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<title>呼吸器疾患の薬物療法を極める | 株式会社文光堂</title>


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<meta name="description" content="呼吸器内科領域の薬物療法の進歩は近年，一層加速しており，各種ガイドラインは整備されているが，専門医でも最新知識をアップデートすることは容易ではない．本書では，各専門領域の第一線のエキスパートが，ガイドラインでは記載しきれない薬物療法のポイントを解説した実践的な内容となっている．最新の知見が，エキスパートオピニオンを交えて解説されており，実臨床に即した呼吸器疾患における薬物療法の「コツ」，「落とし穴">

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		<h1 class="catchCopy">エキスパートが教える実臨床に即した本当の呼吸器疾患の薬物療法！</h1>
		

		<h1 class="title titleWidth">呼吸器疾患の薬物療法を極める<span class="version"></span></h1>
		

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					編集：長瀬洋之（帝京大学医学部内科学講座呼吸器・アレルギー学教授）
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				<ul class="property"><li class="disc">B5判・328頁・2色刷</li><li class="disc">ISBN&nbsp;978-4-8306-1736-2</li><li class="disc">2018年4月13日発行</li></ul>

				
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">呼吸器内科領域の薬物療法の進歩は近年，一層加速しており，各種ガイドラインは整備されているが，専門医でも最新知識をアップデートすることは容易ではない．本書では，各専門領域の第一線のエキスパートが，ガイドラインでは記載しきれない薬物療法のポイントを解説した実践的な内容となっている．最新の知見が，エキスパートオピニオンを交えて解説されており，実臨床に即した呼吸器疾患における薬物療法の「コツ」，「落とし穴」がふんだんに盛り込まれた1冊となった．</section><section class="preface">序　文<br><br>　呼吸器内科領域の薬物療法の進歩は，近年一層加速しています．呼吸器専門医といっても，広大な呼吸器病学の最新の知識を，くまなくアップデートしていくことは容易ではありません．また，多くの診療ガイドラインが整備されていますが，エビデンスが不十分な内容については推奨度が低く，日常診療でどう対応するか困る場面が多いものです．実臨床に役立ち，幅広い分野にわたる最新の知識を効率よく学ぶことができるよう，このたび，「呼吸器疾患の薬物療法を極める」を企画致しました．<br>　本書では，教科書的な配列ではなく，臨床現場での意思決定で問題となる59のquestionを設定しました．そのなかには，エビデンスが不十分だが経験的に投与している，実臨床と添付文書で適応が異なる，最新の薬剤で知見が十分集積していない，など教科書やガイドラインには記載しきれない内容を多く含んでいます．専門領域の第一線でご活躍の先生にお願いし，これらのquestionにお答えいただきました．現場で役立つ実践的な内容や，カンファレンスでよく話題に上るテーマも多く取り上げており，定見の確立していない内容についても，最新の知見に私見を加えてご執筆いただいています．明日からの診療に役立つ知識が豊富に含まれています．<br>　また，日々の診療でお疲れのなかでも手にとれるよう，冒頭に「Essence」としてポイントをまとめ，著者がこれだけはおさえてほしいとする内容は「コツ」もしくは「落とし穴」，解説が必要な用語は「MEMO」として記載され，読みやすく構成されています．