Inhaled treatment of COPD: a Delphi consensus statement
Inhaled treatment of COPD: a Delphi consensus statement
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DOI：
10.2147/copd.s125564
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发表时间：
2017-01-01
影响因子：
2.8
通讯作者：
Lehouck, An
中科院分区：
文献类型：
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作者：
Ninane, Vincent;Corhay, Jean-Louis;Lehouck, An
背景资料：慢性阻塞性肺疾病全球倡议（GOLD）全球战略（2015年）为慢性阻塞性肺疾病（COPD）的治疗提供了指南，每个GOLD类别都有不同的首选治疗方案，但没有具体说明。目的：评估医学专家对不同COPD类别首选治疗方案的共识程度。结果：两组专家对GOLD A的首选药物为长效支气管扩张剂而非短效支气管扩张剂达成了良好的共识。在GOLD B和GOLD C中，长效毒蕈碱拮抗剂（LAMA）单次支气管扩张优于长效β 2受体激动剂（LABA），LABA/LAMA是首选治疗。对于GOLD D患者，基于1秒用力呼气量（FEV 1）50%，对于LAMA/LABA作为首选治疗达成了非常好的共识。对于基于频繁或重度急性加重的GOLD D患者，在比利时组中，LABA/LAMA/吸入性皮质类固醇（ICS）作为首选达成了良好的共识。欧洲专家认为，LABA/LAMA和LABA/LAMA/ICS均可作为这些患者的首选治疗方法。结论：比利时和欧洲专家推荐长效支气管扩张剂作为首选治疗方法。含ICS的治疗仅适用于FEV1.50%和2美元中度急性发作或1次重度急性发作/年的患者。
Background: Global Initiative for Chronic Obstructive Lung Disease (GOLD) global strategy (2015) provides guidance for the treatment of chronic obstructive pulmonary disease (COPD) with different first-choice options per GOLD category without specification.Objectives: To evaluate the level of medical experts' consensus on their preferred first-choice treatment within different COPD categories.Methods: A two-round Delphi Panel consisting of 15 questions was completed by Belgian pulmonologists (n=31) and European (n=10) COPD experts.Results: Good consensus was reached by both expert groups for long-acting bronchodilators instead of short-acting bronchodilators as first-choice treatment in GOLD A. Single bronchodilation with long-acting muscarinic antagonist (LAMA) was preferred over long-acting beta 2-agonist (LABA) and LABA/LAMA as first-choice treatment in GOLD B and GOLD C. For GOLD D patients based on the forced expiratory volume in 1 second (FEV1), 50%, a very good consensus was reached for LAMA/LABA as first-choice treatment. For GOLD D patients based on frequent or severe exacerbations, there was a good consensus for LABA/LAMA/inhaled corticosteroids (ICS) as first choice in the Belgian group. According to the European experts, both LABA/LAMA and LABA/LAMA/ICS could be the first choice for these patients.Conclusion: Belgian and European experts recommend long-acting bronchodilators as first-choice treatment. Treatment containing ICS was found only appropriate in patients with FEV1,50% and $ 2 moderate exacerbations or 1 severe exacerbation/year.