• 第三軍醫(yī)大學(xué)新橋醫(yī)院呼吸科（重慶 400037）;

GOLD 指南將COPD定義為肺部的“異常炎癥反應(yīng)性疾病”已被大家所熟知, GOLD 還指出COPD 的氣流受限為“進(jìn)行性”發(fā)展, COPD 肺功能的下降與疾病過(guò)程密切相關(guān), 用FEV1 作指標(biāo)即表現(xiàn)為每年下降速率超過(guò)正常健康人群。不同的報(bào)道顯示COPD 患者FEV1 的下降速率從47～69 mL/年不等[ 1,2] , 而健康成年人大約為30 mL/ 年[ 3] 。FEV1 是目前評(píng)價(jià)COPD 病情嚴(yán)重度最重要的客觀(guān)指標(biāo)之一, 而戒煙是已知唯一可以減緩COPD 患者肺功能下降速率的干預(yù)方法[ 4] 。既往研究顯示吸入性激素( ICS) [ 1,5] 、N-乙酰半胱氨酸[ 6] 等均不能減緩COPD 患者肺功能下降的速率。Anzueto 等[ 7] 在一項(xiàng)回顧性研究中發(fā)現(xiàn)　托溴銨可以顯著地改善COPD 患者的FEV1 下降速率, 但是回顧性研究的說(shuō)服力有限。

引用本文： 王長(zhǎng)征. 藥物治療能改變慢性阻塞性肺疾病患者肺功能的下降速率嗎?. 中國(guó)呼吸與危重監(jiān)護(hù)雜志, 2009, 09(1): 1-2. doi: 復(fù)制

