慢性阻害性肺疾患のスクリーニング:米国予防サービスタスクフォースの最新証拠報告と体系的レビュー
Elizabeth M Webber1, Jennifer S Lin1, Rachel G Thomas1
1Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon.
JAMA
|May 10, 2022
まとめ
このレビューでは,慢性閉塞性肺疾患 (COPD) のスクリーニングの有効性に関する新しい証拠は見つかりませんでした. 中程度のCOPDの薬剤治療は効果を示したが,非薬剤治療は一貫して結果を改善しなかった.
科学分野:
- 肺医学
- 予防的な心臓科
- 証拠 に 基づく 医学
背景:
- 慢性閉塞性肺疾患 (COPD) は,米国における重大な病気と死因です.
- COPDのスクリーニングと治療に関する勧告を基に,最新の証拠が必要である.
研究 の 目的:
- COPDのスクリーニングと治療の有効性に関する証拠を更新するために,標的を絞った体系的なレビューを実施する.
- 米国予防サービスタスクフォース (USPSTF) に2016年の勧告声明の更新を通知する.
主な方法:
- 2015年1月から2022年3月までの英語研究の体系的レビュー
- 症状のない個体でのスクリーニングと,軽度から中等度のCOPDの治療に関する研究が含まれています.
- 2人の査読者が論文を評価し,適正または質の高い研究からデータを抽出しました.
主要な成果:
- スクリーニングの有効性を評価した試験はありません.
- 薬理学的治療 (例えば,支氣管拡張剤,ティオトロピウム) は,中等度のCOPDの悪化と生活の質の改善に効果を示した.
- 非薬理学的介入には一貫した利点がなかった.観察研究では,特定の薬理学的薬剤の潜在的心血管リスクが認められた.
結論:
- 前回のレビューと一致し,中等度のCOPDの薬理学的治療を支持しています.
- 軽度から中度までまたは最小症状のCOPDにおける非薬理学的介入の証拠は限られている.
- 特定の集団における薬理学的治療のリスクと利益を明らかにするために,さらなる研究が必要になる可能性があります.
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