《慢阻肺诊断、治疗与预防全球倡议(GOLD)》2018版-医学课件.pptVIP

药物治疗-支扩剂 1、患者基线症状越重，联用双支扩剂 (LAMA/LABA) 相比安慰剂或对应单药对生活质量带来的改善越显著。 2、一项双盲平行组的RCT显示,与常规噻托溴铵相比，使用外固定三联疗法治疗症状性COPD的患者有临床益处。 3、另一项双盲RCT表明三联FDC治疗晚期慢阻肺效果优于ICS/LABA。 * 药物治疗-PDE4抑制剂 对于有既往急性加重住院史的患者，罗氟司特能带来更多的临床获益。 The beneficial effects of roflumilast have been reported to be greater in patients with a prior history of hospitalization for an acute exacerbation. (Han et al., 2014; Rabe, Calverley, Martinez, Fabbri, 2017) * 药物治疗-抗生素 1、相比常规治疗，高风险患者接受阿奇霉素 (250mg/天, 或500mg 一周三次) 或红霉素 (500mg BID) 治疗1年降低急性加重风险。 ? 2、应用阿奇霉素与细菌耐药和听力受损相关。 ? 3、一项事后分析表明现吸烟者从阿奇霉素中得到的治疗获益较少。 ? 4、目前没有研究评价阿奇霉素长期治疗1年以上时预防急性加重的有效性或安全性。 ? Azithromycin (250 mg/day or 500 mg three times per week) or erythromycin (500 mg two times per day) for one year in patients prone to exacerbations reduced the risk of exacerbations compared to usual care. (Albert et al., 2011; Seemungal et al., 2008; Uzun et al., 2014) Azithromycin use was associated with an increased incidence of bacterial resistance and impaired hearing tests. (Albert et al., 2011) A post-hoc analysis suggests lesser benefit in active smokers. (Han et al., 2014) There are no data beyond one-year of chronic azithromycin treatment showing the efficacy or safety of its use to prevent COPD exacerbations. ? * 肺康复 1、肺康复可以在多种场所开展。家庭肺康复对资源需求小，是门诊肺康复的等效替代方案，也利于住所远离康复场所的患者开展治疗。 Pulmonary rehabilitation can be conducted at a range of sites. (Spruit et al., 2013) Home rehabilitation delivered with minimal resources in patients with COPD may be an equivalent alternative to facility located outpatient rehabilitation. (Holland et al., 2017) Home rehabilitation may be a solution for many patients who live outside the reach of facility-based programs. 2、肺康复的获益似乎随时间推移逐渐减少。长期肺康复治疗可以维持初次康复治疗后的获益，但也有一项研究指出获益在随访期间减少。 Another challenge is that the benefits of rehabilitation tend to wane over time. Long-term maintenance pulmonary rehabilitation may sustain the benefits achieved after completion of the initial pulmonary rehabilitation program, although one study reporte