从指南变迁看吸入性糖皮质激素在慢性阻塞性肺疾病稳定期治疗中的地位

Overview of the role of inhaled corticosteroids in chronic obstructive pulmonary disease from evolution of guidelines

在慢性阻塞性肺疾病(慢阻肺)稳定期治疗中,国际指南对吸入性糖皮质激素(ICS)治疗的推荐依据临床证据积累而不断更新,经过从“争议”到“肯定”的认识深入过程,直到最新指南中的ICS推荐策略:考虑到临床特征将患者分为呼吸困难和急性加重两类来进行治疗方案调整,对前一年急性加重发生较频繁患者,结合其外周血嗜酸性粒细胞计数,推荐相应的含ICS的个体化给药。

In the treatment of stable chronic obstructive pulmonary disease(COPD),international guidelines have updated the recommendations for inhaled corticosteroids(ICS)based on the accumulated clinical evidences,and the understanding has gone further from"controversy"to"affirmation"until the presence of the lastest guideline that indicates patients are divided into two phenotypes according to the clinical characteristics of dyspnea and acute exacerbation for adjustments in treatment strategy,and for patients with frequent acute exacerbations during the last one year,combined with their blood eosinophil counts,the individualized treatments including ICS are recommended.