哮喘联盟

   摘要
   哮喘和慢性阻塞性肺病（COPD）是世界范围内最常见的慢性疾病之一，以不同程度的气道阻塞和慢性气道炎症为特征。大量人体实验证据已证实在这些临床疾病中作为一个药物靶位的小气道的重要性。尽管对病理生理机制有了更深的理解，但流行病学观察表明有相当比例的哮喘和COPD患者的病情控制不佳(或未控制)。在慢性呼吸系统疾病中不同因素可影响吸入性治疗的有效性：患者相关（如，衰老）；疾病相关（如，伴发疾病）；以及药物相关/配方相关的因素。由于以下两个进程引起老年患者中普遍存在多种疾病：年龄与退行性病变的发生相关；既有疾病并发症随时间的发展。另外，特殊的合并症可能损害吸入器使用的能力，如呼吸系统中有效给药装置。如果不能到达并治疗外周气道可能会导致吸入性治疗的失效。最近研发的吸入性超微颗粒配方使得吸入治疗更均匀的分布于整个呼吸树，包括外周气道。倍氯米松/福莫特罗超微颗粒配方有效治疗哮喘和COPD。与等量吸入性皮质类固醇/长效β2受体激动剂联合配方的非超微颗粒剂（ICS/LABA）相比，倍氯米松/福莫特罗超微颗粒配方治疗可显著改善外周气道的多种生物标记物。这些改善与肺功能和临床预后的改善相关，同时减少吸入性皮质类固醇的系统性暴露。外周气道的病理生理学认识的增加有助于阻塞性肺疾病的特殊表型的确定，这将从专门针对外周气道的靶向治疗中获益。
 

（苏楠 审校）
Patient Relat Outcome Meas. 2014 Nov 27;5:153-62. doi: 10.2147/PROM.S55276. eCollection 2014.

 

Impact of extrafine formulations of inhaled corticosteroids/long-acting beta-2 agonist combinations on patient-related outcomes in asthma and COPD.
 

Scichilone N1, Benfante A1, Morandi L2, Bellini F2, Papi A2.
 

ABSTRACT
Asthma and chronic obstructive pulmonary disease (COPD) are among the most common chronic diseases worldwide, characterized by a condition of variable degree of airway obstruction and chronic airway inflammation. A large body of evidence has demonstrated the importance of small airways as a pharmacological target in these clinical conditions. Despite a deeper understanding of the pathophysiological mechanisms, the epidemiological observations show that a significant proportion of asthmatic and COPD patients have a suboptimal (or lack of) control of their diseases. Different factors could influence the effectiveness of inhaled treatment in chronic respiratory diseases: patient-related (eg, aging); disease-related (eg, comorbid conditions); and drug-related/formulation-related factors. The presence of multiple illnesses is common in the elderly patient as a result of two processes: the association between age and incidence of degenerative diseases; and the development over time of complications of the existing diseases. In addition, specific comorbidities may contribute to impair the ability to use inhalers, such as devices for efficient drug delivery in the respiratory system. The inability to reach and treat the peripheral airways may contribute to the lack of efficacy of inhaled treatments. The recent development of inhaled extrafine formulations allows a more uniform distribution of the inhaled treatment throughout the respiratory tree to include the peripheral airways. The beclomethasone/formoterol extrafine formulation is available for the treatment of asthma and COPD. Different biomarkers of peripheral airways are improved by beclomethasone/formoterol extrafine treatment in comparison with equivalent nonextrafine inhaled corticosteroids/long-acting beta-2 agonist (ICS/LABA) combinations. These improvements are associated with improved lung function and clinical outcomes, along with reduced systemic exposure to inhaled corticosteroids. The increased knowledge in the pathophysiology of the peripheral airways may lead to identify specific phenotypes of obstructive lung diseases that would mostly benefit from the treatments specifically targeting the peripheral airways.
 

Patient Relat Outcome Meas. 2014 Nov 27;5:153-62. doi: 10.2147/PROM.S55276. eCollection 2014.