慢性阻塞性肺疾病三联吸入药物停用ICS的研究进展

Research Progress on Discontinuation of ICS with Triple Inhaled Drugs for Chronic Obstructive Pulmonary Disease

摘要: 慢性阻塞性肺疾病(Chronic Obstructive Pulmonary Disease简称COPD)是一种慢性气道疾病，主要表现为相应的呼吸道症状和不可逆的气流受限，患病率高，病死率高。急性加重的频发会导致肺功能恶化、疾病进展和生活质量下降，是COPD稳定期管理的重点。而三联药物治疗慢阻肺及预防急性加重，目前在市场上广泛应用。由于过度使用ICS，经常用于疗效尚未确定的患者及担心长期使用ICS的不良事件，特别是肺炎，这种方法正在接受审查。因此，需要明确COPD患者使用ICS的个性化方案，并考虑在没有明确指征的患者中停用ICS。本文将围绕COPD稳定期患者三联吸入药物治疗的降级研究进展进行综述，其主要内容包括当前各种指南对COPD提出建议，撤除ICS的相关研究数据、重要结果、亚组分析、结论与展望为COPD的临床用药规范提供参考。

Abstract: Chronic obstructive pulmonary disease (COPD) is a chronic airway disease, mainly manifested by corresponding respiratory symptoms and irreversible airflow limitation, with high morbidity and mortality. Frequent exacerbations can lead to worsening lung function, disease progression, and quality of life, and is the focus of management in stable COPD. The triple drug treatment of COPD and the prevention of acute exacerbations are currently widely used in the market. This approach is under scrutiny due to overuse of ICS, frequent use in patients whose efficacy has not been estab-lished, and concerns about adverse events from long-term ICS use, particularly pneumonia. There-fore, individualized regimens of ICS use in COPD patients need to be identified and ICS discontinua-tion should be considered in patients without a clear indication. This article will review the research progress on de-escalation of triple inhaled drug therapy in stable COPD patients. The main contents include recommendations for COPD by current guidelines, relevant research data on withdrawal of ICS, important results, subgroup analysis, and replacement after drug withdrawal. The treatment, conclusion and prospect provide reference for the clinical medication standard of COPD.