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Guideline
慢性阻塞性肺疾病   CHRONIC OBSTRUCTIVE PULMONARY DISEASE
慢性阻塞性肺疾病(慢阻肺,COPD)是一种以持续存在气流受限、伴有气道和肺对有害颗粒或气体所致慢性炎症反应增加为特征的疾病,非完全可逆性气流受限呈进行性发展。慢阻肺是一种严重危害人类健康的常见病、多发病,严重影响患者的生活质量,病死率较高,并给患者及其家庭以及社会带来沉重的经济负担。我国对7个地区20245名成年人进行的调查显示,40岁以上人群中慢阻肺的患病率高达8.2%。据“全球疾病负担研究项目”估计,到2020年慢阻肺将位居全球死亡原因的第3位。
  查阅疾病用药指南
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医药新闻
2018年6月
尽管中至重度哮喘患者的肺功能会略有下降,但采用LABA/LAMA/ICS三联疗法的患者逐步停用ICS,并未增加COPD的恶化风险。
2018年6月, Pearl Toh
研究表明,糠酸氟替卡松、芜地溴铵和维兰特罗三联吸入疗法显著降低了COPD中度或重度加重的发生率,效果优于长效β2-受体激动剂联合吸入用皮质激素或长效抗胆碱药的双联疗法。
2018年1月
2017年12月首次通过美国食品药品管理局新药审批的药物,包括新化学成份和新生物制剂。但未包括暂时审批的药物。药物通过新药审批后可能还需要补充申请批准。
2017年12月, Elvira Manzano
多中心、双盲、双模拟、平行对照IV期FLASH研究显示,在有症状的中-重度慢性阻塞性肺病(COPD)患者中,从沙美特罗/氟替卡松转换为茚达特罗/格隆铵可改善肺功能,且耐受性相近。
2017年10月
2017年9月首次通过美国食品药品管理局新药审批的药物,包括新化学成份和新生物制剂。但未包括暂时审批的药物。药物通过新药审批后可能还需要补充申请批准。
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药物信息

辅舒酮 Flixotide  [  葛兰素史克 GlaxoSmithKline   ]  氟替卡松 Fluticasone
适应症: ≥1岁人群哮喘的预防性治疗。
MIMS药理分类 平喘药及慢阻肺用药 Antiasthmatic & COPD Preparations  
Flixotide MDI 125 mcg_spray0a848487-1e3d-4d51-9cc4-9fcb0188c6d7.GIF
舒利迭 Seretide  [  葛兰素史克 GlaxoSmithKline   ]  沙美特罗+氟替卡松 Salmeterol + Fluticasone
适应症: 干粉吸入剂 成人和儿童哮喘。50 ug/500 ug规格 除哮喘外,还用于COPD,包括慢性支气管炎及肺气肿的常规治疗。气雾剂 对哮喘进行常规治疗的患者的联合用药。详见说明书。
MIMS药理分类 平喘药及慢阻肺用药 Antiasthmatic & COPD Preparations  
Seretide diskus 50 ug_100 ugfb0e5615-a339-4882-9898-9fcb01892816.GIF
万托林 Ventolin  [  葛兰素史克 GlaxoSmithKline   ]  沙丁胺醇 Salbutamol
适应症: 气雾剂:缓解哮喘或慢性阻塞性肺部疾患(可逆性气道阻塞疾病)患者的支气管痉挛、急性预防运动诱发的哮喘或其他过敏原诱发的支气管痉挛。吸入溶液:对传统治疗方法无效的慢性支气管痉挛的治疗及严重的急性哮喘发作。
MIMS药理分类 平喘药及慢阻肺用药 Antiasthmatic & COPD Preparations  
Ventolin Nebules 5 mg_2.5 mL2dde2201-3a93-4873-9532-a08201066dee.GIF
阿斯美 Asmeton  [  第一三共(中国) Daiichi-Sankyo (China)   ]  -  氨茶碱 + 氯苯那敏 + 盐酸甲氧那明 + 那可丁 aminophylline + chlorphenamine + methoxyphenamine ...
