Abstract：
Chronic obstructive pulmonary disease patient care must include confirming a diagnosis with postbronchodilator spirometry. Because of the clinical heterogeneity and the reality that airflow obstruction assessed by spirometry only partially reflects disease severity, a thorough clinical evaluation of the patient should include assessment of symptom burden and risk of exacerbations that permits the implementation of evidence-informed pharmacologic and nonpharmacologic interventions. This guideline provides recommendations from a comprehensive systematic review with a meta-analysis and expert-informed clinical remarks to optimize maintenance pharmacologic therapy for individuals with stable COPD, and a revised and practical treatment pathway based on new evidence since the 2019 update of the Canadian Thoracic Society (CTS) Guideline. The key clinical questions were developed using the Patients/Population (P), Intervention(s) (I), Comparison/Comparator (C), and Outcome (O) model for three questions that focuses on the outcomes of symptoms (dyspnea)/health status, acute exacerbations, and mortality. The evidence from this systematic review and meta-analysis leads to the recommendation that all symptomatic patients with spirometry-confirmed COPD should receive long-acting bronchodilator maintenance therapy. Those with moderate to severe dyspnea (modified Medical Research Council ≥ 2) and/or impaired health status (COPD Assessment Test ≥ 10) and a low risk of exacerbations should receive combination therapy with a long-acting muscarinic antagonist/long-acting ẞ2-agonist (LAMA/LABA). For those with a moderate/severe dyspnea and/or impaired health status and a high risk of exacerbations should be prescribed triple combination therapy (LAMA/LABA/inhaled corticosteroids) azithromycin, roflumilast or N-acetylcysteine is recommended for specific populations; a recommendation against the use of theophylline, maintenance systemic oral corticosteroids such as prednisone and inhaled corticosteroid monotherapy is made for all COPD patients.
摘要：
慢性阻塞性肺疾病患者的护理必须包括使用支气管扩张剂后肺活量测定法确认诊断。由于临床异质性以及肺活量测定法评估的气流阻塞仅部分反映疾病的严重程度，对患者进行全面的临床评估应包括评估症状负担和急性加重风险,以便实施循证药物和非药物干预措施.本指南提供了综合系统评价的建议，包括荟萃分析和专家知情的临床评论，以优化稳定COPD患者的维持药物治疗。以及自2019年更新加拿大胸科学会（CTS）指南以来的新证据，修订和实用的治疗途径。关键的临床问题是使用患者/人群（P），干预（I），比较/比较器(C),和结果（O）模型三个问题，重点是症状（呼吸困难）/健康状况的结果，急性加重,和死亡率。这项系统评价和荟萃分析的证据导致建议所有肺活量测定证实为COPD的有症状患者应接受长效支气管扩张剂维持治疗。那些中度至重度呼吸困难（改良医学研究理事会≥2）和/或健康状况受损（COPD评估测试≥10）且恶化风险较低的患者应接受长效毒蕈碱拮抗剂/长效+2-激动剂（LAMA/LABA）的联合治疗。对于中度/重度呼吸困难和/或健康状况受损且恶化风险高的患者，应使用三联疗法（LAMA/LABA/吸入糖皮质激素）阿奇霉素，罗氟司特或N-乙酰半胱氨酸被推荐用于特定人群;反对使用茶碱的建议，对所有COPD患者进行全身性口服皮质类固醇如泼尼松和吸入性皮质类固醇单药治疗.
