摘要 : In recent years, data have accumulated from randomized clinical trials comparing different free or fixed-dose combinations of inhaled drugs, including long-acting (β_2-agonists (LABAs), long-acting muscarinic antagonists (LAMAs), ... 展开 In recent years, data have accumulated from randomized clinical trials comparing different free or fixed-dose combinations of inhaled drugs, including long-acting (β_2-agonists (LABAs), long-acting muscarinic antagonists (LAMAs), and/or inhaled corticosteroids (ICS), for the treatment of chronic obstructive pulmonary disease (COPD). These studies have led to a paradigm shift in evidence-based recommendations concerning the preferred treatment options for initiating and optimizing different classes of pharmacotherapeutic agents, tied to the severity of the disease as classified by the level of symptoms and risk for acute exacerbations of COPD, as well as to the response to the initial medication chosen (1). An increasing body of evidence from randomized clinical trials has demonstrated the superiority of LABA/LAMA over LABA/ICS combinations, at least with respect to bronchodilation, consistent with the concept that two bronchodilators lead to greater bronchodilation than one (2-8). Less evidence exists regarding the comparative efficacy of dual bronchodilators versus LABA/ICS combinations with respect to acute exacerbations and other patient-centered outcomes. One study (FLAME [Indacaterol-Glycopyrronium versus Salmeterol-Fluticasone for COPD]) has recently demonstrated superiority of a once-daily LABA/LAMA over a twice-daily LABA/ICS with respect to prevention of exacerbations in patients with mostly severe airflow obstruction and a documented history of one or more exacerbations during the previous year, in addition to superior improvement in lung function, health-related quality of life (St. George's Respiratory Questionnaire), and rescue medication use (9). Analyses of data generated from ongoing registration trials of different LAB A/LAM A/ICS ("triple") combinations comparing the efficacy of other LABA/LAMA combinations versus both the LABA/ICS components and the full triple combinations are anticipated in the near future. 收起