基本的にこの論文は、3ヶ月CLIMB (Evaluation of Efficacy and Safety of Symbicort as an Add-on Treatment to Spiriva in Patients With Severe COPD)研究により、tiotropium +budesonide/formoterolが肺機能、急性増悪、朝の活動性に関するトライアルの紹介の記事

CLIMB study design. ICS, inhaled corticosteroid; LABA, long-acting β2-agonist

Chronic obstructive pulmonary disease (COPD)は、マルチコンポーネントな疾患で、気流制限と、気道炎症を伴うのを特徴とし、急性増悪は、QOL、日常活動、一般健康状態にインパクトを与え、医療体系に広範な影響を与える。COPDの病状維持の目的は、症状改善・進展予防だけでなく、急性増悪の予防・治療である。疾患のday-to-day burdenへの関心がむき、一日のうちもっとも重度である朝でもその価値がある治療が必要で、朝の活動性を良好に保つ治療にその関心が向いている。

Optimising treatment for COPD – new strategies for combination therapy
the International Journal of Clinical Practice Volume 63, Issue 8, Pages 1136-1149

Figure 5 Clinical benefits of adding tiotropium to other respiratory medications (8). (A) Probability of treatment discontinuation, (B) mean forced expiratory volume in 1 s (FEV1) and (C) forced vital capacity (FVC) before and after bronchodilation and (D) scores for health-related quality of life in patients randomised to receive tiotropium (18 μg once daily) plus any other COPD medication apart from anticholinergics vs. placebo. Bars represent standard errors and horizontal dashed lines represent baseline levels. *p < 0.001; †p = 0.002; ‡p = 0.04. Reprinted from Ref. (8). Copyright © (2008) Massachusetts Medical Society. All rights reserved.

Kaplan–Meier curves for mortality. Kaplan–Meier curves for mortality for budesonide-containing therapies (budesonide alone or budesonide/formoterol) vs. (A) reference (non-budesonide) groups (72), (B) salmeterol/fluticasone vs. placebo (43) and (C) salmeterol/fluticasone (SFC) vs. tiotropium (66). (A) Reprinted from Ref. (72). Copyright © (2008), with permission from Respiratory Medicine. (B) Reprinted from the Ref. (43). Copyright © (2007) Massachusetts Medical Society. All rights reserved. (C) Reprinted from Ref. (66). Official Journal of the American Thoracic Society© American Thoracic Society

by internalmedicine | 2009-08-06 16:51 | 呼吸器系  

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