继续医学教育
2020版慢性阻塞性肺疾病全球倡议解读
周敏
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DOI: 10.3760/cma.j.issn.1001-0939.2020.03.027
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摘要

慢性阻塞性肺疾病(慢阻肺)全球倡议(global initiative for chronic obstructive lung disease,GOLD)于2019年11月发布了2020更新版。新版指南整体变动不大,主要更新在于新增慢阻肺非药物治疗的随访路径和急性加重的鉴别诊断,明确了慢阻肺稳定期管理流程及起始吸入糖皮质激素治疗需要考虑的因素,同时纳入了关于三联疗法、抗IL-5疗法及电子烟等方面的最新循证资料。本文拟对GOLD 2020更新要点进行解读。

引用本文

周敏. 2020版慢性阻塞性肺疾病全球倡议解读[J]. 中华结核和呼吸杂志,2020,43(03):268-271.

DOI:10.3760/cma.j.issn.1001-0939.2020.03.027

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慢性阻塞性肺疾病(慢阻肺)全球倡议(global initiative for chronic obstructive lung disease,GOLD)作为慢阻肺防治的战略性指导文件,自2001年第一次发布,已经进行了四次大的修订,数次更新。GOLD2020在GOLD2017修订的基础上进行第3次更新,新增62篇2018年1月至2019年7月发表的文献。整体变动不大,对于慢阻肺诊治的基本原则没有作出更改 [ 1 ]。主要更新点在于总结了在长效支气管舒张剂(长效β 2受体激动剂,long-acting β 2-agonist,LABA;长效M受体阻断剂,long-acting muscarinic antagonist,LAMA)基础上启动吸入性糖皮质激素(inhaled glucocorticosteroid,ICS)治疗时需要考虑的因素,新增慢阻肺非药物治疗的随访路径和急性加重的鉴别诊断,取消哮喘-慢阻肺重叠综合征(ACO)的概念。同时,增加关于三联疗法ICS/LAMA/LABA降低全因病死率的最新循证证据及抗IL-5疗法、生物标志物、电子烟及自我管理等方面的最新进展 [ 1 ]。本文拟简要介绍GOLD2020的更新要点。
附录
问答题

1.生物标志物可辅助慢阻肺的诊断及评估。其中,下列哪种血的生物标志物可以用于指导ICS对急性加重的预测结果?( )

A.PCT B.CRP C.NEUT D、EOS

2.慢阻肺患者在长效支气管扩张剂维持治疗的基础上,具有下列哪种情况时不建议加用ICS?( )

A.分枝杆菌感染史 B.频繁急性加重 C.哮喘病史 D.EOS>300/μl

3.下列哪种细菌的定植可作为慢阻肺病情加重而住院及全因死亡风险增加的独立预测因素?( )

A.肺炎克雷伯杆菌 B.铜绿假单胞杆菌 C.金黄色葡萄球菌 D.大肠杆菌

4.GOLD指出,三联制剂可显著改善慢阻肺患者的肺功能、症状和健康状况,减少急性加重。请问下列哪种药品不包括在三联制剂内?( )

A.ICS B.LABA C.LAMA D.SABA

5.下列哪项不属于慢阻肺患者自我管理和教育的内容?( )

