Koblizek Vladimir, Chlumsky Jan, Zindr Vladimir, Neumannova Katerina, Zatloukal Jakub, Zak Jaroslav, Sedlak Vratislav, Kocianova Jana, Zatloukal Jaromir, Hejduk Karel, Pracharova Sarka
Pulmonary Department, Faculty of Medicine in Hradec Kralove, Charles University in Prague and University Hospital Hradec Kralove, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2013 Jun;157(2):189-201. doi: 10.5507/bp.2013.039. Epub 2013 May 24.
COPD is a global concern. Currently, several sets of guidelines, statements and strategies to managing COPD exist around the world.
The Czech Pneumological and Phthisiological Society (CPPS) has commissioned an Expert group to draft recommended guidelines for the management of stable COPD. Subsequent revisions were further discussed at the National Consensus Conference (NCC). Reviewers' comments contributed to the establishment of the document's final version.
The hallmark of the novel approach to COPD is the integrated evaluation of the patient's lung functions, symptoms, exacerbations and identifications of clinical phenotype(s). The CPPS defines 6 clinically relevant phenotypes: frequent exacerbator, COPD-asthma overlap, COPD-bronchiectasis overlap, emphysematic phenotype, bronchitic phenotype and pulmonary cachexia phenotype.
Treatment recommendations can be divided into four steps. 1(st) step = Risk exposure elimination: reduction of smoking and environmental tobacco smoke (ETS), decrease of home and occupational exposure risks. 2(nd) step = Standard treatment: inhaled bronchodilators, regular physical activity, pulmonary rehabilitation, education, inhalation training, comorbidity treatment, vaccination. 3(rd) step = Phenotype-specific therapy: PDE4i, ICS+LABA, LVRS, BVR, AAT augmentation, physiotherapy, mucolytic, ABT. 4(th) step = Care for respiratory insufficiency and terminal COPD: LTOT, lung transplantation, high intensity-NIV and palliative care.
Optimal treatment of COPD patients requires an individualised, multidisciplinary approach to the patient's symptoms, clinical phenotypes, needs and wishes. The new Czech COPD guideline reflects and covers these requirements.
慢性阻塞性肺疾病（COPD）是一个全球性问题。目前，世界各地存在几套管理COPD的指南、声明和策略。
捷克肺病与结核病学会（CPPS）委托一个专家小组起草稳定期COPD管理的推荐指南。随后的修订在全国共识会议（NCC）上进一步讨论。审稿人的意见促成了该文件最终版本的确定。
COPD新方法的标志是对患者肺功能、症状、急性加重情况以及临床表型识别进行综合评估。CPPS定义了6种临床相关表型：频繁急性加重者、COPD-哮喘重叠型、COPD-支气管扩张重叠型、肺气肿表型、支气管炎表型和肺恶病质表型。
治疗建议可分为四个步骤。第一步=消除风险暴露：减少吸烟和环境烟草烟雾（ETS），降低家庭和职业暴露风险。第二步=标准治疗：吸入支气管扩张剂、规律体育活动、肺康复、教育、吸入训练、合并症治疗、疫苗接种。第三步=针对表型的治疗：磷酸二酯酶4抑制剂（PDE4i）、吸入性糖皮质激素+长效β2受体激动剂（ICS+LABA）、肺减容术（LVRS）、支气管镜肺减容术（BVR）、α1抗胰蛋白酶增加疗法（AAT augmentation）、物理治疗、黏液溶解剂、抗生素治疗（ABT）。第四步=呼吸功能不全和终末期COPD的护理：长期氧疗（LTOT）、肺移植、高强度无创通气（NIV）和姑息治疗。
COPD患者的最佳治疗需要针对患者症状、临床表型、需求和意愿采取个体化、多学科方法。新的捷克COPD指南反映并涵盖了这些要求。
