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香港,中国 - Media OutReach - 20181016- 慢性阻塞性肺病患者的呼吸系统经长期破坏,使得肺部呼出和吸入空气变得困难。呼吸内科专科医生黄永政表示,慢阻肺最令人担心的是急性发作会增加死亡风险,"每次急性发作均会造成肺功能断层式下降,导致不可逆转的损害,治疗目的是预防急性发作"。 

  

 滥用吸入式类固醇副作用大 慢阻肺病情稳定无必要

慢阻肺治疗方法包括药物、肺康复治疗及手术等,吸入式气管舒张剂有助放松气管肌肉及扩张气管,是最为常用的方法,吸入式气管舒张剂包括长效型β2受体激动剂(LABA)、长效型毒蕈碱拮抗剂(LAMA)、长效双效气管舒张剂(LAMA/LABA)及吸入式类固醇(ICS)等。

 

不建议病情稳定患者使用

 

类固醇有不少副作用,包括骨质疏松、发声困难和喉咙痛、消化性溃疡、白内障及肺炎等。有国际研究指出,治疗慢阻肺并不一定需要使用吸入式类固醇,而是应该按病情而定,研究数据显示,相比长效型β2受体激动剂加吸入式类固醇,慢阻肺患者使用长效双效气管舒张剂,能减低严重急性发作风险达19%、延迟首次中等至严重急性发作风险达22%,以及减少并发肺炎的风险达33%

 

黄永政医生表示:"国际指南提醒吸入式类固醇应只适用于病情严重及经常急性发作的病人,不建议病情稳定的患者使用。"但数据也显示约一半病情稳定的患者曾使用吸入式类固醇,承受了不必要的风险。

 

79岁的郭伯伯两三年前确诊慢阻肺,曾试过两种气雾剂,由于未能掌握吸入器用法,治疗一段时间后,病情也没有改善。

 

直至大半年前,他转用单一剂量、较易使用的干粉吸入器(长效双效气管舒张剂),用后即见效,气喘大大减少。每次吸药后,他都会检查胶囊,以确保吸入正确剂量。郭伯伯如今病情受控,可如常人般旅行及陪伴孙女玩耍。

 

吸药后感觉到甜味确认成功

 

有研究显示,患者使用压力定量气雾及软雾吸入器时,会比干粉吸入器出现更多严重错误。适当地用药及使用吸入器可达到最佳治疗效果,患者应留意是否吸入正确剂量的药物。如吸入器设有计量器,患者可查看剩余容量;如使用单一剂量干粉吸入器,可于吸药后检查胶囊是否仍有药粉,有些吸入器会在患者吸药时发出声音,或在吸药后感觉到甜味,以助确认已吸入药物。另外在吸药时,患者应注意手和呼吸的协调。

Source http://www.media-outreach.com/release.php/View/6914#Contact

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