Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, UK.
Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.
Eur Respir J. 2017 Sep 9;50(3). doi: 10.1183/13993003.02265-2016. Print 2017 Sep.
This document provides clinical recommendations for the prevention of chronic obstructive pulmonary disease (COPD) exacerbations. It represents a collaborative effort between the European Respiratory Society and the American Thoracic Society.Comprehensive evidence syntheses were performed to summarise all available evidence relevant to the Task Force's questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of COPD experts.After considering the balance of desirable (benefits) and undesirable consequences (burden in the form of adverse effects and cost), quality of evidence, feasibility, and acceptability of various interventions, the Task Force made recommendations for mucolytic, long-acting muscarinic antagonist, phosphodiesterase-4 inhibitor (roflumilast) and macrolide therapy, as well as a conditional recommendation against fluoroquinolone therapy. All of the recommendations were conditional, except for a strong recommendation for the use of a long-acting antimuscarinic agent a long-acting β-adrenergic, indicating that there was uncertainty about the balance of desirable and undesirable consequences of the intervention, and that well-informed patients may make different choices regarding whether to have or not have the specific intervention.The guideline summarises the evidence and provides recommendations for pharmacological therapy for the prevention of COPD exacerbations.
本文件提供了预防慢性阻塞性肺疾病（COPD）加重的临床建议。它代表了欧洲呼吸学会和美国胸科学会之间的合作努力。综合证据综合分析总结了与特别工作组问题相关的所有现有证据。使用推荐评估、制定和评估方法评估证据，并在证据概况中总结结果。证据综合分析由 COPD 专家组成的多学科特别工作组进行讨论和建议制定。在考虑到所需（益处）和不良后果（以不良反应和成本的形式出现的负担）之间的平衡、证据质量、各种干预措施的可行性和可接受性之后，特别工作组对粘液溶解剂、长效抗毒蕈碱药、磷酸二酯酶-4 抑制剂（罗氟司特）和大环内酯类药物治疗提出了建议，以及对氟喹诺酮类药物治疗的条件性建议。除了强烈建议使用长效抗毒蕈碱药和长效β-肾上腺素能激动剂外，所有建议都是有条件的，这表明干预措施的有利和不利后果之间的平衡存在不确定性，知情患者可能会对是否进行特定干预做出不同的选择。该指南总结了预防 COPD 加重的药物治疗的证据并提供了建议。
