Management of severe acute exacerbations of COPD: an updated narrative review.
Management of severe acute exacerbations of COPD: an updated narrative review.
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DOI：
10.1186/s40248-018-0149-0
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发表时间：
2018
影响因子：
2.3
通讯作者：
Torres A
中科院分区：
文献类型：
--
作者：
Crisafulli E;Barbeta E;Ielpo A;Torres A
慢性阻塞性肺疾病（COPD）患者可能发生呼吸道症状急性恶化，导致需要额外治疗;该事件定义为COPD急性加重（AECOPD）。AECOPD住院治疗伴随着健康状况的快速下降，具有高死亡风险或其他不良结局，如需要气管插管或重症监护室（ICU）住院。AECOPD的治疗旨在最大限度地减少当前加重的负面影响，并预防后续事件，如复发或再次入院。在这篇叙述性综述中，我们更新了用于重度AECOPD管理的院内药物和非药物治疗的科学证据。我们回顾了吸入性支气管扩张剂、类固醇和抗生素的药理学方法，以及氧气、高流量鼻插管（HFNC）氧疗、无创机械通气（NIMV）和肺康复（PR）的非药理学治疗。我们还回顾了一些非常规药物的研究，已提出了严重的AECOPD。对于需要住院治疗的重度AECOPD患者，存在几种治疗方法。一些治疗，如类固醇和NIMV（在高碳酸血症急性呼吸衰竭和呼吸性酸中毒患者中），得到了其疗效的有力证据的支持。HFNC氧治疗需要进一步的前瞻性研究。尽管ICU患者首选抗生素，但缺乏关于非ICU患者首选药物和最佳治疗持续时间的证据。早期康复，如果与患者的标准治疗，建议由于其可行性和安全性。目前几乎没有有前途的新药或现有药物的新应用。
Patients with chronic obstructive pulmonary disease (COPD) may experience an acute worsening of respiratory symptoms that results in additional therapy; this event is defined as a COPD exacerbation (AECOPD). Hospitalization for AECOPD is accompanied by a rapid decline in health status with a high risk of mortality or other negative outcomes such as need for endotracheal intubation or intensive care unit (ICU) admission. Treatments for AECOPD aim to minimize the negative impact of the current exacerbation and to prevent subsequent events, such as relapse or readmission to hospital. In this narrative review, we update the scientific evidence about the in-hospital pharmacological and non-pharmacological treatments used in the management of a severe AECOPD. We review inhaled bronchodilators, steroids, and antibiotics for the pharmacological approach, and oxygen, high flow nasal cannulae (HFNC) oxygen therapy, non-invasive mechanical ventilation (NIMV) and pulmonary rehabilitation (PR) as non-pharmacological treatments. We also review some studies of non-conventional drugs that have been proposed for severe AECOPD. Several treatments exist for severe AECOPD patients requiring hospitalization. Some treatments such as steroids and NIMV (in patients admitted with a hypercapnic acute respiratory failure and respiratory acidosis) are supported by strong evidence of their efficacy. HFNC oxygen therapy needs further prospective studies. Although antibiotics are preferred in ICU patients, there is a lack of evidence regarding the preferred drugs and optimal duration of treatment for non-ICU patients. Early rehabilitation, if associated with standard treatment of patients, is recommended due to its feasibility and safety. There are currently few promising new drugs or new applications of existing drugs.