Ninane Vincent, Corhay Jean-Louis, Germonpré Paul, Janssens Wim, Joos Guy F, Liistro Giuseppe, Vincken Walter, Gurdain Sandra, Vanvlasselaer Evelyne, Lehouck An
Department of Respiratory Medicine, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels.
Department of Respiratory Medicine, CHU, Liege.
Int J Chron Obstruct Pulmon Dis. 2017 Mar 6;12:793-801. doi: 10.2147/COPD.S125564. eCollection 2017.
Global Initiative for Chronic Obstructive Lung Disease (GOLD) global strategy (2015) provides guidance for the treatment of chronic obstructive pulmonary disease (COPD) with different first-choice options per GOLD category without specification.
To evaluate the level of medical experts' consensus on their preferred first-choice treatment within different COPD categories.
A two-round Delphi Panel consisting of 15 questions was completed by Belgian pulmonologists (n=31) and European (n=10) COPD experts.
Good consensus was reached by both expert groups for long-acting bronchodilators instead of short-acting bronchodilators as first-choice treatment in GOLD A. Single bronchodilation with long-acting muscarinic antagonist (LAMA) was preferred over long-acting β2-agonist (LABA) and LABA/LAMA as first-choice treatment in GOLD B and GOLD C. For GOLD D patients based on the forced expiratory volume in 1 second (FEV)<50%, a very good consensus was reached for LAMA/LABA as first-choice treatment. For GOLD D patients based on frequent or severe exacerbations, there was a good consensus for LABA/LAMA/inhaled corticosteroids (ICS) as first choice in the Belgian group. According to the European experts, both LABA/LAMA and LABA/LAMA/ICS could be the first choice for these patients.
Belgian and European experts recommend long-acting bronchodilators as first-choice treatment. Treatment containing ICS was found only appropriate in patients with FEV<50% and ≥2 moderate exacerbations or 1 severe exacerbation/year.
慢性阻塞性肺疾病全球倡议组织（GOLD）全球策略（2015年）为慢性阻塞性肺疾病（COPD）的治疗提供了指导，针对不同的GOLD类别有不同的首选治疗方案，但未作具体说明。
评估医学专家对于不同COPD类别中首选治疗方案的共识程度。
由15个问题组成的两轮德尔菲专家组由比利时肺科医生（n = 31）和欧洲（n = 10）COPD专家完成。
两个专家小组在GOLD A类中均达成了良好共识，即长效支气管扩张剂而非短效支气管扩张剂作为首选治疗方案。在GOLD B类和GOLD C类中，单药使用长效毒蕈碱拮抗剂（LAMA）作为首选治疗方案优于长效β2受体激动剂（LABA）和LABA/LAMA。对于1秒用力呼气容积（FEV）<50%的GOLD D类患者，对于LAMA/LABA作为首选治疗方案达成了非常好的共识。对于基于频繁或严重加重的GOLD D类患者，比利时专家组对于LABA/LAMA/吸入性糖皮质激素（ICS）作为首选方案达成了良好共识。根据欧洲专家的意见，LABA/LAMA和LABA/LAMA/ICS均可作为这些患者的首选。
比利时和欧洲专家推荐长效支气管扩张剂作为首选治疗方案。仅在FEV<50%且每年有≥2次中度加重或1次重度加重的患者中发现含ICS的治疗是合适的。
