Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon.
JAMA. 2022 May 10;327(18):1812-1816. doi: 10.1001/jama.2022.4708.
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in the US.
To conduct a targeted systematic review to update the evidence on the effectiveness of screening for COPD and the treatment of COPD to inform the US Preventive Services Task Force (USPSTF) update of the 2016 recommendation statement on COPD screening.
MEDLINE, the Cochrane Central Register of Controlled Trials, and CINAHL for relevant studies published between January 1, 2015, to January 22, 2021; surveillance through March 25, 2022.
English-language studies of screening in individuals who do not recognize or report respiratory symptoms; studies of treatment in persons with mild or moderate, or minimally symptomatic, COPD.
Two reviewers independently appraised the articles and extracted relevant data from fair- or good-quality studies; no quantitative synthesis was conducted.
COPD-related morbidity or mortality, measures of health-related quality of life, and adverse events.
The review included no trials on the effectiveness of screening, 3 trials or analyses (n = 20 058) of pharmacologic treatment published since 2015, 13 trials (n = 3657) on nonpharmacologic interventions, and 2 large observational studies (n = 243 517) addressing the harms of pharmacologic treatment published since 2015. The results from the clinical trials of pharmacologic therapy are consistent with the previous review supporting the USPSTF that bronchodilators with or without inhaled corticosteroids can reduce COPD exacerbations and tiotropium can improve health-related quality of life in adults with moderate COPD. Overall, there was no consistent benefit observed for any type of nonpharmacologic intervention across a range of patient outcomes. None of the included treatment trials that reported adverse effects found significant harms. Two large observational studies in a screen-relevant population demonstrated an association of the initiation of a long-acting muscarinic antagonist or long-acting beta agonist with the risk of a serious cardiovascular event in treatment-naïve patients and an association of inhaled corticosteroids use with the risk of developing diabetes.
The findings of this targeted evidence update are generally consistent with the findings of the previous systematic review supporting the 2016 USPSTF recommendation. Evidence of pharmacologic treatment was still largely limited to persons with moderate airflow obstruction, and there was no consistent benefit observed for a range of nonpharmacologic interventions in mild to moderate COPD or in minimally symptomatic persons with COPD.
慢性阻塞性肺疾病（COPD）是美国发病率和死亡率的主要原因。
进行有针对性的系统评价，更新 COPD 筛查和治疗效果的证据，为美国预防服务工作组（USPSTF）更新 2016 年关于 COPD 筛查的建议声明提供信息。
MEDLINE、Cochrane 对照试验中心注册库和 CINAHL，检索时间为 2015 年 1 月 1 日至 2021 年 1 月 22 日；通过 2022 年 3 月 25 日的监测。
针对没有识别或报告呼吸症状的个体进行的筛查的英语研究；针对轻度或中度、或症状轻微的 COPD 患者进行的治疗研究。
两名审查员独立评估文章，并从高质量或良好质量的研究中提取相关数据；未进行定量综合。
COPD 相关发病率或死亡率、健康相关生活质量测量指标和不良事件。
该综述没有关于筛查效果的试验，有 3 项药物治疗的试验或分析（n=20058）于 2015 年后发表，13 项非药物干预的试验（n=3657），2 项大型观察性研究（n=243517）于 2015 年后发表，探讨药物治疗的危害。药物治疗的临床试验结果与之前的综述一致，支持 USPSTF 的观点，即联合或不联合吸入皮质激素的支气管扩张剂可以减少 COPD 恶化，噻托溴铵可以改善中度 COPD 患者的健康相关生活质量。总体而言，在一系列患者结局中，没有观察到任何一种非药物干预的一致获益。纳入的治疗试验报告的不良反应均未发现显著危害。两项在有筛查意义的人群中进行的大型观察性研究表明，在未接受治疗的患者中，长效毒蕈碱拮抗剂或长效β激动剂的起始治疗与严重心血管事件风险相关，吸入皮质激素的使用与糖尿病发病风险相关。
本针对性证据更新的结果与之前支持 2016 年 USPSTF 建议的系统评价结果基本一致。药物治疗的证据仍然主要局限于中重度气流阻塞患者，在轻度至中度 COPD 或症状轻微的 COPD 患者中，各种非药物干预措施并没有观察到一致的获益。
