Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela.
Universidad de la República, Hospital Maciel, Montevideo, Uruguay.
Arch Bronconeumol. 2015 Aug;51(8):403-16. doi: 10.1016/j.arbres.2014.11.017. Epub 2015 Jan 14.
ALAT-2014 COPD Clinical Practice Guidelines used clinical questions in PICO format to compile evidence related to risk factors, COPD screening, disease prognosis, treatment and exacerbations. Evidence reveals the existence of risk factors for COPD other than tobacco, as well as gender differences in disease presentation. It shows the benefit of screening in an at-risk population, and the predictive value use of multidimensional prognostic indexes. In stable COPD, similar benefits in dyspnea, pulmonary function and quality of life are achieved with LAMA or LABA long-acting bronchodilators, whereas LAMA is more effective in preventing exacerbations. Dual bronchodilator therapy has more benefits than monotherapy. LAMA and combination LABA/IC are similarly effective, but there is an increased risk of pneumonia with LABA/IC. Data on the efficacy and safety of triple therapy are scarce. Evidence supports influenza vaccination in all patients and anti-pneumococcal vaccination in patients <65years of age and/or with severe airflow limitation. Antibiotic prophylaxis may decrease exacerbation frequency in patients at risk. The use of systemic corticosteroids and antibiotics are justified in exacerbations requiring hospitalization and in some patients managed in an outpatient setting.
ALAT-2014 COPD 临床实践指南使用 PICO 格式的临床问题来汇编与风险因素、COPD 筛查、疾病预后、治疗和加重相关的证据。证据表明，COPD 存在除烟草以外的其他风险因素，以及疾病表现的性别差异。它显示了在高危人群中进行筛查的益处，以及多维预后指标的预测价值的使用。在稳定期 COPD 中，长效抗胆碱能药物或长效β2 受体激动剂（LABA）长作用支气管扩张剂在改善呼吸困难、肺功能和生活质量方面具有相似的益处，而 LAMA 在预防加重方面更有效。双支气管扩张剂治疗比单药治疗更有效。长效抗胆碱能药物和 LABA/ICS 联合治疗同样有效，但 LABA/ICS 会增加肺炎的风险。关于三联治疗的疗效和安全性的数据很少。证据支持所有患者接种流感疫苗，<65 岁且/或有严重气流受限的患者接种肺炎球菌疫苗。抗生素预防可能会降低高危患者的加重频率。在需要住院治疗的加重和某些门诊患者中，全身皮质激素和抗生素的使用是合理的。