A.危险因素管理 B.吸入技术 C.撰写执行计划 D.接种疫苗

参考文献
[1]
Committee GE . . Global initiative for chronic obstructive lung disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease 2020 report[EB/OL]. http://www.goldcopd.org. Last searched on Nov, 2019.
返回引文位置Google Scholar
百度学术
万方数据
[2]
De Matteis S , Jarvis D , Darnton A ,et al. The occupations at increased risk of COPD: analysis of lifetime job-histories in the population-based UK Biobank Cohort[J]. Eur Respir J, 2019,54(1): 10.1183/13993003.00186-2019 1900186. DOI:.
返回引文位置Google Scholar
百度学术
万方数据
[3]
Chan KH , Kurmi OP , Bennett DA ,et al. Solid fuel use and risks of respiratory diseases. a cohort study of 280,000 chinese never-smokers[J]. Am J Respir Crit Care Med, 2019,199(3):352-361. DOI: 10.1164/rccm.201803-0432OC .
返回引文位置Google Scholar
百度学术
万方数据
[4]
Eklof J , Sorensen R , Ingebrigtsen TS ,et al. Pseudomonas aeruginosa and risk of death and exacerbations in patients with chronic obstructive pulmonary disease: an observational cohort study of 22 053 patients[J]. Clin Microbiol Infect, 2019, 10.1016/j.cmi.2019.06.011 :S1198-743X(19)30336-2. DOI:.
返回引文位置Google Scholar
百度学术
万方数据
[5]
Lipson DA , Barnacle H , Birk R ,et al. FULFIL Trial: Once-Daily Triple Therapy for Patients with Chronic Obstructive Pulmonary Disease[J]. Am J Respir Crit Care Med, 2017,196(4):438-446. DOI: 10.1164/rccm.201703-0449OC .
返回引文位置Google Scholar
百度学术
万方数据
[6]
Calverley PM , Anderson JA , Celli B ,et al. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease[J]. N Engl J Med, 2007,356(8):775-789. DOI: 10.1056/NEJMoa063070 .
返回引文位置Google Scholar
百度学术
万方数据
[7]
Vestbo J , Anderson JA , Brook RD ,et al. Fluticasone furoate and vilanterol and survival in chronic obstructive pulmonary disease with heightened cardiovascular risk (SUMMIT): a double-blind randomised controlled trial[J]. Lancet, 2016,387(10030):1817-1826. DOI: 10.1016/S0140-6736(16)30069-1 .
返回引文位置Google Scholar
百度学术
万方数据
[8]
Lipson DA , Barnhart F , Brealey N ,et al. Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD[J]. N Engl J Med, 2018,378(18):1671-1680. DOI: 10.1056/NEJMoa1713901 .
返回引文位置Google Scholar
百度学术
万方数据
[9]
Vestbo J , Fabbri L , Papi A ,et al. Inhaled corticosteroid containing combinations and mortality in COPD[J]. Eur Respir J, 2018,52(6): 10.1183/13993003.01230-2018 1801230. DOI:.
返回引文位置Google Scholar
百度学术
万方数据
[10]
Vestbo J , Papi A , Corradi M ,et al. Single inhaler extrafine triple therapy versus long-acting muscarinic antagonist therapy for chronic obstructive pulmonary disease (TRINITY): a double-blind, parallel group, randomised controlled trial[J]. Lancet, 2017,389(10082):1919-1929. DOI: 10.1016/S0140-6736(17)30188-5 .
返回引文位置Google Scholar
百度学术
万方数据
[11]
Papi A , Vestbo J , Fabbri L ,et al. Extrafine inhaled triple therapy versus dual bronchodilator therapy in chronic obstructive pulmonary disease (TRIBUTE): a double-blind, parallel group, randomised controlled trial[J]. Lancet, 2018,391(10125):1076-1084. DOI: 10.1016/S0140-6736(18)30206-X .
返回引文位置Google Scholar
百度学术
万方数据
[12]
Devereux G , Cotton S , Fielding S ,et al. Effect of Theophylline as Adjunct to Inhaled Corticosteroids on Exacerbations in Patients With COPD: A Randomized Clinical Trial[J]. JAMA, 2018,320(15):1548-1559. DOI: 10.1001/jama.2018.14432 .
返回引文位置Google Scholar
百度学术
万方数据
[13]
Jolliffe DA , Greenberg L , Hooper RL ,et al. Vitamin D to prevent exacerbations of COPD: systematic review and meta-analysis of individual participant data from randomised controlled trials[J]. Thorax, 2019,74(4):337-345. DOI: 10.1136/thoraxjnl-2018-212092 .
返回引文位置Google Scholar
百度学术
万方数据
[14]
Suissa S , Dell′Aniello S , Ernst P . Comparative Effectiveness and Safety of LABA-LAMA vs LABA-ICS Treatment of COPD in Real-World Clinical Practice[J]. Chest, 2019,155(6):1158-1165. DOI: 10.1016/j.chest.2019.03.005 .
返回引文位置Google Scholar
百度学术
万方数据
[15]
Layden JE , Ghinai I , Pray I ,et al. Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin -Preliminary Report[J]. N Engl J Med, 2019. DOI: 10.1056/NEJMoa1911614 .
返回引文位置Google Scholar
百度学术
万方数据
[16]
Gordon CS , Waller JW , Cook RM ,et al. Effect of Pulmonary Rehabilitation on Symptoms of Anxiety and Depression in COPD: A Systematic Review and Meta-Analysis[J]. Chest, 2019,156(1):80-91. DOI: 10.1016/j.chest.2019.04.009 .
返回引文位置Google Scholar
百度学术
万方数据
[17]
Benzo R , Vickers K , Novotny PJ ,et al. Health Coaching and Chronic Obstructive Pulmonary Disease Rehospitalization. A Randomized Study[J]. Am J Respir Crit Care Med, 2016,194(6):672-680. DOI: 10.1164/rccm.201512-2503OC .
返回引文位置Google Scholar
百度学术
万方数据
[18]
Gouzi F , Maury J , Heraud N ,et al. Additional Effects of Nutritional Antioxidant Supplementation on Peripheral Muscle during Pulmonary Rehabilitation in COPD Patients: A Randomized Controlled Trial[J]. Oxid Med Cell Longev, 2019,2019:5496346. DOI: 10.1155/2019/5496346 .
返回引文位置Google Scholar
百度学术
万方数据
[19]
Prins HJ , Duijkers R , van der Valk P ,et al. CRP-guided antibiotic treatment in acute exacerbations of COPD in hospital admissions[J]. Eur Respir J, 2019,53(5): 10.1183/13993003.02014-2018 1802014. DOI:.
返回引文位置Google Scholar
百度学术
万方数据
[20]
Butler CC , Gillespie D , White P ,et al. C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations[J]. N Engl J Med, 2019,381(2):111-120. DOI: 10.1056/NEJMoa1803185 .
返回引文位置Google Scholar
百度学术
万方数据
[21]
Lin H , Lu Y , Lin L ,et al. Does chronic obstructive pulmonary disease relate to poor prognosis in patients with lung cancer?:A meta-analysis[J]. Medicine (Baltimore), 2019,98(11):e14837. DOI: 10.1097/MD.0000000000014837 .
返回引文位置Google Scholar
百度学术
万方数据
[22]
Sampaio MS , Vieira WA , Bernardino IM ,et al. Chronic obstructive pulmonary disease as a risk factor for suicide: A systematic review and meta-analysis[J]. Respir Med, 2019,151:11-18. DOI: 10.1016/j.rmed.2019.03.018 .
返回引文位置Google Scholar
百度学术
万方数据
[23]
康健,文富强. 从医保数据分析中国慢性阻塞性肺疾病管理的不足[J]. 中华结核和呼吸杂志, 2017,40(12):884-886. DOI: 10.3760/cma.j.issn.1001-0939.2017.12.002 .
返回引文位置Google Scholar
百度学术
万方数据
备注信息
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作者声明不存在利益冲突
B
国家自然科学基金 (81570029)
上海重中之重临床重点学科建设项目 (2017ZZ02014)
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