支气管舒张剂是COPD药物治疗的基石——兼谈我国COPD患者支气管舒张剂的应用现状  

Bronchodilators Are Basic Therapeutics in Treatment of Chronic Obstructive Pulmonary Disease(COPD)(Current Status in Treating COPD with Bronchodilators Administration in China)

作　　者：罗勇[1,2] 

机构地区：[1]上海交通大学医学院附属新华医院崇明分院呼吸科,上海202150 [2]上海交通大学医学院附属新华医院呼吸科,上海200092

出　　处：《临床误诊误治》2012年第8期5-8,共4页Clinical Misdiagnosis & Mistherapy

基　　金：上海市慢性病综合防治项目(SHDC12007301)

摘　　要：支气管舒张剂主要包括β2-受体激动剂、抗胆碱能药物、甲基黄嘌呤类药物。慢性阻塞性肺疾病(chronic obstruc-tive pulmonary disease,COPD)患者使用长效β2-受体激动剂,尤其是和糖皮质激素联合应用,可显著减少病情恶化、改善肺功能和生活质量。抗胆碱能药物也能显著提高COPD患者的活动能力和生活质量,长效抗胆碱能药物有降低COPD患者病死率的趋势。《COPD诊断、处理和预防全球策略》推荐首先使用β2-受体激动剂和抗胆碱能药物,而我国使用最为普遍的是价格低廉的甲基黄嘌呤类药物。我国基层医院对COPD患者使用吸入型支气管舒张剂严重不足,使用长效支气管舒张剂几乎为空白,虽然三级医院呼吸科医生对COPD患者使用吸入型支气管舒张剂的比例较高,但仍然较少应用长效制剂,预防症状加重或长期控制症状的治疗观念尚显不足。因此,极有必要强化内科及呼吸科医生"支气管舒张剂是药物治疗COPD的基石"这一理念。Bronchodilators, such as [32-receptor agonists, antieholinergic agengts and metbylxanthine, are basic therapeutics in treatment of chronic ohstlaxctive pulmonary disease （COPD）. Long acting β2-receptor agonists, especially when combined with glucocorticoids, can alleviate exacerbation, improve lung function and quality of hfe. Anticholinergic agents can also significantly improve locomotor activity and quality of life in treatment of COPD, and long acting anticholinergic agents can reduce mortality rate as well. The position paper Global Strategy for the Diagnosis, Management and Prevention of COPD recommends β2-receptor agonists and anticholinergic agengts as first choice in treating COPD, while Chinese clinicians prefer to use cheaper methylxanthine. In primary health centers, few clinicians choose nebulization bronchodilators, and almost no clinician treat the disease with long acting bronchodilators in China. Although many clinicians choose nebulization bronchodilators in the higher level hospitals, but the clinicians still do not choose the long acting bronchodilators when needed. The concept of alleviating exacerbation and long-term controlling pathogenetic condition is not emphasized. It is necessary to emphasize the concept that bronchodilators are the basic therapeutics in treatment of COPD.

关 键 词：肺疾病 慢性阻塞性 支气管扩张药 

分 类 号：R563.9[医药卫生—呼吸系统]