托溴铵的临床试验的增加，这种治疗在将来可能成为吸入性糖皮质激素/长效ß受体拮抗剂的附加治疗中以及在不耐受长效支气管扩张剂或其他药物的患者的关键选择。
(中日友好医院呼吸与危重症医学科 张鑫 摘译 林江涛 审校)
(J Asthma Allegy.2107;10:231-236 Emma R Mclvor)
(J Asthma Allegy.2107;10:231-236 Emma R Mclvor)
The Evolving Role of Tiotropium in Asthma
Abstract
Tiotropium is a long-acting muscarinic antagonist (LAMA) that exerts its bronchodilatoryeffect by blocking endogenous acetylcholine receptors in the airways. Its safety andefficacy are well established for the treatment of COPD, and it is now being recognized for its role in improving lung function and control in asthma. This review discusses the evolving role oftiotropium delivered by the Respimat in patients across the range of asthma severities and ages,and provides an overview of safety and efficacy data. Tiotropium is the only LAMA currentlyapproved for the treatment of asthma, and evidence from a large-scale clinical trial program,including several Phase III studies in adults, has demonstrated that tiotropium improves lungfunction and asthma control, with a safety profile comparable with that of placebo. Clinical trials in adolescent patients (aged 12–17 years) have also shown improvements in lung functionand trends towardimproved asthma control. Of note, the efficacy and safety profiles areconsistent regardless of baseline characteristics and phenotype. Given the large and growingbody of evidence, it is likely that as clinical experience with tiotropium increases, this treatmentmay possibly emerge as the key choice for add-on therapy to inhaledcorticosteroids/long-acting2-agonists, and in patients who do not tolerate long-acting bronchodilators or other medications,in the future.
上一篇：
重症哮喘患者Benralizumab增强反应的预测因素：SIROCCO和CALIMA研究的汇总分析
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布地奈德+福莫特罗通过信必可都保方式传送对于哮喘和COPD的管理：与吸入器相比，改善吸入技术的非计划医疗费用的潜在影响
