PDF(Pubmed)
Abstract：
Although pharmacological treatment of COPD is codified in different guidelines and strategy documents, there is abundant evidence of discrepancy between what they suggest and what health professionals prescribe, especially in low-risk groups where there is widespread overprescription of triple therapy. It is therefore necessary to clarify when the use of triple therapy is indicated in COPD patients and when it is preferable to maintain treatment with dual bronchodilation. In this article, we discuss our views based on our experience and what is reported in the literature and try to give answers to these two questions. The evidence generated by pivotal RCTs supports the use of triple therapy in patients who present for the first time and have severe airway obstruction, are symptomatic, have had frequent moderate or severe exacerbations in the previous year, and have peripheral eosinophilia. However, it is difficult to determine whether step-up is useful in all other cases because the available data are quite conflicting. It is likely that the inconsistency in the information generated by the various available studies may explain the prescribing behaviour of many physicians who do not adhere to recommendations of guidelines and strategies. However, it is necessary to establish whether and when the addition of an ICS to the LAMA/LABA combination is effective, to determine whether triple therapy can induce an additional clinical benefit over dual bronchodilation, irrespective of a preventive effect on COPD exacerbations, to establish its value, and to examine whether cost differences can support the use of triple therapy over combined LAMA/LABA therapy in real life.
摘要：
虽然COPD的药物治疗在不同的指南和策略文件中被编码，有大量证据表明他们的建议和卫生专业人员的处方之间存在差异，特别是在低危人群中，三联疗法普遍存在过度处方。因此，有必要澄清在COPD患者中何时使用三联疗法，以及何时优选维持双支气管扩张治疗。在这篇文章中,我们根据我们的经验和文献报道的内容讨论我们的观点，并试图回答这两个问题。关键随机对照试验产生的证据支持在首次出现严重气道阻塞的患者中使用三联疗法。有症状，在过去一年中经常有中度或重度恶化，并有外周嗜酸性粒细胞增多。然而,很难确定在所有其他情况下升级是否有用，因为可用数据是相当矛盾的。各种现有研究产生的信息的不一致可能解释了许多不遵守指南和策略建议的医生的处方行为。然而,有必要确定在LAMA/LABA组合中添加ICS是否以及何时有效，为了确定三联疗法是否可以引起比双支气管扩张额外的临床益处，无论对COPD加重的预防作用如何，为了确立它的价值，并检查成本差异是否可以支持在现实生活中使用三联疗法而不是LAMA/LABA联合疗法。