これらの点だけでも目を通すと，効率よく概要を把握できると思います．<br>　呼吸器内科専門医はもちろん，呼吸器内科診療に高い関心を持つ一般内科医や研修医の先生方にとっても役に立つ1冊となりました．是非，興味をひかれたquestionからお目通し下さい．本書が呼吸器診療の向上につながることを願っております．<br>　最後に，第一線で多忙を極めるなか，ご執筆頂きました先生方，ならびに本書の完成に尽力されました，文光堂編集企画部末冨聡氏に心より感謝申し上げます．<br><br>2018年4月<br>長瀬 洋之<br>帝京大学医学部内科学講座呼吸器・アレルギー学</section><section class="indexes">I章　気管支喘息<br>ICS/LABAをどう使い分けるか？<br>　成人慢性喘息治療の第一選択薬はICS/LABA製剤／製剤の選び方：DPIとpMDI吸入デバイス<br>　の利点と欠点／吸入指導とアドヒアランス／pMDI製剤による末梢気道を意識した喘息治<br>　療／SMART療法の有用性／おわりに<br>ICS/LABAをどうステップダウンしていくか<br>　喘息のコントロールは何を目標にするのか，コントロールが達成されたらどうするのか<br>　／ICS減量に関する最近の知見／ICSのstep downの実際／ICS中止に関して／成人におい<br>　てICS中止は不可能なのか<br>ロイコトリエン受容体拮抗薬の有効症例は？<br>　ロイコトリエン受容体拮抗薬の臨床的位置づけ／LTRAが特に有効な病型／LTRAの可能性<br>鼻炎治療（ロイコトリエン受容体拮抗薬，点鼻ステロイド薬）が喘息病態に及ぼす効果<br>　喘息とアレルギー性鼻炎との関連／アレルギー性鼻炎の治療体系／鼻炎治療で喘息病態<br>　は改善するか<br>LAMA（長時間作用性吸入抗コリン薬）はどのような場面で使用するか<br>　LAMA（長時間作用性吸入抗コリン薬）の喘息における作用メカニズム／LAMA（長時間作<br>　用性吸入抗コリン薬）をどのような患者に使用するか／どのような患者にLAMAが有効か<br>　／おわりに<br>ドライパウダー製剤の種類別ピットフォールの予防法と対応<br>　ドライパウダー製剤の歴史と種類／吸入デバイスそれぞれにおけるピットフォール／各<br>　デバイスのピットフォール／指導の重要性／アドヒアランス（コンコーダンス）に<br>　ついて<br>pMDI製剤・SMI製剤で生じるピットホールと対応法<br>　pMDI製剤で生じる共通のピットホールとその対処法／SMI製剤のデバイス（レスピマッ<br>　ト）で生じるピットホールとその対処法／ピットホール発生の原因は，主に患者側にある<br>上気道局所副作用症例への対応と処方選択薬<br>　吸入ステロイド薬と嗄声／吸入ステロイド薬とカンジダ症／抗コリン薬とうがい<br>吸入ステロイド経鼻呼出法のエビデンスと薬剤選択<br>　気管支喘息と好酸球性副鼻腔炎／副鼻腔炎を合併した喘息に対する吸入ステロイド経鼻<br>　呼出法／経鼻呼出の方法／経鼻呼出法に適した吸入ステロイドと効果／おわりに<br>アレルギー性気管支肺アスペルギルス症に抗真菌薬はどのように使用するか<br>　アレルギー性気管支肺真菌症について／ABPAの治療の原則／ABPAに対する抗真菌薬投与<br>　の問題点／ABPAに対する抗真菌薬投与の適正使用<br>アレルゲン免疫療法の喘息における可能性<br>　はじめに／喘息治療におけるアレルゲン免疫療法／アレルギー診療におけるアレルゲン<br>　免疫療法のポジショニング／適応患者の選択／投与法の実際／安全性<br>抗IgE抗体と抗IL-5抗体をどう使い分けるか<br>　抗IgE抗体の有用性／抗IL-5抗体の有用性／抗IgE抗体と抗IL-5抗体をどう使い分けるか<br>重症喘息に対する分子標的治療─現状と今後の展望─<br>　新規治療薬が必要な重症喘息患者はまだ存在する／喘息における気道炎症病態／Th2サイ<br>　トカインを標的とした治療／Th2分化・活性化を標的とした治療／ILC2，好中球，マスト<br>　細胞活性化に関連する分子標的薬／抗IgE抗体（ゾレア <sup>Ⓡ</sup>）／併存症への効<br>　果／おわりに<br>II章　COPD<br>吸入長時間作用性抗コリン薬（LAMA）製剤の特徴と使い分け<br>　チオトロピウム一択ではなくなったLAMA／どのLAMAを用いるか／LAMA使用前の注意点<br>LAMA/LABA配合剤開始のタイミングと使い分け<br>　COPD治療薬における気管支拡張薬の重要性／単剤とLAMA/LABA配合剤の効果の違い／いつ<br>　単剤からLAMA/LABA配合剤にステップアップすべきか？