慢性閉塞性肺疾患の現代的な管理:科学的なレビュー
Don D Sin1, Finlay A McAlister, S F Paul Man
1Division of Pulmonary Medicine, University of Alberta, Edmonton, Canada. don.sin@ualberta.ca
JAMA
|November 6, 2003
まとめ
長期にわたって作用する支氣管拡張剤と吸入用コルチコステロイドは,COPD患者の悪化を効果的に軽減します. 家庭用酸素療法は,生存期間を延長することが示された唯一の介入であり,特に静止状態の低酸素症の患者では特にそうである.
科学分野:
- 肺内医学 肺内医学 肺内医学
- 呼吸器のケアについて
背景:
- 慢性阻害性肺疾患 (COPD) の治療は著しく進化しました.
- 新しい治療法は,患者の健康状態を改善し,疾患の進行を変化させる可能性を秘めています.
研究 の 目的:
- 主要なCOPD介入の臨床効果を体系的に検討する.
- 評価された治療には,支支支管拡張剤,コルチコステロイド,換気,リハビリテーション,酸素,および管理プログラムが含まれています.
主な方法:
- 1980年から2002年にかけてのランダム化対照試験とシステマティックレビューの体系的レビューを実施しました.
- MEDLINEとCochraneのデータベースを検索し,文献の検索と専門家の相談で補完しました.
- 生活の質,悪化,または死亡率を評価する3ヶ月以上のフォローアップ (6週間以上のリハビリテーション) の研究が含まれています.
主要な成果:
- 長期にわたって作用するブロンコディレーターおよび吸入用コルチコステロイドは,COPDの悪化を20〜30%減少させた.
- 肺リハビリテーションは健康状態を改善したが,長期的な生存率は改善しなかった.
- ドミシリアル酸素療法により,静止状態の低酸素症 (PaO2 <60 mm Hg) の患者で生存率が約40%増加しました.
- 非侵襲的機械換気および疾病管理プログラムは,生存または入院に有意な利点を示さなかった.
結論:
- COPDの悪化を軽減するために,長時間作用する支柱管拡張剤と吸入用コルチコステロイドの有力な証拠が支持されています.
- ドミシリアル酸素療法は,生存期間を延長することが証明された唯一の介入であり,特に低血量患者の場合のみです.
- さらなる研究は,中等度から重度のCOPDの治療戦略を洗練することができます.
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