Chronic obstructive pulmonary disease (COPD) is a Corresponding respiratory symptoms are the main clinical features, and airway and/or alveolar abnormalities are the main pathological changes in chronic respiratory diseases. In-depth exploration of the immune pathogenesis of COPD and intervention on key targets may provide new methods for the prevention and treatment of COPD. The writing group of the “Expert Consensus on Immunomodulatory Treatment of Chronic Obstructive Pulmonary Disease” put forward 4 recommendations.
Recommendation 1
Bacterial lysates, phosphodiesterase inhibitors, macrolides and other biological and chemical preparations can enhance the immune function of the body and improve the activity of immune cells. Plays an immunoregulatory role in chronic obstructive pulmonary disease.
Common Biologics
Bacterial lysate (grade of recommendation: A): For patients with COPD exacerbation hospitalization or recurrent bacterial infection in the past 1 year Bacterial lysate therapy may be considered for patients with COPD who require antibiotics.
BCG polysaccharide nucleic acid (recommended level: C): BCG polysaccharide nucleic acid contains 0.35 mg of BCG polysaccharide, and the nucleic acid is not less than 30 μg. As an immunomodulator, it has the effect of regulating the body’s innate and adaptive immunity, and helps the body to effectively remove the virus Antigen and various antigen-antibody complexes, thereby improving the body’s disease resistance; in addition, BCG polysaccharide nucleic acid can also play an anti-allergic effect by stabilizing mast cells and inhibiting the release of IgE.
Klebsiella extract (recommended grade: C): Klebsiella extract is a glycoprotein extracted from Klebsiella. As a non-antigenic biological immunomodulatory stimulant, it can effectively prevent respiratory tract infections, reduce the number of acute infection episodes of chronic bronchitis and antibiotics. Use to shorten the duration of acute infection in chronic bronchitis.
Common Chemicals
phosphodiesterase inhibitors (recommendation grade: B): for chronic bronchitis, severe and very severe ventilatory dysfunction and COPD has been regulated Treatment (including inhaled long-acting bronchodilators and ICS therapy, etc.) but there is still a history of repeated acute exacerbations, especially in patients with chronic obstructive pulmonary disease with a history of acute exacerbation hospitalization, treatment with phosphodiesterase inhibitors can be considered, but close attention should be paid during treatment. Monitor patients for weight loss, gastrointestinal adverse reactions, etc. Patients with low body weight and patients with depressive symptoms should use this drug with caution, and should not be used at the same time as theophylline drugs.
Macrolide drugs (recommendation grade: A): At present, the best benefit population and Its adverse reactions still need more evidence-based medical evidence.
Pidotimod (recommendation grade: C): Pidotimod is a synthetic dipeptide. It is an immunomodulatory agent, mainly suitable for patients with low immune function.
Recommendation 2
Vaccination against influenza virus and pneumococcal infection can prevent acute exacerbation of COPD and reduce mortality.
Vaccines
Influenza vaccine (Recommendation level: A): Influenza vaccine is recommended for COPD patients.
Pneumococcal vaccine (recommendation grade: A): Pneumococcal vaccination can reduce the possibility of acute exacerbations in patients with COPD. Beneficial for lung patients.
Other vaccines (Recommendation grade: A): Other vaccines mainly include DTP vaccine and shingles vaccine.
Immune preparations
Thymosin preparations (Recommendation grade: C): As an immunomodulator, thymosin preparations can promote lymphocyte production, regulate the proportion of T lymphocyte subsets, and improve cellular immunity function, improve the body’s immunity, and then enhance the patient’s ability to resist respiratory tract infections.
Recommendation 3
Statins and vitamin D have immunomodulatory effects, and may have a certain therapeutic effect on COPD, but the There is little evidence of application in COPD and there are certain adverse reactions, and further evidence needs to be accumulated.
Immunomodulatory drugs to be supported by more evidence-based evidence
Statins (Recommendation grade: C): Statins mainly include simvastatin, atorvastatin, rosuvastatin Wait. Since the application of statins in the treatment of COPD patients is still controversial, the therapeutic effect of statins on COPD still needs to be further explored.
Vitamin D (grade of recommendation: B): GOLD2022 recommended for all patients hospitalized for severe vitamin D deficiency Assess and investigate for severe deficiency (<10 μg/L or <25 nmol/L) and supplement if needed.
New targeted anti-inflammatory drugs (recommendation grade: C): rigorous clinical trials are urgently needed to confirm their clinical efficacy, safety and evaluation Which phenotype of COPD patients has better clinical benefit.
Recommendation 4
TCM compound and Cordyceps preparation may improve the quality of life of patients with stable COPD by regulating immune function and improving immune cell activity , reduce acute exacerbations.
Chinese Medicine Immunotherapy
The methods of traditional Chinese medicine for COPD include internal therapy, external therapy and non-drug therapy.
From “Chronic Obstructive Pulmonary” Expert consensus on immunomodulatory treatment of diseases” writing group. Expert consensus on immunomodulatory treatment of chronic obstructive pulmonary disease[J]. China General Medicine, 2022,25(24):2947-2959.
>>>Click to read: Expert consensus on immunomodulatory treatment of chronic obstructive pulmonary disease
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