GOLD2011及雾化吸入激素治疗AECOPD.ppt-.pptVIP

常用方法 普米克令舒1支 特布他林 1支 爱全乐 1支 * The risk of adverse effects was higher with oral corticosteroid versus placebo use.Wood-Baker et al. 2005/6/1/5 One extra adverse effect occurred for every 6 patients treated. Three studies showed an increased incidence of hyperglycemia Wood-Baker RR, Gibson PG, Hannay M, Walters EH, Walters JAE. Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews. 2005;1:CD001288. * 雾化吸入的糖皮质激素药物能直接进入支气管和肺部，较少了全身药物得用量，并且无需特殊吸入技巧，能迅速发挥作用，副作用小，使用安全可靠成为治疗AECOPD的理想选择。 Pulmicort? Paediatric Product Monograph: Chapter 1 Figure 2 雾化糖皮质激素治疗非酸中毒AECOPD, 替代或减少全身激素的剂量；并减轻全身激素的副作用； * With regard to the absolute values of arterial blood gases and spirometric measurements at 10 days, mean forced expiratory flow between 25 and 75% of FVC (FEF25–75%) value in group 3 was significantly higher than the values in group 1 and 2 (p50.03 and p50.027 respectively). In addition to this, while direct comparison of arterial blood gases and spirometric parameters did not reveal any difference between group 1 and 2, FEV1 was also found to be significantly higher in group 3 than in group 1 (p＝0.004). while mean blood glucose levels were decreasing during the hospitalisation period in groups 1 and 3, it was found to be higher than the admission value in group 2 at 7- and 10-day controls. * 入院第7天和第10天泼尼松龙组血糖明显升高（P0.05），而BUD 1mg组、BUD 2mg组和对照组血糖变化不大，且呈逐渐下降趋势。 在整个实验观察期间，患者均无严重的副作用发生。泼尼松龙组患者胃部不适4例，出现睡眠障碍3例，出现上消化道出血1例，且出现不同程度药物相关性血糖升高，停药后改善，不良反应发生率达36％；布地奈德2组发生口腔霉菌感染l例，胃部不适1例；而布地奈德1组和对照组未出现明显不适。布地奈德1组、2组的副作用明显少于泼尼松龙组(P0.05)，与对照组相仿(P0．05)。 * * BUD 4mg/d（2mg bid 雾化吸入）；PRED 30mg/d（30mg qd po）治疗阻塞性肺病急性加重。作者假设雾化吸入激素治疗慢性阻塞性肺病急性加重有效，进行初步的研究验证这一假设。结果显示雾化吸入激素与全身激素相比疗效相同，且全身副作用较少。（Morice AH et al, Clinical Pharmacology Therapeutics.1996,60,675-678.） BUD 8mg/d（2mg q6h 雾化吸入）；PRED 60mg/d（30mg q12h po）治疗COPD急性加重。有研究显示雾化吸入激素可替代全身激素治疗急性重症哮喘，提示在COPD急性加重的治疗中，雾化吸入激素可能有效。研究结果显示雾化吸入激素可以替代