Internal Medicine Department, Quironsalud Valencia Hospital, Valencia, Valencian Community, Spain.
Internal Medicine Department, Royo Villanova Hospital, Zaragoza, Aragon, Spain.
Int J Chron Obstruct Pulmon Dis. 2020 May 7;15:1015-1037. doi: 10.2147/COPD.S242009. eCollection 2020.
Chronic obstructive pulmonary disease (COPD) is associated with multiple comorbidities, which impact negatively on patients and are often underdiagnosed, thus lacking a proper management due to the absence of clear guidelines.
To elaborate expert recommendations aimed to help healthcare professionals to provide the right care for treating COPD patients with comorbidities.
A modified RAND-UCLA appropriateness method consisting of nominal groups to draw up consensus recommendations (6 Spanish experts) and 2-Delphi rounds to validate them (23 Spanish experts) was performed.
A panel of Spanish internal medicine experts reached consensus on 73 recommendations and 81 conclusions on the clinical consequences of the presence of comorbidities. In general, the experts reached consensus on the issues raised with regard to cardiovascular comorbidity and metabolic disorders. Consensus was reached on the use of selective serotonin reuptake inhibitors in cases of depression and the usefulness of referring patients with anxiety to respiratory rehabilitation programmes. The results also showed consensus on the usefulness of investigating the quality of sleep, the treatment of pain with opioids and the evaluation of osteoporosis by lateral chest radiography.
This study provides conclusions and recommendations that are intended to improve the management of the complexity of patients with COPD and important comorbidities, usually excluded from clinical trials.
慢性阻塞性肺疾病（COPD）常伴有多种合并症，这些合并症对患者产生负面影响，且常常被漏诊，由于缺乏明确的指南，因此未能得到适当的管理。
阐述专家建议，旨在帮助医疗保健专业人员为患有合并症的 COPD 患者提供正确的护理。
采用改良的 RAND-UCLA 适宜性方法，包括制定共识建议的名义小组（6 名西班牙专家）和验证建议的 2 轮 Delphi 法（23 名西班牙专家）。
一组西班牙内科专家就 73 条建议和 81 条关于合并症临床后果的结论达成共识。一般来说，专家们就心血管合并症和代谢紊乱问题达成了共识。在抑郁症患者中使用选择性 5-羟色胺再摄取抑制剂和将焦虑患者转介至呼吸康复计划的有用性方面达成了共识。研究结果还表明，调查睡眠质量、使用阿片类药物治疗疼痛以及通过侧胸射线照相评估骨质疏松症的有用性方面也达成了共识。
本研究提供了结论和建议，旨在改善 COPD 患者和重要合并症的管理，这些合并症通常被排除在临床试验之外。
