GOLD指南和LAMA的应用摘要.ppt

* * Tiotropium significantly increased the time to first exacerbation (primary endpoint) compared with salmeterol by 42 days (187 vs 145 days in the first quartile of patients), corresponding to a 17% reduction in risk (HR 0.83; 95% CI 0.77-0.90; P0.001). Given that less than 50% of patients experienced an exacerbation, it was not possible to calculate the median time to first exacerbation, therefore the time to first exacerbation in the first quartile of patients was calculated instead. Randomized patients taking ≥1 dose of study medication included in analysis. COPD exacerbations with onset during actual treatment. Hazard ratio based on Cox proportional hazards regression model including terms for (pooled) centre and treatment. * Randomized patients taking ≥1 dose of study medication included in analysis. COPD exacerbations with onset during actual treatment. Hazard ratio based on Cox proportional hazards regression model including terms for (pooled) centre and treatment. * HR 95% CI Adverse events 0.81 0.65, 1.0 Serious adverse events 0.78 0.62, 0.98 Fatal events 0.69 0.48, 1.01 死亡率是一预先设定的终点，有三种分析评估方式: 治疗分析 方案所定治疗期末意向治疗分析 (1440天) 30天随访期后意向治疗分析 (1470天). * According to COPD 2007, COPD treatment has the goal as above. Most patients see doctors aiming to relieve symptoms, which can be achieved in short term by pharmacological therapy. Beyond this, based on the nature of COPD, the long term success via medication should be “impacting clinical course” and then prevent disease progression. But up to now, there is no existing medications proven to be able to slow the lung-function decline ( embodied by FEV1 decline rate) that is the hallmark of COPD. 根据2007年GOLD指南，COPD的治疗具有以上目标。绝大数病人去看医生是因为要缓解症状，以达到短期的疗效。但对于COPD疾病进程来说，改变疾病进程的长期疗效也很重要，但目前为止，没有任何药物能直接逆转COPD疾病进程。 * * * * * * * * * * * * * * * * 这张幻灯片主要强调迷走神经通路在COPD的发病机制中的重要地位（当然同时，迷走神经通路和气道炎症通路又是相互影响的。） COPD发病机制主要中包括2种通路，气道炎症通路和迷走通路，这两个通路相互独立又相互影响。 例如，在COPD发生发展过程中，烟草以及其他吸入型刺激性物质进入气道诱发炎症反应；与此同时，吸烟也可以刺激迷走神经引起