适应症: 用于支气管哮喘和喘息性支气管炎,以及其它呼吸系统疾病引起的咳嗽、咳痰、喘息等症状。
MIMS药理分类 止咳祛痰和感冒药 Cough & Cold Preparations  
Asmeton capde750cfc-4ed7-4e84-bc59-9fcb0188cd42.GIF
爱全乐 250 Atrovent 250  [  勃林格殷格翰 Boehringer Ingelheim   ]  异丙托溴铵 Ipratropium bromide
适应症: 可与吸入性β-受体激动剂合用于治疗急性或慢性哮喘引起的可逆性气道阻塞。
MIMS药理分类 平喘药及慢阻肺用药 Antiasthmatic & COPD Preparations  
Atrovent 250 soln for inhalation 250 ug_2 mL7fc9fbcb-a0c0-4eb8-a52e-9fcb0188f238.GIF
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参考文献
  1. 临床诊疗指南-呼吸病学分册(中华医学会编著)-人民卫生出版社,2009年1月
  2. 实用内科学(第13版) - 人民卫生出版社,2009年(主编:陈灏珠)
  3. 循证内科学丛书,呼吸内科-北京科学技术出版社,2010年3月(主编:高占成、胡大一)
  4. 慢性阻塞性肺疾病急性加重(AECOPD)诊治中国专家共识(草案),慢性阻塞性肺疾病急性加重(AECOPD)诊治专家组 - 中华哮喘杂志(电子版),2013年2月,第7卷第1期:1-13页
  5. 慢性阻塞性肺疾病诊治指南(2007年修订版),中华医学会呼吸病学分会慢性阻塞性肺疾病学组 - 中华内科杂志,2007年3月,第46卷第3期
  6. 慢性阻塞性肺疾病诊疗规范(2011年版)-卫生部,2011年8月( URL: http://www.moh.gov.cn/publicfiles/business/ htmlfiles/mohyzs/s3586/201108/52675.htm)
  7. Alberta Medical Association. Guideline for the management of acute exacerbations of chronic bronchitis (AECB)/acute or chronic COPD. Alberta Medical Association. http://www.albertadoctors.org/. May 2000. Accessed 05 Aug 2002.
  8. Decramer M, Celli B, Kesten S, et al; UPLIFT investigators. Effect of tiotropium on outcomes in patients with moderate chronic obstructive pulmonary disease (UPLIFT): a prespecified subgroup analysis of a randomised controlled trial. Lancet. 2009 Oct;374(9696):1171-1178. PMID: 19716598
  9. Ferguson GT, Calverley PM, Anderson JA, et al. Prevalence and progression of osteoporosis in patients with COPD: results from the Towards a Revolution in COPD Health study. Chest. 2009 Dec;136(6):1456-1465. PMID: 19581353
  10. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. http://www.goldcopd.org/. 2011.
  11. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. http://www.goldcopd.org/uploads/users/files/GOLD_Report_2013_Feb20.pdf. 2013
  12. Gross N, Levin D. Primary care of the patient with chronic obstructive pulmonary disease-part 2: pharmacologic treatment across all stages of disease. Am J Med. 2008 Jul;121(7)(Suppl):S13-S24. PMID: 18558103
  13. Institute for Clinical Systems Improvement (ICSI). Health care guideline: chronic obstructive pulmonary disease. http://www.icsi.org. 2004
  14. Ministry of Health Singapore. Clinical practice guidelines: chronic obstructive pulmonary disease. MOH (Singapore). http://www.moh.gov.sg. 2006
  15. National Clinical Guideline Centre. Chronic obstructive pulmonary disease: management of chronic obstructive pulmonary disease in adults in primary and secondary care. http://guidance.nice.org.uk/. 2010.
  16. National Heart, Lung and Blood institute. Global Initiative for Asthma. Global strategy for asthma management and prevention. http://www.ginasthma.org/. 2006. Accessed 07 Sep 2007.
  17. National Heart, Lung, and Blood Institute. Global Initiative for Asthma. Global strategy for asthma management and prevention Updated 2009. 2009
  18. National Institute for Health and Care Excellence. Chronic obstructive pulmonary disease: management of chronic obstructive pulmonary disease in adults in primary and secondary care. NICE. http://www.nice.org.uk. 2004.
  19. O'Donnell DE, Aaron S, Bourbeau J, et al. Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease - 2007 update. Can Respir J. 2007 Sep;14(Suppl B):5B-32B. PMID: 17885691
  20. O'Donnell DE, Hernandez P, Kaplan A, et al. Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease - 2008 update - highlights for primary care. Can Respir J. 2008 Jan;15(Suppl A):1A-8A. PMID: 18292855
  21. Qaseem A, Snow V, Shekelle P, et al; Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2007 Nov;147(9):633-638. PMID: 17975186
  22. Rennard SI. Overview of causes of COPD. New understanding of pathogenesis and mechanisms can guide future therapy. Postgrad Med. 2002 Jun;111(6):28-38. PMID: 12082919
  23. Snow V, Lascher S, Mottur-Pilson C; Joint Expert Panel on Chronic Obstructive Pulmonary Disease of the American College of Chest Physicians and the American College of Physicians-American Society of Internal Medicine. Evidence base for management of acute exacerbations of chronic obstructive pulmonary disease. Ann Intern Med. 2001 Apr;134(7):595-599. PMID: 11281744
  24. The Asia Pacific COPD Roundtable Group. Global Initiative for Chronic Obstructive Lung Disease strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease: an Asia-Pacific perspective. Respirology. 2005 Jan;10(1):009-17. PMID: 15691232
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