长效抗胆碱药在哮喘治疗中的作用
2013/07/26
摘要
综述目的：抗胆碱药物已经常规用于慢性阻塞性肺疾病（COPD）的维持治疗。在中-重度哮喘治疗中，抗胆碱药物的应用也越来越多。本综述旨在总结抗胆碱药物用于哮喘治疗的科学证据。
近期发现：早期病例报道和小型研究评估了抗胆碱药物——噻托溴铵在哮喘维持治疗中的应用。本综述纳入了几项近期的临床研究，这些研究为加用噻托溴铵治疗哮喘提供了额外的证据。清晨呼气峰流速（PEF）的变化证明应用噻托溴铵的疗效优于吸入两倍剂量的糖皮质激素（ICS）和安慰剂。两个大型多国家研究证实了噻托溴铵在使用了ICS和LABA联合治疗后仍未获得哮喘控制的亚组患者中的疗效。
总结：对于某些使用了ICS和LABA联合治疗后哮喘仍未取得控制的中-重度哮喘患者，在维持治疗中应用长效抗胆碱药物噻托溴铵是有效的。关于哪些表型患者将受益于噻托溴铵，还需要进一步研究来更好的定义。
（苏楠 审校）
Curr Opin Allergy Clin Immunol. 2013 Jun 10. [Epub ahead of print]
Long-acting anticholinergics in the treatment of asthma.
Guyer AC, Long AA.
Abstract
PURPOSE OF REVIEW: The use of anticholinergic medications is well established as maintenance therapy for chronic obstructive pulmonary disease (COPD). There is a growing interest in the use of anticholinergic medications in the treatment of moderate to severe asthma. The purpose of this review is to summarize the scientific evidence for the use of anticholinergic therapy in the management of asthma.
RECENT FINDINGS: Early case reports and small studies evaluated the use of the anticholinergic agent, tiotropium bromide, as maintenance therapy in asthma. Included in this review are several recent clinical trials which provide additional evidence for the use of tiotropium as add-on therapy for asthma. The use of tiotropium was demonstrated to be superior to doubling the dose of an inhaled corticosteroid (ICS) and more effective than placebo based on change in morning peak expiratory flow (PEF). Two large multinational trials provide evidence for the use of tiotropium in a subset of asthmatic patients who have not achieved control using combination therapy with an ICS and a long-acting β2 agonist (LABA).
SUMMARY: The use of the long-acting anticholinergic agent, tiotropium, as maintenance of therapy in asthma, has been shown to be effective in some patients with moderate to severe asthma who are uncontrolled on combination therapy with ICS and LABA. Further studies are needed to better define which phenotypic subset of patients would benefit from the use of tiotropium.
Curr Opin Allergy Clin Immunol. 2013 Jun 10. [Epub ahead of print]