／初めからLAMA/LABA配合剤で治<br>　療開始すべき症例は？／LAMA/LABA配合剤の種類と特徴を踏まえた使い分けは？／まとめ<br>喀痰調整薬のエビデンスと使い方<br>　COPDにおける気流制限の原因／喀痰調整薬のこれまでの役割／喀痰調整薬に期待される<br>　こと／それぞれの喀痰調整薬の特徴／各喀痰調整薬のエビデンス／喀痰調整薬の今後／<br>　慢性気管支炎（CB）への有効性／日常臨床の現状（まとめ）<br>COPDに対する吸入ステロイド薬の有用性は好酸球数で見分けられるか？<br>　変わりつつある吸入ステロイド薬の位置づけ／喀痰好酸球比率とステロイド反応性／末<br>　梢血好酸球数でICS有効症例を選択できるか<br>β遮断薬使用は避けるべきか？<br>　心血管疾患はCOPDの病態や予後に重大な影響を与えている／心血管疾患におけるβ遮断<br>　薬の位置づけ／β遮断薬の気道への薬理作用／COPDにおけるβ遮断薬の作用／COPD患者<br>　へのβ遮断薬投与の実際<br>前立腺疾患合併例に対するLAMA投与の実際<br>　抗コリン薬の副作用／前立腺肥大症や排尿困難のあるCOPD患者に対するLAMA投与の実際<br>　／COPD患者におけるLAMA投与の実際<br>III章　喘息・COPDと周辺疾患<br>副鼻腔気管支症候群やびまん性汎細気管支炎に対するマクロライドの選択と治療期間<br>　びまん性汎細気管支炎（DPB）に対する少量エリスロマイシン（EM）長期療法の有効性／<br>　ニューマクロライドの開発とDPBへの応用／慢性鼻副鼻腔炎（CRS）に対するMLsの効果／<br>　気管支拡張症（非囊胞性線維症）に対するMLsの効果／どのMLsを選択すべきか？：EM vs <br>　CAM vs RXM vs AZM／MLsの治療期間はどのように決定するか？：症状改善効果 vs 増悪<br>　予防効果／14・15員環MLsによる治療のフローチャート（私案）<br>慢性閉塞性肺疾患（COPD）・喘息でどのような症例にマクロライドを用いるか<br>　マクロライド維持療法の実際／マクロライド維持療法の臨床効果<br>日常診療における慢性咳嗽の治療的診断<br>　慢性咳嗽における鑑別診断の考え方／慢性咳嗽の治療方針<br>IV章　間質性肺炎<br>抗線維化薬（ピルフェニドン，ニンテダニブ）をどう使い分けるか？<br>　特発性肺線維症idiopathic pulmonary fibrosis（IPF）治療における抗線維化薬（ピル<br>　フェニドン，ニンテダニブ）の位置づけ／抗線維化薬の使用時の基本的な考え方／抗線<br>　維化薬（ピルフェニドン，ニンテダニブ）の使い分け／単剤が有効でないときにどうす<br>　るか？<br>いつから，どのような症例に抗線維化薬を開始するか<br>　IPFの治療戦略と抗線維化薬／早期治療によるIPF進行抑制（呼吸不全の予防）／IPF急性<br>　増悪の回避／少なくとも死亡リスクが高い患者は早期治療導入の対象<br>抗線維化薬の臨床試験適応外症例への有効性<br>　non-IPFを対象とした臨床試験／当院におけるnon-IPFに対する抗線維化薬の投与経験／<br>　おわりに<br>抗線維化薬（ニンテダニブ，ピルフェニドン）の有害事象と対応<br>　抗線維化薬の有害事象のエビデンス／ピルフェニドン／ニンテダニブ／まとめ<br>特発性肺線維症に経口ステロイドを使ってはいけないのか<br>　特発性肺線維症の薬物療法は，抗炎症薬から抗線維化薬へ／最新のガイドラインにおけ<br>　るステロイドの位置づけ／実臨床からみたIPFに対するステロイド治療／残された課題<br>Nアセチルシステインのエビデンスと処方の実際<br>　特発性肺線維症idiopathic