中重度慢阻肺吸入三联治疗研究进展

Research Progress in Inhaled Triple Therapy for Moderate-to-Severe Chronic Obstructive Pulmonary Disease

摘要: 吸入三联治疗作为中重度慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)稳定期维持治疗的重要策略，近年来在症状控制、肺功能改善及急性加重预防方面受到广泛关注。围绕吸入性糖皮质激素(inhaled corticosteroids, ICS)、长效β2受体激动剂(long-acting beta2-agonists, LABA)和长效抗胆碱能药物(long-acting muscarinic antagonists, LAMA)组成的三联方案，近年来已积累较多随机对照试验、系统评价/Meta分析、真实世界研究及指南证据。现有研究表明，与双联支气管舒张治疗相比，吸入三联治疗可进一步降低中重度COPD患者急性加重风险，并在改善肺功能、缓解呼吸道症状和提升健康相关生活质量方面表现出一定优势。对于既往急性加重频繁、症状负担较重、血嗜酸性粒细胞水平较高或具有特定症状表型的患者，三联治疗获益更为明显。然而，肺炎等ICS相关不良反应风险、不同人群获益差异及临床个体化选择问题仍需重视。未来仍需结合真实世界研究、精准分层和长期随访结果，进一步明确三联治疗的最佳适用人群及优化路径，为中重度COPD患者个体化治疗提供依据。

Abstract: Inhaled triple therapy has become an important maintenance strategy for patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) and has received increasing attention for its potential benefits in symptom control, lung function improvement, and exacerbation prevention. Triple therapy, consisting of inhaled corticosteroids (ICS), long-acting beta2-agonists (LABA), and long-acting muscarinic antagonists (LAMA), has been supported in recent years by accumulating evidence from randomized controlled trials, systematic reviews and meta-analyses, real-world studies, and guideline documents. Current evidence indicates that, compared with dual bronchodilator therapy, inhaled triple therapy can further reduce the risk of acute exacerbations in patients with moderate-to-severe COPD and may also provide additional benefits in improving pulmonary function, relieving respiratory symptoms, and enhancing health-related quality of life. These benefits appear to be more pronounced in patients with a history of frequent exacerbations, greater symptom burden, elevated blood eosinophil counts, or specific clinical phenotypes. However, ICS-related adverse events, such as pneumonia, interindividual differences in treatment benefits, and individualized clinical decision-making remain important considerations in clinical practice. Future studies should further integrate real-world data, precision-based patient stratification, and long-term follow-up outcomes to better define the optimal target population and treatment pathway for inhaled triple therapy, thereby supporting more individualized management of moderate-to-severe COPD.