1. Pauwels RA, L fdahl CG, Laitinen LA, et al. Long-term treatment with inhaled budesonide in persons with mild chronic obstructive pulmonary disease who continue smoking. European Respiratory Society Study on Chronic Obstructive Pulmonary Disease. N Engl J Med, 1999, 340: 1948-1953.
2. Lung Health Study Research Group. Effect of inhaled triamcinolone on the decline in pulmonary function in chronic obstructive pulmonary disease. N Engl J Med, 2000, 343: 1902-1909.
3. James AL, Palmer LJ, Kicic E, et al. Decline in lung function in the Busselton Health Study: the effects of asthma and cigarette smoking.AmJ Respir Crit Care Med, 2005, 171: 109-114.
4. Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1 : the Lung Health Study. JAMA, 1994 , 272 : 1497 -1505 .
5. Soriano JB, Sin DD, Zhang X, et al. A pooled analysis of FEV1 decline in COPD patients randomized to inhaled corticosteroids or placebo. Chest, 2007, 131: 682-689.
6. Decramer M, Rutten-van M lken M, Dekhuijzen PN, et al. Effects of N-acetylcysteine on outcomes in chronic obstructive pulmonary disease ( Bronchitis Randomized on NAC Cost-Utility Study, BRONCUS): a randomised placebo-controlled trial. Lancet, 2005 , 365 :1552-1560.
7. Anzueto A, Tashkin D, Menjoge S, et al. One-year analysis of longitudinal changes in spirometry in patients with COPD receiving tiotropium. Pulm Pharmacol Ther, 2005, 18: 75-81.
8. Tashkin DP, Celli B, Senn S, et al. A 4-Year Trial of Tiotropium in Chronic Obstructive Pulmonary Disease. N Engl J Med, 2008, 359: 1543-1554.
9. Celli BR, Thomas NE, Anderson JA, et al. Effect of Pharmacotherapy on Rate of Decline of Lung Function in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med, 2008, 178: 332 – 338.
10. Wedzicha JA, Calverley PMA, Seemungal TA, et al, The Prevention of Chronic Obstructive Pulmonary Disease Exacerbations by Salmeterol /Fluticasone Propionate or TiotropiumBromide. Am JRespir Crit Care Med, 2008, 177: 19 – 26 .
11. Suissa S. Medications to modify lung function decline in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2008 ,178: 322-323.
12. Powrie DJ, Wikinson TMA, Donaldson GC, et al. Effect of tiotropium on inflammation and exacerbations in chronic obstructive pulmonary disease. Eur Respir J, 2007, 30: 472.
13. Hattotuwa KL, Gizycki MJ, Ansari TW, et al. The Effects of Inhaled Fluticasone on Airway Inflammation in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med, 2002, 165: 1592-1596.
14. Barnes NC, Qiu YS, Pavord ID, et al. Antiinflammatory Effects of Salmeterol/ Fluticasone Propionate in Chronic Obstructive Lung Disease. Am J Respir Crit Care Med, 2006, 173: 736-743.
  1. 1. Pauwels RA, L fdahl CG, Laitinen LA, et al. Long-term treatment with inhaled budesonide in persons with mild chronic obstructive pulmonary disease who continue smoking. European Respiratory Society Study on Chronic Obstructive Pulmonary Disease. N Engl J Med, 1999, 340: 1948-1953.
  2. 2. Lung Health Study Research Group. Effect of inhaled triamcinolone on the decline in pulmonary function in chronic obstructive pulmonary disease. N Engl J Med, 2000, 343: 1902-1909.
  3. 3. James AL, Palmer LJ, Kicic E, et al. Decline in lung function in the Busselton Health Study: the effects of asthma and cigarette smoking.AmJ Respir Crit Care Med, 2005, 171: 109-114.
  4. 4. Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1 : the Lung Health Study. JAMA, 1994 , 272 : 1497 -1505 .
  5. 5. Soriano JB, Sin DD, Zhang X, et al. A pooled analysis of FEV1 decline in COPD patients randomized to inhaled corticosteroids or placebo. Chest, 2007, 131: 682-689.
  6. 6. Decramer M, Rutten-van M lken M, Dekhuijzen PN, et al. Effects of N-acetylcysteine on outcomes in chronic obstructive pulmonary disease ( Bronchitis Randomized on NAC Cost-Utility Study, BRONCUS): a randomised placebo-controlled trial. Lancet, 2005 , 365 :1552-1560.
  7. 7. Anzueto A, Tashkin D, Menjoge S, et al. One-year analysis of longitudinal changes in spirometry in patients with COPD receiving tiotropium. Pulm Pharmacol Ther, 2005, 18: 75-81.
  8. 8. Tashkin DP, Celli B, Senn S, et al. A 4-Year Trial of Tiotropium in Chronic Obstructive Pulmonary Disease. N Engl J Med, 2008, 359: 1543-1554.
  9. 9. Celli BR, Thomas NE, Anderson JA, et al. Effect of Pharmacotherapy on Rate of Decline of Lung Function in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med, 2008, 178: 332 – 338.
  10. 10. Wedzicha JA, Calverley PMA, Seemungal TA, et al, The Prevention of Chronic Obstructive Pulmonary Disease Exacerbations by Salmeterol /Fluticasone Propionate or TiotropiumBromide. Am JRespir Crit Care Med, 2008, 177: 19 – 26 .
  11. 11. Suissa S. Medications to modify lung function decline in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2008 ,178: 322-323.
  12. 12. Powrie DJ, Wikinson TMA, Donaldson GC, et al. Effect of tiotropium on inflammation and exacerbations in chronic obstructive pulmonary disease. Eur Respir J, 2007, 30: 472.
  13. 13. Hattotuwa KL, Gizycki MJ, Ansari TW, et al. The Effects of Inhaled Fluticasone on Airway Inflammation in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med, 2002, 165: 1592-1596.
  14. 14. Barnes NC, Qiu YS, Pavord ID, et al. Antiinflammatory Effects of Salmeterol/ Fluticasone Propionate in Chronic Obstructive Lung Disease. Am J Respir Crit Care Med, 2006, 173: 736-743.

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