pulmonary fibrosis（IPF）に対するNAC吸入療法の位置づけ<br>　／NACと酸化ストレス／実臨床におけるNAC単独吸入療法の効果とレドックスバランスの<br>　関連性<br>リコンビナントトロンボモジュリンの特発性肺線維症急性増悪における有用性と使い方<br>　特発性肺線維症急性増悪の病態／特発性肺線維症急性増悪に対する治療法／特発性肺線<br>　維症急性増悪に対するrhTMの報告／特発性肺線維症急性増悪に対するrhTMの投与の実際<br>膠原病肺における免疫抑制薬の選択と使用法<br>　膠原病における肺病変の合併と治療の考え方／各免疫抑制薬の特徴／原疾患に応じた免<br>　疫抑制薬の選択（主に強皮症，多発性筋炎/皮膚筋炎に関して）／免疫抑制薬選択におけ<br>　る注意点<br>V章　肺　癌<br>一次治療におけるEGFR-TKIをどう選択するか？<br>　EGFR-TKI治療の特徴／各ERFR-TKIの特徴／有害事象の対策<br>EGFR-TKI再投与の実際<br>　EGFR-TKIの登場／初回ゲフィチニブ投与後の，ゲフィチニブ再投与について／ゲフィチ<br>　ニブ投与後の，エルロチニブ投与について／アファチニブについて／オシメルチニブに<br>　ついて／血管新生阻害薬との併用について／おわりに<br>ALK阻害薬の使い方（治療シークエンスを含めて）<br>　ALK阻害薬について／ALK阻害薬耐性について／ALK阻害薬の治療シークエンスについて<br>TPS≧50％における治療戦略<br>　非小細胞肺癌におけるTPS50％以上という患者集団の確立／既治療例に対するエビデンス<br>　／未治療例におけるエビデンス／TPS≧50％という患者群における診断・治療の留意点／<br>　おわりに<br>PD-L1発現1〜49％の非小細胞肺癌の二次治療以降の戦略<br>　ニボルマブ／ペムブロリズマブ／抗PD-L1抗体／ラムシルマブ／EAST-LCの結果／薬剤の<br>　使い分け<br>PD-L1発現1％未満の非小細胞肺癌の二次治療以降の戦略<br>　非小細胞肺癌二次治療以降の治療薬／PD-L1発現1％未満の非小細胞肺癌二次治療以降の<br>　薬剤はどのようなものがあるか？／それではPD-L1発現1％未満の非小細胞肺癌の二次治<br>　療以降はどうするか？／PD-L1発現1％未満の非小細胞肺癌の二次治療以降の将来的な展<br>　望について<br>ROS1陽性肺癌の治療展望<br>　ROS1肺癌に対するクリゾチニブ治療の確立／クリゾチニブに対する抵抗性機序／新たな<br>　ROS1阻害薬の開発<br>血管新生阻害薬の位置づけ<br>　腫瘍における血管新生と血管新生阻害薬の作用／ベバシズマブ（BEV）の位置づけ／ラム<br>　シルマブ（RAM）の位置づけ／血管新生阻害薬とEGFRチロシンキナーゼ阻害薬併用療法／<br>　血管新生阻害薬の安全な投与のために<br>非小細胞肺癌脳転移に対する肺癌治療薬の効果の差異<br>　はじめに／ドライバー遺伝子変異に対する分子標的薬／細胞障害性抗癌薬／免疫チェッ<br>　クポイント阻害薬／血管新生阻害薬／おわりに<br>間質性肺炎合併肺癌に対する薬剤選択<br>　間質性肺炎合併肺癌のマネージメント／非小細胞肺癌における治療選択／小細胞肺癌に<br>　おける治療選択<br>ペグフィルグラスチム使用の実際<br>　ペグフィルグラスチム使用のガイドラインについて／非小細胞肺癌の一次予防的投与に<br>　ついて／小細胞肺癌の一次予防的投与について／ペグフィルグラスチム使用の注意点<br>VI章　肺感染症<br>A．細菌感染症<br>市中肺炎の外来診療における抗菌薬の選択<br>　市中肺炎の特徴と原因菌／肺炎に対して使用可能な経口抗菌薬／外来初診時に行う迅速<br>　検査と標的治療／外来でのエンピリック（経験的）治療／レスピラトリーキノロン系抗<br>　菌薬の使い分け／外来での抗菌薬点滴治療<br>院内肺炎の動向と抗菌薬選択<br>　はじめに／院内肺炎の重症度診断（予後予測）／院内肺炎における抗菌薬の選択と使用<br>　法／わが国の院内肺炎診療と米国のガイドラインの比較<br>マクロライド耐性マイコプラズマ肺炎の疫学と治療の実際<br>　耐性株の動向／耐性株の臨床的意義／実臨床での治療の実際／補助療法の活用<br>抗菌薬を処方すべきかぜ症候群<br>　かぜ症候群とは／抗菌薬が有効なかぜ症候群<br>B．