Global Initiative for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease. The 2020 GOLD Science Committee Report on COVID-19 and Chronic Obstructive Pulmonary Disease.
Global Initiative for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease. The 2020 GOLD Science Committee Report on COVID-19 and Chronic Obstructive Pulmonary Disease.
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慢性阻塞性肺疾病的诊断、管理和预防全球倡议。2020年GOLD科学委员会关于COVID-19和慢性阻塞性肺疾病的报告。
DOI：
10.1164/rccm.202009-3533so
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发表时间：
2021-01-01
影响因子：
24.7
通讯作者：
Vogelmeier CF
中科院分区：
文献类型：
--
作者：
Halpin DMG;Criner GJ;Papi A;Singh D;Anzueto A;Martinez FJ;Agusti AA;Vogelmeier CF
严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）大流行引发了许多关于慢性阻塞性肺疾病（COPD）患者的管理以及是否需要修改其治疗的问题。鉴于冠状病毒病（COVID-19）与COPD症状的相似性，它提出了识别和区分两者的问题。慢性阻塞性肺疾病全球倡议（GOLD）科学委员会使用既定的文献综述方法，概述了COVID-19大流行期间COPD患者的管理。目前尚不清楚COPD患者感染SARS-CoV-2的风险是否增加。在COVID-19社区高流行期间，肺功能测定仅应在对COPD诊断和/或评估肺功能状态以进行介入手术或手术至关重要时使用。COPD患者应遵循基本的感染控制措施，包括社交距离、洗手和戴口罩或面罩。患者应及时接种适当的疫苗，特别是每年的流感疫苗。虽然数据有限，但应继续使用吸入性皮质类固醇、长效支气管扩张剂、罗氟司特或慢性大环内酯类药物，以适应稳定的COPD管理。COPD急性加重应根据通常的适应症使用全身性类固醇和抗生素。区分COVID-19感染的症状与慢性基础症状或COPD急性加重的症状可能具有挑战性。如果怀疑是COVID-19，应考虑进行SARS-CoV-2检测。发生中度至重度COVID-19（包括住院和肺炎）的患者应酌情采用不断发展的药物治疗方法进行治疗，包括瑞德西韦、地塞米松和抗凝治疗。急性呼吸衰竭的管理应包括COPD和严重急性呼吸窘迫综合征患者的适当供氧、俯卧位、无创通气和肺保护策略。出现无症状或轻度COVID-19的患者应遵循常规COPD方案。对于出现中度或重度COVID-19的患者，应比一般COPD患者更频繁、更准确地进行监测，尤其要注意氧疗的必要性。
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has raised many questions about the management of patients with chronic obstructive pulmonary disease (COPD) and whether modifications of their therapy are required. It has raised questions about recognizing and differentiating coronavirus disease (COVID-19) from COPD given the similarity of the symptoms. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) Science Committee used established methods for literature review to present an overview of the management of patients with COPD during the COVID-19 pandemic. It is unclear whether patients with COPD are at increased risk of becoming infected with SARS-CoV-2. During periods of high community prevalence of COVID-19, spirometry should only be used when it is essential for COPD diagnosis and/or to assess lung function status for interventional procedures or surgery. Patients with COPD should follow basic infection control measures, including social distancing, hand washing, and wearing a mask or face covering. Patients should remain up to date with appropriate vaccinations, particularly annual influenza vaccination. Although data are limited, inhaled corticosteroids, long-acting bronchodilators, roflumilast, or chronic macrolides should continue to be used as indicated for stable COPD management. Systemic steroids and antibiotics should be used in COPD exacerbations according to the usual indications. Differentiating symptoms of COVID-19 infection from chronic underlying symptoms or those of an acute COPD exacerbation may be challenging. If there is suspicion for COVID-19, testing for SARS-CoV-2 should be considered. Patients who developed moderate-to-severe COVID-19, including hospitalization and pneumonia, should be treated with evolving pharmacotherapeutic approaches as appropriate, including remdesivir, dexamethasone, and anticoagulation. Managing acute respiratory failure should include appropriate oxygen supplementation, prone positioning, noninvasive ventilation, and protective lung strategy in patients with COPD and severe acute respiratory distress syndrome. Patients who developed asymptomatic or mild COVID-19 should be followed with the usual COPD protocols. Patients who developed moderate or worse COVID-19 should be monitored more frequently and accurately than the usual patients with COPD, with particular attention to the need for oxygen therapy.