Zysman Maeva, Mahay Guillaume, Guibert Nicolas, Barnig Cindy, Leroy Sylvie, Guilleminault Laurent
Service de Pneumologie, CHU Haut-Lévèque, Bordeaux, France; Univ. Bordeaux, Centre de Recherche cardio-thoracique, INSERM U1045, CIC 1401, Pessac, France.
Service de Pneumologie, Oncologie thoracique et soins intensifs respiratoires, CHU Rouen, Rouen, France.
Respir Med Res. 2023 Nov;84:101035. doi: 10.1016/j.resmer.2023.101035. Epub 2023 Jun 24.
This review aimed to summarise evidence about the impact of pharmacological and non-pharmacological interventions on survival in COPD patients.
We performed a narrative literature review on the effect of pharmacological and non-pharmacological interventions on survival in COPD patients.
Inhaled therapies are central to reduce symptoms in COPD. In particular, inhaled steroids seem to have the greatest effect on mortality. Despite the anti-inflammatory effects attributed to statins, their benefit in COPD has been shown only in cases of combined cardiovascular diseases. The use of beta-blockers in COPD has not been associated with increased COPD-related mortality and a beneficial effect on all-cause mortality has even been shown in COPD patients with cardiovascular diseases. Influenza and pneumococcal vaccination reduced the occurrence of exacerbations and mortality due to COPD. In addition, long-term oxygen therapy (LTOT) (≥15h/day) in COPD patients with severe hypoxemia had a positive effect on survival. Regarding non-pharmacological interventions, it has been demonstrated that smoking cessation, treatment compliance and nutritional supplementation for underweight patients also have a positive effect on survival. Non-invasive ventilation results were dependent on patient PaCO levels. In patients with advanced COPD, further prospective studies are needed to know the effect of bronchoscopic lung volume reduction and lung transplant on COPD survival. Regarding lung transplant, a survival benefit in patients with a pre-transplant BODE score of ≥7 has been shown in retrospective studies.
Most of the studies did not evaluate survival as the main criteria and further long-term studies on the global management of COPD are required.
本综述旨在总结有关药物和非药物干预对慢性阻塞性肺疾病（COPD）患者生存率影响的证据。
我们对药物和非药物干预对COPD患者生存率的影响进行了叙述性文献综述。
吸入疗法是减轻COPD症状的核心。特别是，吸入性类固醇似乎对死亡率影响最大。尽管他汀类药物具有抗炎作用，但其在COPD中的益处仅在合并心血管疾病的病例中得到证实。在COPD患者中使用β受体阻滞剂与COPD相关死亡率增加无关，甚至在患有心血管疾病的COPD患者中显示出对全因死亡率有有益影响。流感和肺炎球菌疫苗接种减少了COPD急性加重的发生和死亡率。此外，对重度低氧血症的COPD患者进行长期氧疗（LTOT）（≥15小时/天）对生存率有积极影响。关于非药物干预，已证明戒烟、治疗依从性和对体重过轻患者的营养补充对生存率也有积极影响。无创通气的结果取决于患者的动脉血二氧化碳分压（PaCO）水平。对于晚期COPD患者，需要进一步的前瞻性研究来了解支气管镜肺减容术和肺移植对COPD生存率的影响。关于肺移植，回顾性研究表明，移植前BODE指数≥7的患者有生存获益。
大多数研究未将生存率作为主要评估标准，因此需要对COPD的整体管理进行进一步的长期研究。