抗酸菌症<br>非結核性抗酸菌症における抗菌薬の選択<br>　肺MAC症の薬物療法─RFP，EB，CAMの3剤による多剤併用療法が基本となる─／肺MAC症の<br>　薬物療法の治療対象・開始時期について／肺MAC症の薬物療法の継続期間について／副作<br>　用への対応／間欠療法について／CAM耐性肺MAC症の薬物治療について／RFPやEBが使用で<br>　きない場合の薬物療法について／肺M. kansasii症／肺M. abscessus症／アミノグリコシ<br>　ド系抗菌薬の使用について／キノロン系抗菌薬の使用について／おわりに<br>肺非結核性抗酸菌症（肺NTM症）におけるマクロライドの位置づけと単剤投与されていた症例への対応<br>　わが国におけるマクロライドの位置づけと，海外ガイドラインとの乖離についての理解<br>　／CAMを耐性化させないために─CAM耐性MAC症の検討からみえてきたもの─／マクロライ<br>　ドが単剤投与されていた症例への対応／マクロライド無効となる耐性誘導遺伝子<br>　erm（41）geneについての理解─M. abscessus complex症について<br>生物学的製剤使用前/使用中の抗酸菌感染症への対応<br>　生物学的製剤の歴史と副反応／結核症／NTM症<br>結核治療薬の現状と将来展望〜多剤耐性結核への対応も含めて〜<br>　はじめに／現在の抗結核薬／RFPとRBTの使い分け／アミカシン／多剤耐性結核／おわ<br>　りに<br>抗結核薬の副作用発現時の対応と薬剤選択<br>　はじめに／副作用出現時の基本的な注意点と対応法／各副作用への対応法<br>抗結核薬の減感作療法の実際<br>　はじめに／薬剤有害反応／薬剤減感作療法の一般論／抗結核薬の減感作療法／減感作療<br>　法実施時の注意点／急速減感作療法について<br>C．その他<br>慢性進行性肺アスペルギルス症と単純性肺アスペルギローマにおける抗真菌薬の選択<br>　はじめに／単純性肺アスペルギローマ（SPA）／慢性進行性肺アスペルギルス症（CPPA）／肺非<br>　結核性抗酸菌症との合併例／アゾール耐性Aspergillus fumigatus<br>誤嚥性肺炎の予防薬<br>　誤嚥性肺炎のメカニズムに対応した予防薬の考え方／嚥下反射改善薬による治療と予防<br>　／中止，減量を検討すべき薬剤と多剤服用の改善／服薬時に薬剤を誤嚥させない配慮の<br>　必要性<br>誤嚥性肺炎におけるステロイドの適応と抗菌薬選択<br>　誤嚥性肺炎に対するステロイド投与の適応について／誤嚥性肺炎の抗菌薬選択の注意点<br>　／誤嚥性肺炎の抗菌薬選択の実際<br>VII章　肺循環/肺損傷<br>ARDSに対するステロイド，シベレスタット，抗凝固薬のエビデンス<br>　ARDSの診断と治療の現状／副腎皮質ステロイド／好中球エラスターゼ阻害薬／抗凝固療<br>　法<br>呼吸器疾患に伴う肺高血圧症の薬物治療の考え方<br>　呼吸器疾患に伴う肺高血圧症の病態／COPDに合併した肺高血圧症に対する肺血管拡張薬<br>　治療／特発性間質性肺炎に合併した肺高血圧症に対する肺血管拡張薬治療／気腫合併肺<br>　線維症に合併した肺高血圧症に対する肺血管拡張薬治療／どのような3群PH症例に対し<br>　て，どのような薬剤の投与を検討すべきか？<br>VIII章　その他<br>肺炎球菌ワクチンの有効性と現在の使用適応についての考え方<br>　肺炎球菌性肺炎の現状／肺炎球菌ワクチンの種類／肺炎球菌ワクチンの有効性のエビデ<br>　ンス／肺炎球菌ワクチンの適応について<br>プロトンポンプインヒビターの呼吸器疾患における有用性<br>　呼吸器疾患と胃食道逆流／慢性咳嗽／喘息／特発性肺線維症（IPF）／まとめ<br>禁煙治療薬の使い分けのポイント<br>　ニコチン依存症とは／禁煙外来で使う禁煙補助薬／薬局で購入する禁煙治療薬／加熱式<br>　タバコの問題<br>索　引</section></article>
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