基于《2024年意大利共识：慢性阻塞性肺疾病的三联吸入治疗》对中国慢性阻塞性肺疾病患者管理的启示

doi:10.12114/j.issn.1007-9572.2024.0616

中国全科医学 ›› 2026, Vol. 29 ›› Issue (06): 688-692.DOI: 10.12114/j.issn.1007-9572.2024.0616

所属专题：呼吸疾病文章合辑

基于《2024年意大利共识：慢性阻塞性肺疾病的三联吸入治疗》对中国慢性阻塞性肺疾病患者管理的启示

陈楚萍¹, 刘力滴¹, 杨梓钰¹, 张鹏¹, 张瑞¹, 袁波¹, 沈灿¹, 杨荣¹, 李东泽², 廖晓阳¹, 雷弋¹^,^*()

1．610041　四川省成都市，四川大学华西医院全科医学中心全科医学教研室
2．610041　四川省成都市，四川大学华西医院急诊科

收稿日期:2024-10-15 修回日期:2025-07-07 出版日期:2026-02-20 发布日期:2026-01-05
通讯作者: 雷弋
作者贡献：
陈楚萍、刘力滴、杨梓钰、张鹏负责文章的构思与设计、资料收集与整理分析、论文撰写与修订，对文章整体负责；张瑞、袁波、沈灿、杨荣、李东泽负责论文修订；廖晓阳、雷弋进行文章的可行性分析，参与论文修订，负责监督管理、文章的质量控制及审校。
基金资助:
四大慢病重大专项(2023ZD0506101，2023ZD0506100); 国家临床重点专科建设项目(川卫医政函〔2023〕87号)

Implications for the Management of Chronic Obstructive Pulmonary Disease Patients Based on the Italian Consensus in 2024: Triple Inhalation Therapy in Chronic Obstructive Pulmonary Disease

CHEN Chuping¹, LIU Lidi¹, YANG Ziyu¹, ZHANG Peng¹, ZHANG Rui¹, YUAN Bo¹, SHEN Can¹, YANG Rong¹, LI Dongze², LIAO Xiaoyang¹, LEI Yi¹^,^*()

1. Teaching & Research Section/General Practice Research Institute, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu 610041, China
2. Emergency Department, West China Hospital, Sichuan University, Chengdu 610041, China

Received:2024-10-15 Revised:2025-07-07 Published:2026-02-20 Online:2026-01-05
Contact: LEI Yi

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摘要/Abstract

摘要： 在中国，慢性阻塞性肺疾病（COPD）属于常见慢性病，具有较高的发病率和死亡率，给个人健康和社会经济带来了巨大的负担。药物治疗是COPD患者管理的核心，应遵循个性化原则，其中三联疗法[吸入性糖皮质激素（ICS）、长效抗胆碱受体药物（LAMA）和长效β2受体激动剂（LABA）]备受关注。2024年意大利呼吸科专家组为规范化管理COPD患者，通过科学委员会与专家小组探讨，发布了《意大利共识：慢性阻塞性肺疾病的三联吸入治疗》。本文旨在解读该共识中有关三联疗法的核心要点，重点分析三联疗法在不同的临床情景下的适用情况，为我国临床实践中优化COPD药物选择提供参考，助力提升治疗规范化水平，减少治疗的盲目性，提高治疗效果。

关键词: 肺疾病，慢性阻塞性, 三联疗法, 共识, 疾病管理

Abstract:

In China, chronic obstructive pulmonary disease (COPD) is a prevalent chronic disorder. With high incidence and mortality, it burdens both individual health and socioeconomic systems. Pharmacological treatment is essential for COPD management, and personalized therapy is key. Triple therapy combining inhaled corticosteroids (ICS), long-acting muscarinic antagonist (LAMA), and long-acting beta-agonist (LABA) has become a focal point. In 2024 Italy has refined the management of COPD patients through the establishment of an expert panel focusing on the applicability of triple therapy in order to standardize the management of patients with COPD and published the "An Italian Delphi Consensus on the Triple Inhalation Therapy in Chronic Obstructive Pulmonary Disease". This article interprets the consensus' core points on triple therapy, analyzes its applications in diverse clinical scenarios, and provides evidence - based guidance for optimizing drug selection in Chinese COPD treatment. The goal is to improve treatment standardization and enhance patient outcomes.

Key words: Pulmonary disease, chronic obstructive, Triple therapy, Consensus, Disease management

中图分类号:

R 563.9

陈楚萍,刘力滴,杨梓钰,等. 基于《2024年意大利共识：慢性阻塞性肺疾病的三联吸入治疗》对中国慢性阻塞性肺疾病患者管理的启示[J]. 中国全科医学, 2026, 29(06): 688-692. DOI: 10.12114/j.issn.1007-9572.2024.0616.
CHEN Chuping,LIU Lidi,YANG Ziyu, et al. Implications for the Management of Chronic Obstructive Pulmonary Disease Patients Based on the Italian Consensus in 2024: Triple Inhalation Therapy in Chronic Obstructive Pulmonary Disease[J]. Chinese General Practice, 2026, 29(06): 688-692. DOI: 10.12114/j.issn.1007-9572.2024.0616.

图/表 2

参考文献 33

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国家	适用情况	备注
意大利	坚持二联疗法的患者未达到治疗目标时（使用双重支气管扩张剂治疗后出现加重；使用ICS/LABA后呼吸道症状持续）	适用于没有合并症的情况，特别是心血管疾病
中国	·使用ICS+LABA治疗仍存在呼吸困难或运动受限 ·接受ICS+LABA治疗后发生急性加重 ·接受LAMA+LABA治疗后发生急性加重且血EOS≥100个/μL^[11]
	适用于稳定期COPD患者非初始治疗
美国	接受LABA/LAMA二联疗法后，在过去1年中仍因1次或多次加重而需要口服皮质类固醇、抗生素或住院；仍有呼吸困难症状或运动耐量减低^[17]	有条件推荐，中等质量证据
加拿大	中度/重度呼吸困难和/或健康状况受损以及病情加重风险较高^[22]
英国	接受LABA/LAMA二联疗法后在1年内仍出现需要住院治疗的加重，或者出现2次中度加重^[23]

国家	适用情况	备注
意大利	坚持二联疗法的患者未达到治疗目标时（使用双重支气管扩张剂治疗后出现加重；使用ICS/LABA后呼吸道症状持续）	适用于没有合并症的情况，特别是心血管疾病
中国	·使用ICS+LABA治疗仍存在呼吸困难或运动受限 ·接受ICS+LABA治疗后发生急性加重 ·接受LAMA+LABA治疗后发生急性加重且血EOS≥100个/μL^[11]
	适用于稳定期COPD患者非初始治疗
美国	接受LABA/LAMA二联疗法后，在过去1年中仍因1次或多次加重而需要口服皮质类固醇、抗生素或住院；仍有呼吸困难症状或运动耐量减低^[17]	有条件推荐，中等质量证据
加拿大	中度/重度呼吸困难和/或健康状况受损以及病情加重风险较高^[22]
英国	接受LABA/LAMA二联疗法后在1年内仍出现需要住院治疗的加重，或者出现2次中度加重^[23]

基于《2024年意大利共识：慢性阻塞性肺疾病的三联吸入治疗》对中国慢性阻塞性肺疾病患者管理的启示

Implications for the Management of Chronic Obstructive Pulmonary Disease Patients Based on the Italian Consensus in 2024: Triple Inhalation Therapy in Chronic Obstructive Pulmonary Disease

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