Chronic treatment-chronic obstructive pulmonary disease
COPD Staging and Recommended Therapies by GOLD Criteria
一年兩次以下算A,B
- A Short-acting inh dilator prn
- B LAMA
一年兩次以上算C,D
- C LAMA
- D LAMA + LABA ± ICS
- 考慮在支氣管擴張劑中添加PDE-4抑制
Treatment
- Bronchodilators
- Corticosteroids for chronic obstructive pulmonary disease
- Triple Therapy (LAMA+LABA+ICS) ↓ exac, ↓ hosp, ↑ PNA (NEJM 2020;383:35)
- Roflumilast
- Anti-IL5
- daily azithro ↓ exacerbations, but not routine (JAMA 2014;311:2225)
- Oxygen for chronic obstructive pulmonary disease
- Night NPPV if recent exacerb & PaCO2 >“53” ↓ risk of readmit or death (JAMA 2017;317:2177)
- Prevention of chronic obstructive pulmonary disease
- Rehabilitation: ↓ dyspnea and fatigue, ↑ exercise tolerance, ↑ QoL (NEJM 2009;360:1329)
- Surgery & bronchoscopic interventions Lung volume reduction surgery: ↑ exercise capacity, ↓ mortality if FEV1 >20%, upper lobe, low exercise capacity (NEJM 2003;348:2059) Bronchoscopic lung reduction with endobronchial valves or coils: ↑ lung fxn but significant complications (PTX, PNA) (NEJM 2015;373:2325; Lancet 2015;386:1066; JAMA 2016;315:175)
- Lung transplant: ↑ QoL and ↓ sx (Lancet 1998;351:24), ? survival benefit (Am J Transplant 2009;9:1640)