Tratamento farmacológico da DPOC

Abstract

ResumoAproximadamente sete milhões de brasileiros acima de 40 anos são acometidos pela DPOC. Nos últimos anos, importantes avanços foram registrados no campo do tratamento medicamentoso dessa condição. Foi realizada uma revisão sistemática incluindo artigos originais sobre tratamento farmacológico da DPOC publicados entre 2005 e 2009, indexados em bases de dados nacionais e internacionais e escritos em inglês, espanhol ou português. Artigos com tamanho amostral menor de 100 indivíduos foram excluídos. Os desfechos sintomas, função pulmonar, qualidade de vida, exacerbações, mortalidade e efeitos adversos foram pesquisados. Os artigos foram classificados segundo o critério da Global Initiative for Chronic Obstructive Lung Disease para nível de evidência científica (grau de recomendação A, B e C). Dos 84 artigos selecionados, 40 (47,6%), 18 (21,4%) e 26 (31,0%) foram classificados com graus A, B e C, respectivamente. Das 420 análises oriundas desses artigos, 236 referiam-se à comparação de fármacos contra placebo nos diversos desfechos estudados. Dessas 236 análises, os fármacos mais frequentemente estudados foram anticolinérgicos de longa duração, a combinação β 2 -agonistas de longa duração + corticosteroides inalatórios e corticosteroides inalatórios isolados em 66, 48 e 42 análises, respectivamente. Nas mesmas análises, os desfechos função pulmonar, efeitos adversos e sintomas geraram 58, 54 e 35 análises, respectivamente. A maioria dos estudos mostrou que os medicamentos aliviaram os sintomas, melhoraram a qualidade de vida, a função pulmonar e preveniram as exacerbações. Poucos estudos contemplaram o desfecho mortalidade, e o papel do tratamento medicamentoso nesse desfecho ainda não está completamente definido. Os fármacos estudados são seguros no manejo da DPOC, com poucos efeitos adversos.Descritores: Doença pulmonar obstrutiva crônica/terapia; Doença pulmonar obstrutiva crônica/mortalidade; Revisão. AbstractApproximately seven million Brazilians over 40 years of age have COPD. In recent years, major advances have been made in the pharmacological treatment of this condition. We performed a systematic review including original articles on pharmacological treatments for COPD. We reviewed articles written in English, Spanish, or Portuguese; published between 2005 and 2009; and indexed in national and international databases. Articles with a sample size < 100 individuals were excluded. The outcome measures were symptoms, pulmonary function, quality of life, exacerbations, mortality, and adverse drug effects. Articles were classified in accordance with the Global Initiative for Chronic Obstructive Lung Disease criteria for the determination of the level of scientific evidence (grade of recommendation A, B, or C). Of the 84 articles selected, 40 (47.6%), 18 (21.4%), and 26 (31.0%) were classified as grades A, B, and C, respectively. Of the 420 analyses made in these articles, 236 were regarding the comparison between medications and placebos. Among these 236 analyses, the most commonly studied medications (in 66...

Hospitalized patients with COPD: analysis of prior treatment

“…Therefore, patients with COPD that is more severe predominated, the benefits of maintenance treatment being greater in such patients. ( 5 ) …”

“…( 13 - 16 ) A recent systematic review showed that there is evidence for IC use only in patients with severe COPD and symptoms and in those with moderate or severe COPD, symptoms, and more than two COPD exacerbations per year. ( 5 ) Incorrect prescription of LABA + IC is common among patients with moderate disease treated at primary or secondary health care facilities. ( 17 - 20 ) Studies have shown that 45% of patients with moderate COPD receive ICs only, whereas 60% receive LABA + IC.…”

“…( 2 ) The consequences of delayed, inappropriate treatment are disastrous and include increased exacerbations, loss of lung function, increased morbidity, and increased mortality. ( 2 , 5 ) However, data on the maintenance treatment of COPD are scarce in Brazil. ( 5 ) …”

Inhaler use in adolescents and adults with self-reported physician-diagnosed asthma, bronchitis, or emphysema in the city of Pelotas, Brazil

“…( 1 ) The type of inhaled medication recommended for individuals with emphysema also deserves attention because it does not seem to be in accordance with the recommendations. ( 2 , 26 ) Finally, the implementation of new policies for the free distribution of these drugs will meet the needs identified in the present study, because although few individuals reported lack of financial resources to purchase an inhaler as the reason for not using an inhaler, inhaler use is lowest among those of lowest socioeconomic status. …”

“…A recent systematic review highlighted that ICs should be used only in those with frequent exacerbations. ( 26 ) According to the Global Initiative for Chronic Obstructive Lung Disease guidelines, ICs should be reserved for those belonging to high-risk groups. ( 2 ) In our study, we did not evaluate the frequency or type of symptoms that can lead to an estimation of the severity of COPD; however, data from a previous population-based study showed that those for whom ICs are indicated account for only approximately 1% of all COPD patients.…”