" SABD prn (as needed) should accompany all recommended therapies across the spectrum of COPD"という記載と予測FEV1 80%以上の場合でもLAMAなどの長時間作用性気管支拡張剤使用推奨というのは良いのだろうか?
Bourbeau, Jean, Mohit Bhutani, Paul Hernandez, Shawn D Aaron, Marie-France Beauchesne, Sophie B Kermelly, Anthony D’Urzo, et al. “2023 Canadian Thoracic Society Guideline on Pharmacotherapy in Patient s With Stable COPD.” Chest, September 6, 2023, S0012-3692(23)05275-3.
P.1.A. In individuals with stable COPD, at low risk of exacerbations, with low symptom burden and health status impairment (CAT < 10, mMRC 1), and only mildly impaired lung function (FEV1 ≥ 80% predicted), we recommend starting initial monotherapy with either LAMA or LABA.
P.1.C. In individuals with stable COPD, at low risk of exacerbations, with a moderate to high symptom burden and/or health status impairment (CAT ≥ 10, mMRC ≥ 2) and impaired lung function (FEV1 < 80% predicted) despite LAMA/LABA dual therapy or ICS/LABA combination therapy, we recommend step-up to a LAMA/LABA/ICS triple combination therapy.
P.2.A. In individuals with stable COPD, at low risk of exacerbations, a moderate to high symptom burden and/or health status impairment (CAT ≥ 10, mMRC ≥ 2) and impaired lung function (FEV1 < 80% predicted), we recommend starting LAMA/LABA dual therapy as initial maintenance therapy.
P.2.B. In individuals with stable COPD, at high risk of exacerbations, with a moderate to high symptom burden and/or health status impairment (CAT ≥ 10, mMRC ≥ 2) and impaired lung function (FEV1 < 80% predicted), we recommend the use of LAMA/LABA/ICS triple combination therapy.
P.3.A. In individuals with stable COPD, at a high risk of exacerbations, with a moderate to high symptom burden and/or health status impairment (CAT ≥ 10, mMRC ≥ 2) and impaired lung function (FEV1 < 80% predicted), we recommend the use of LAMA/LABA/ICS triple combination therapy over LABA/LAMA dual therapy.