Neues zur COPD – Die aktuellen GOLD-Empfehlungen 2017

Was ist neu

Neue Klassifikation der COPD nach GOLD 2017 Die neue Klassifikation erfasst den funktionellen Schweregrad GOLD 1 – 4 entsprechend dem FEV1-Prozent vom Soll getrennt von den Risikogruppen ABCD nach Symptomatik und Exazerbation-Historie.

Prävention Die Bedeutung der Prävention (Tabakentwöhnung, Impfungen) und nicht-medikamentösen Therapien (insbesondere REHA und Trainingstherapie) sind wesentliche Bestandteile der Therapie.

Medikamentöse Therapie Die jeweilige Risikogruppe und nicht die funktionelle Einschränkung der Lungenfunktion bestimmt über die medikamentöse Therapie.

Interventionelle Verfahren Sowohl die nicht-invasive Beatmung bei Hyperkapnie als auch die Volumenreduktion bei schwerem Lungenemphysem haben feste Indikationskriterien.

• Literatur

• 1 Brown JP, Martinez CH. Chronic obstructive pulmonary disease comorbidities. Current opinion in pulmonary medicine 2016; 22: 113-118
• 2 Vanfleteren LE, Spruit MA, Groenen M. et al. Clusters of comorbidities based on validated objective measurements and systemic inflammation in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2013; 187: 728-735
• 3 Hurst JR, Vestbo J, Anzueto A. et al. Evaluation of CLtIPSEI. Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med 2010; 363: 1128-1138
• 4 Global Initiative for Chronic Obstructive Lung Disease: Global Strategy for the Diagnosis, Management and Prevention of COPD (2017 Report). http://goldcopd.org/gold-2017-global-strategy-diagnosis-management-prevention-copd/ Stand: August 2017
• 5 Vogelmeier CF, Criner GJ, Martinez FJ. et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary. Am J Respir Crit Care Med 2017; 195: 557-582
• 6 Criee CP, Baur X, Berdel D. et al. Standardization of spirometry: 2015 update. Published by German Atemwegsliga, German Respiratory Society and German Society of Occupational and Environmental Medicine. Pneumologie 2015; 69: 147-164
• 7 Hartmann-Boyce J, McRobbie H, Bullen C. et al. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev 2016; 9: CD010216
• 8 Kalkhoran S, Glantz SA. E-cigarettes and smoking cessation in real-world and clinical settings: a systematic review and meta-analysis. Lancet Respir Med 2016; 4: 116-128
• 9 Calverley PMA, Anderson JA, Brook RD. et al. Fluticasone Furoate, Vilanterol and Lung Function Decline in Patients with Moderate COPD and Heightened Cardiovascular Risk. Am J Respir Crit Care Med 2017; DOI: 10.1164/rccm.201610-2086OC.
• 10 Vestbo J, Hurd SS, Agusti AG. et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2013; 187: 347-365
• 11 Vogelmeier C, Hederer B, Glaab T. et al. Tiotropium versus salmeterol for the prevention of exacerbations of COPD. N Engl J Med 2011; 364: 1093-1103
• 12 Albert RK, Connett J, Bailey WC. et al. Azithromycin for prevention of exacerbations of COPD. N Engl J Med 2011; 365: 689-698
• 13 Han MK, Tayob N, Murray S. et al. Predictors of chronic obstructive pulmonary disease exacerbation reduction in response to daily azithromycin therapy. Am J Respir Crit Care Med 2014; 189: 1503-1508
• 14 Magnussen H, Disse B, Rodriguez-Roisin R. et al. Withdrawal of inhaled glucocorticoids and exacerbations of COPD. N Engl J Med 2014; 371: 1285-1294
• 15 Siddiqui SH, Guasconi A, Vestbo J. et al. Blood Eosinophils: A Biomarker of Response to Extrafine Beclomethasone/Formoterol in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2015; 192: 523-525
• 16 Pavord ID, Lettis S, Locantore N. et al. Blood eosinophils and inhaled corticosteroid/long-acting beta-2 agonist efficacy in COPD. Thorax 2016; 71: 118-125
• 17 Bafadhel M, Pavord ID, Russell REK. Eosinophils in COPD: just another biomarker?. Lancet Respir Med 2017; 5: 747-759
• 18 Pascoe S, Locantore N, Dransfield MT. et al. Blood eosinophil counts, exacerbations, and response to the addition of inhaled fluticasone furoate to vilanterol in patients with chronic obstructive pulmonary disease: a secondary analysis of data from two parallel randomised controlled trials. Lancet Respir Med 2015; 3: 435-442
• 19 Watz H, Tetzlaff K, Wouters EF. et al. Blood eosinophil count and exacerbations in severe chronic obstructive pulmonary disease after withdrawal of inhaled corticosteroids: a post-hoc analysis of the WISDOM trial. Lancet Respir Med 2016; 4: 390-398
• 20 Leuppi JD, Schuetz P, Bingisser R. et al. Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: the REDUCE randomized clinical trial. JAMA 2013; 309: 2223-2231
• 21 Kohnlein T, Windisch W, Kohler D. et al. Non-invasive positive pressure ventilation for the treatment of severe stable chronic obstructive pulmonary disease: a prospective, multicentre, randomised, controlled clinical trial. Lancet Respir Med 2014; 2: 698-705
• 22 Murphy PB, Rehal S, Arbane G. et al. Effect of home noninvasive ventilation with oxygen therapy vs oxygen therapy alone on hospital readmission or death after an acute copd exacerbation: A randomized clinical trial. JAMA 2017; 317: 2177-2186
• 23 Long-Term Oxygen Treatment Trial Research G. A Randomized Trial of Long-Term Oxygen for COPD with Moderate Desaturation. N Engl J Med 2016; 375: 1617-1627
• 24 Magnussen H, Kirsten AM, Kohler D. et al. Guidelines for long-term oxygen therapy. German Society for Pneumology and Respiratory Medicine. Pneumologie 2008; 62: 748-756