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Chronisch-obstruktive Lungenerkrankung

Neue Optionen in der Arzneimitteltherapie

Chronic obstructive pulmonary disease

New pharmacotherapeutic options

  • Arzneimitteltherapie
  • Published:
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Zusammenfassung

Daten über die klinische Präsentation der chronisch-obstruktiven Lungenerkrankung (COPD) haben zu einer neuen Klassifikation der Erkrankung geführt. Außer der spirometrischen Schweregradeinteilung werden das Ausmaß der Symptome sowie die Exazerbationsrate berücksichtigt. Die Standardtherapie der stabilen COPD befindet sich im Umbruch, da in naher Zukunft Fixkombinationen aus langwirksamen Betamimetika und langwirksamen Anticholinergika eingesetzt werden können. Damit wird der Stellenwert von inhalativen Steroiden neu zu bewerten sein. Die Zulassung von Roflumilast hat die medikamentöse Therapie um eine Option erweitert, mit Hilfe derer bei Patienten mit schwerer Obstruktion (FEV1 <50%) und den Symptomen einer chronischen Bronchitis eine Senkung der Exazerbationsfrequenz erreicht werden kann. Bezüglich des Managements der COPD-Exazerbation hat sich die Neuerung ergeben, dass unter Zuhilfenahme des Prokalzitoninspiegels bei gleichem klinischem Outcome ein sparsamerer Antibiotikaeinsatz erreicht werden kann.

Abstract

Data about the clinical presentation of chronic obstructive pulmonary disease (COPD) have resulted in a new classification of the disease. The degree of airflow limitation has been amended by symptoms and exacerbation rate. The standard pharmacotherapy of stable COPD is in transition, as fixed combinations of long acting beta agonists and long acting anticholinergics are in the late stages of clinical development. On this background inhaled corticosteroids will need to be re-evaluated. Roflumilast is a recently approved therapeutic option that primarily diminishes exacerbation frequency in patients with chronic bronchitis and severe airflow obstruction (FEV1 < 50%). In COPD patients with acute exacerbations procalcitonin levels can be used to guide antibiotic therapy. Comparable clinical outcomes can be achieved while using significantly less amounts of antibiotics.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Teilnahme an Kongressen, Übernahme von Reisekosten: GSK, Grifols. Advisory Board: Grifols. Vorträge: Novartis, GSK, Chiesi, Grifols. Grants: GSK, Grifols.

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  1. Klinik für Innere Medizin, Schwerpunkt Pneumologie, Universitätsklinikum Gießen und Marburg, Philipps-Universität Marburg, Baldingerstr., 35043, Marburg, Deutschland

    T. Greulich, A.R. Koczulla & C. Vogelmeier

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  1. T. Greulich
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  2. A.R. Koczulla
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  3. C. Vogelmeier
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Greulich, T., Koczulla, A. & Vogelmeier, C. Chronisch-obstruktive Lungenerkrankung. Internist 53, 1364–1375 (2012). https://doi.org/10.1007/s00108-012-3119-1

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