Koblížek V, Chlumský J, Zindr V, Neumannová K, Zatloukal J, Sedlák V, Kociánová J, Zatloukal J, Novotná B
Plicní klinika Lékařské fakulty UK a FN Hradec Králové.
Vnitr Lek. 2013 Jun;59(6):505-14.
COPD is a global health and social problem. Morbidity and mortality increases in the Czech Republic. There are currently several global statements and strategies.
The Czech Pneumological and Phthisiological Society (CPFS) at the end of 2011 mandated the Section of bronchial obstruction in drafting national guidelines concerning the stable COPD. Subsequently, this document was discussed during the National Consensus Conference (COPD forum) in November 2012 and presented at series of local workshops and national conferences. National guidelines has been subject to a review and eventually posted on the website for another round of comments.
A modern approach to COPD is a view of the patient through the pulmonary function, symptoms, exacerbation rates and the presence of specific phenotypes. CPFS identified six clinically relevant phenotypes: frequent exacerbators, COPD and asthma overlap, COPD and bronchiectasis overlap, emphysematic phenotype, bronchitic phenotype and phenotype of pulmonary cachexia.
TREATMENT recommendations can be divided into four elementary steps: the first step is the Elimination of all risks factors. The second one is the Standard therapy including in particular inhaled bronchodilators, pulmonary rehabilitation, and treatment of severe comorbidities. The third step is the Targeted therapy centered on clinical phenotypes of COPD. The final fourth step is the treatment of respiratory insufficiency and palliative care of the terminal COPD.
The optimal treatment of COPD requires a personalized approach to the patient.
慢性阻塞性肺疾病（COPD）是一个全球性的健康和社会问题。在捷克共和国，其发病率和死亡率呈上升趋势。目前有多项全球声明和策略。
2011年底，捷克肺科与结核病学会（CPFS）授权支气管阻塞分会起草关于稳定期COPD的国家指南。随后，该文件在2012年11月的全国共识会议（COPD论坛）上进行了讨论，并在一系列地方研讨会和全国会议上进行了展示。国家指南经过了审核，最终发布在网站上以供新一轮评论。
现代对COPD的认识是通过肺功能、症状、急性加重率和特定表型的存在来观察患者。CPFS确定了六种临床相关表型：频繁急性加重者、COPD与哮喘重叠、COPD与支气管扩张重叠、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基本步骤：第一步是消除所有危险因素。第二步是标准治疗，尤其包括吸入性支气管扩张剂、肺康复以及对严重合并症的治疗。第三步是以COPD临床表型为中心的靶向治疗。最后的第四步是呼吸功能不全的治疗和晚期COPD的姑息治疗。
COPD的最佳治疗需要针对患者采取个性化方法。
