Abstract：
The Spanish COPD Guidelines (GesEPOC) were first published in 2012, and since then have undergone a series of updates incorporating new evidence on the diagnosis and treatment of COPD. GesEPOC was drawn up in partnership with scientific societies involved in the treatment of COPD and the Spanish Patients\' Forum. Their recommendations are based on an evaluation of the evidence using GRADE methodology, and a narrative description of the evidence in areas in which GRADE cannot be applied. In this article, we summarize the recommendations on the pharmacological treatment of stable COPD based on 9 PICO questions. COPD treatment is a 4-step process: 1) diagnosis; 2) determination of the risk level; 3) initial and subsequent inhaled therapy; and 4) identification and management of treatable traits. For the selection of inhaled therapy, high-risk patients are divided into 3 phenotypes: non-exacerbator, eosinophilic exacerbator, and non-eosinophilic exacerbator. Some treatable traits are general and should be investigated in all patients, such as smoking or inhalation technique, while others affect severe patients in particular, such as chronic hypoxemia and chronic bronchial infection. COPD treatment is based on long-acting bronchodilators with single agents or in combination, depending on the patient\'s risk level. Eosinophilic exacerbators must receive inhaled corticosteroids, while non-eosinophilic exacerbators require a detailed evaluation to choose the best therapeutic option. The new GesEPOC also includes recommendations on the withdrawal of inhaled corticosteroids and on indications for alpha-1 antitrypsin treatment. GesEPOC offers a more individualized approach to COPD treatment tailored according to the clinical characteristics of patients and their level of complexity.
摘要：
西班牙COPD指南（GesEPOC）于2012年首次发布，此后进行了一系列更新，纳入了COPD诊断和治疗的新证据。GesEPOC是与参与COPD治疗的科学协会和西班牙患者论坛合作制定的。他们的建议是基于使用GRADE方法对证据的评估，以及对无法应用GRADE的领域的证据的叙述性描述。在这篇文章中,我们根据9个PICO问题总结了关于药物治疗稳定期COPD的建议.COPD治疗是4步过程:1)诊断;2)确定风险水平;3)初始和随后的吸入治疗;和4)可治疗性状的识别和管理。对于吸入疗法的选择，高危患者分为3种表型：非恶化，嗜酸性粒细胞恶化,和非嗜酸性粒细胞恶化。一些可治疗的特征是一般性的，应该在所有患者中进行调查，如吸烟或吸入技术，而其他人尤其影响重症患者，如慢性低氧血症和慢性支气管感染。COPD治疗基于长效支气管扩张剂与单药或联合治疗，取决于患者的风险水平。嗜酸性粒细胞的exacerbators必须接受吸入性皮质类固醇，而非嗜酸性粒细胞的exacerbators需要进行详细的评估以选择最佳的治疗方案。新的GesEPOC还包括关于停用吸入性皮质类固醇和α-1抗胰蛋白酶治疗适应症的建议。GesEPOC根据患者的临床特征及其复杂性水平提供了更个性化的COPD治疗方法。
