專題討論8:常見疾病治療新進展工作坊

S8-4
慢性阻塞性肺疾之治療指引
李政宏
成大醫院內科部胸腔內科

 Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients.•Its pulmonary component is characterized by airflow limitation that is not fully reversible.•The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases.
The diagnosis of COPD is based on clinical picture and spirometry. The evaluation of severity is based of post bronchodilator test FEV1. From the Japanese study (NICE), we know the diagnosis of COPD by doctor is still far below the actual patients. The highly suspicious by clinician and use of the spirometry are the key for diagnosis. There is questionnaire may be used by patients themselves to evaluate the risk of COPD and help them to see the doctor for help. The principle of treating COPD is based on improving the life quality and avoiding acute exacerbation.
Education patient quitting smoking plays a major role in improving the health status and improving lung function. By now there is no any medication that proof to improve the FEV1 by long term care. From the TORCH study and the UPLIFT study that measure the pulmonary function during treatment, both medication ICS and LABA or long-acting anticholinergic agent show improving the life quality and reducing the acute exacerbation rate but no evidence to decrease the mortality rate.
Regular use of long-acting bronchodilator is proved to control the daily symptoms and either combined with theophylline or inhaled corticosteroid may suggest for more severe cases of COPD.(GOLD guideline Stage 3 to Stage 4 with repeating acute exacerbation). Oral steroid are used only in acute exacerbation and rule out bacterial infection. Oxygen therapy and rehabilitation may be beneficial for more severe cases and improving the survival rate.