Review: long acting beta_2 agonists and inhaled corticosteroids reduce exacerbations in chronic obstructive pulmonary disease

摘要

The review by Sin et al contributes to the knowledge base on pharmacological and non-pharmacological management of COPD by going beyond evaluation of physiological endpoints, such as FEV_1 to include patient centred outcomes, such as health related quality of life (HRQOL), exacerbations, and mortality. However, the search strategy was limited to English language studies, which could have had an impact on the findings.COPD is a progressively debilitating condition that requires multimodal interventions to optimise health and functioning. Traditionally, SAbeta_2As and anticholinergic medications, alone or in combination, have been used for symptomatic relief of COPD. Recently, LA bronchodilators were introduced to achieve improvements in lung function for longer time periods. LAbveta_2As and anticholinergic medications, along with inhaled corticosteroids, improve HRQOL and reduce exacerbations in patients with moderate to severe COPD. Pulmonary rehabilitation, which may include exercise training, education, and behaviour modification, also improves HRQOL in such patients. Home oxygen prolongs survival but only in patients with resting hypoxia.Disease management or self management programmes provide patients with the knowledge, skills, and support needed to manage their illness and aim to improve overall functioning. Although commonly acknowledged as an essential component of COPD care,efficacy of such programmes remains unclear, and more research is needed to evaluate effects on health outcomes. On the other hand, smoking cessation is the only measure that has been shown to slow decline in lung function and disease progression.Therefore, patients with COPD who smoke must have access to resources to help them to quit.