Cabrera Carlos, Casanova Ciro, Martín Yolanda, Mirabal Virginia, Sánchez María Del Carmen, Álvarez Felisa, Juliá Gabriel, Cabrera-Navarro Pedro, García-Bello Miguel Ángel, Marín José María, de-Torres Juan Pablo, Divo Miguel, Celli Bartolomé
University Hospital of Gran Canaria Dr Negrín, Respiratory Service, Las Palmas de Gran Canaria, Spain.
University Hospital Nuestra Señora de la Candelaria, Respiratory Service, Santa Cruz de Tenerife, Spain.
Int J Chron Obstruct Pulmon Dis. 2016 Jun 8;11:1217-22. doi: 10.2147/COPD.S100853. eCollection 2016.
Guidelines recommendations for the treatment of COPD are poorly followed. This could be related to the complexity of classification and treatment algorithms. The purpose of this study was to validate a simpler dyspnea-based treatment algorithm for inhaled pharmacotherapy in stable COPD, comparing its concordance with the current Global Initiative for Obstructive Lung Disease (GOLD) guideline.
We enrolled patients who had been diagnosed with COPD in three primary care facilities and two tertiary hospitals in Spain. We determined anthropometric data, forced expiratory volume in the 1st second (percent), exacerbations, and dyspnea based on the modified Medical Research Council scale. We evaluated the new algorithm based on dyspnea and exacerbations and calculated the concordance with the current GOLD recommendations.
We enrolled 100 patients in primary care and 150 attending specialized care in a respiratory clinic. There were differences in the sample distribution between cohorts with 41% vs 26% in grade A, 16% vs 12% in grade B, 16% vs 22% in grade C, and 27% vs 40% in grade D for primary and respiratory care, respectively (P=0.005). The coincidence of the algorithm with the GOLD recommendations in primary care was 93% and 91.8% in the respiratory care cohort.
A simple dyspnea-based treatment algorithm for inhaled pharmacotherapy of COPD could be useful in the management of COPD patients and concurs very well with the recommended schema suggested by the GOLD initiative.
慢性阻塞性肺疾病（COPD）治疗的指南建议执行情况不佳。这可能与分类和治疗算法的复杂性有关。本研究的目的是验证一种更简单的基于呼吸困难的稳定期COPD吸入药物治疗算法，并将其与当前的慢性阻塞性肺疾病全球倡议（GOLD）指南的一致性进行比较。
我们纳入了西班牙三家初级保健机构和两家三级医院中被诊断为COPD的患者。我们根据改良的医学研究委员会量表确定人体测量数据、第1秒用力呼气量（百分比）、急性加重情况和呼吸困难情况。我们评估了基于呼吸困难和急性加重情况的新算法，并计算了其与当前GOLD建议的一致性。
我们纳入了100名初级保健患者和150名在呼吸科门诊接受专科护理的患者。两个队列的样本分布存在差异，初级保健组和呼吸科护理组中，A级分别为41%对26%，B级分别为16%对12%，C级分别为16%对22%，D级分别为27%对40%（P = 0.005）。该算法与初级保健中GOLD建议的一致性为93%，在呼吸科护理队列中为91.8%。
一种简单的基于呼吸困难情况的COPD吸入药物治疗算法可能有助于COPD患者的管理，并且与GOLD倡议建议的方案非常吻合。
