Diagnosis and pharmacotherapy of stable chronic obstructive pulmonary disease: the finnish guidelines.
Diagnosis and pharmacotherapy of stable chronic obstructive pulmonary disease: the finnish guidelines.
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DOI：
10.1111/bcpt.12366
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发表时间：
2015-04
影响因子：
3.1
通讯作者：
Lehtimäki L
中科院分区：
文献类型：
--
作者：
Kankaanranta H;Harju T;Kilpeläinen M;Mazur W;Lehto JT;Katajisto M;Peisa T;Meinander T;Lehtimäki L
芬兰医学会Duodecim发起并管理了芬兰慢性阻塞性肺疾病（COPD）国家指南的更新。修订了芬兰COPD指南，以确认COPD诊断和管理方面的进展。这份英文版的芬兰COPD指南是原始指南的一部分，重点关注稳定期COPD的诊断、评估和药物治疗。它主要用于初级卫生保健，但不要忘记呼吸专家和其他卫生保健工作者。新的建议和声明是基于医学文献、其他已发表的国家指南和GOLD（慢性阻塞性肺疾病全球倡议）报告中的最佳证据。本指南介绍了诊断方法、哮喘鉴别诊断、评估和治疗策略，以控制症状和预防加重。药物治疗是基于个体患者的症状和临床表型。该指南定义了三种临床相关表型，包括低和高加重风险表型和被忽视的哮喘-COPD重叠综合征（ACOS）。这些临床表型可以帮助临床医生识别对特定药物干预有反应的患者。对于低急性加重风险表型，建议在症状较少的患者中使用短效β2-受体激动剂（沙丁胺醇、特布他林）或抗胆碱能药物（异丙托铵）或其组合（非诺特罗-异丙托铵）进行药物治疗。如果短效支气管扩张剂不足以控制症状，建议使用长效β2受体激动剂（福莫特罗、茚达特罗、奥达特罗或沙美特罗）或长效抗胆碱能药物（毒蕈碱受体拮抗剂;阿地铵、格隆溴铵、噻托溴铵、乌美地铵）或其组合。对于高急性加重风险表型，建议首选长效抗胆碱能药物或吸入性糖皮质激素和长效β2受体激动剂（布地奈德-福莫特罗、二丙酸倍氯米松-福莫特罗、丙酸氟替卡松-沙美特罗或糠酸氟替卡松-维兰特罗）的固定组合药物治疗。该表型的其他治疗选择包括长效支气管扩张剂联合给药，通过单独的吸入器给药或作为固定组合（格隆铵-茚达特罗或芜地铵-维兰特罗）给药，或吸入糖皮质激素、长效β2-激动剂和长效抗胆碱能药的三联组合。如果患者患有重度至极重度COPD（FEV 1 < 50%预测值）、慢性支气管炎和尽管使用长效支气管扩张剂仍频繁加重，药物治疗也可包括罗氟司特。ACOS是COPD的一种表型，其中存在符合哮喘和COPD的特征。属于这种表型的患者通常被排除在评估哮喘和COPD药物作用的研究之外。因此，无法提供循证治疗建议。治疗应涵盖这两种疾病。通常，治疗应至少包括吸入糖皮质激素（丙酸倍氯米松、布地奈德、环索奈德、糠酸氟替卡松、丙酸氟替卡松或莫米松）联合长效支气管扩张剂（β2-激动剂或抗胆碱能药或两者兼而有之）。
The Finnish Medical Society Duodecim initiated and managed the update of the Finnish national guideline for chronic obstructive pulmonary disease (COPD). The Finnish COPD guideline was revised to acknowledge the progress in diagnosis and management of COPD. This Finnish COPD guideline in English language is a part of the original guideline and focuses on the diagnosis, assessment and pharmacotherapy of stable COPD. It is intended to be used mainly in primary health care but not forgetting respiratory specialists and other healthcare workers. The new recommendations and statements are based on the best evidence available from the medical literature, other published national guidelines and the GOLD (Global Initiative for Chronic Obstructive Lung Disease) report. This guideline introduces the diagnostic approach, differential diagnostics towards asthma, assessment and treatment strategy to control symptoms and to prevent exacerbations. The pharmacotherapy is based on the symptoms and a clinical phenotype of the individual patient. The guideline defines three clinically relevant phenotypes including the low and high exacerbation risk phenotypes and the neglected asthma–COPD overlap syndrome (ACOS). These clinical phenotypes can help clinicians to identify patients that respond to specific pharmacological interventions. For the low exacerbation risk phenotype, pharmacotherapy with short-acting β2-agonists (salbutamol, terbutaline) or anticholinergics (ipratropium) or their combination (fenoterol–ipratropium) is recommended in patients with less symptoms. If short-acting bronchodilators are not enough to control symptoms, a long-acting β2-agonist (formoterol, indacaterol, olodaterol or salmeterol) or a long-acting anticholinergic (muscarinic receptor antagonists; aclidinium, glycopyrronium, tiotropium, umeclidinium) or their combination is recommended. For the high exacerbation risk phenotype, pharmacotherapy with a long-acting anticholinergic or a fixed combination of an inhaled glucocorticoid and a long-acting β2-agonist (budesonide–formoterol, beclomethasone dipropionate–formoterol, fluticasone propionate–salmeterol or fluticasone furoate–vilanterol) is recommended as a first choice. Other treatment options for this phenotype include combination of long-acting bronchodilators given from separate inhalers or as a fixed combination (glycopyrronium–indacaterol or umeclidinium–vilanterol) or a triple combination of an inhaled glucocorticoid, a long-acting β2-agonist and a long-acting anticholinergic. If the patient has severe-to-very severe COPD (FEV1 < 50% predicted), chronic bronchitis and frequent exacerbations despite long-acting bronchodilators, the pharmacotherapy may include also roflumilast. ACOS is a phenotype of COPD in which there are features that comply with both asthma and COPD. Patients belonging to this phenotype have usually been excluded from studies evaluating the effects of drugs both in asthma and in COPD. Thus, evidence-based recommendation of treatment cannot be given. The treatment should cover both diseases. Generally, the therapy should include at least inhaled glucocorticoids (beclomethasone dipropionate, budesonide, ciclesonide, fluticasone furoate, fluticasone propionate or mometasone) combined with a long-acting bronchodilator (β2-agonist or anticholinergic or both).
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影响因子：
4.4
作者：
Broekhuizen, Berna D. L.;Sachs, Alfred P. E.;Hoes, Arno W.
通讯作者：
Hoes, Arno W.
影响因子：
10
作者：
Alfageme, I;Vazquez, R;Lima, J
通讯作者：
Lima, J
DOI：
10.1164/ajrccm/138.3.624
发表时间：
1988-09-01
期刊：
AMERICAN REVIEW OF RESPIRATORY DISEASE
影响因子：
--
作者：
BERGER, R;SMITH, D
通讯作者：
SMITH, D
影响因子：
168.9
作者：
Calverley, Peter M. A.;Rabe, Klaus F.;Martinez, Fernando J.
通讯作者：
Martinez, Fernando J.
影响因子：
24.3
作者：
Bateman, Eric D.;Ferguson, Gary T.;Banerji, Donald
通讯作者：
Banerji, Donald