Griffiths C, Feder G, Wedzicha J, Foster G, Livingstone A, Marlowe G S
Department of General Practice and Primary care, St. Bartholomew's and the Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, London, UK.
Respir Med. 1999 Dec;93(12):903-8. doi: 10.1016/s0954-6111(99)90057-4.
There is renewed interest in the diagnosis of chronic obstructive pulmonary disease (COPD) within primary care. Primary care physicians have difficulty distinguishing asthma from COPD. We tested the feasibility of using spirometry and if appropriate, reversibility testing, to identify patients with COPD on asthma registers in primary care. We carried out a cross-sectional study in three inner-city group practices in east London. Three hundred and twenty-eight patients aged 50 years and over on practice asthma registers were invited to attend for spirometry and, if appropriate, a trial of oral corticosteroids. The main outcome measures were: feasibility of carrying out spirometry; lung function; severity of COPD; prior diagnosis of COPD; response to a corticosteroid trial; quality of life. One hundred and sixty-eight of 328 (51%) patients attended for spirometry. According to British Thoracic Society criteria, 58 (34%) patients had normal spirometry at the time of assessment; 40 (24%) had active asthma and 57 (34%) had COPD. Thirteen patients (8%) were unable to perform spirometry. Of 57 patients with COPD 30 (53%) had mild, 15 (26%) had moderate and 12 (21%) had severe disease. Twenty-three of 57 (40%) patients with COPD on spirometry had this diagnosis recorded prior to the study. New diagnoses of COPD were more likely in those with mild or moderate disease (P<0.05). Twenty-three of 57 (40%) patients with COPD completed a corticosteroid trial: one showed significant reversibility of lung function. Spirometry was feasible and helped identify patients with COPD on asthma registers in these inner-city practices. Patients aged 50 years and over on asthma registers had a wide spectrum of lung function with considerable diagnostic misclassification. Some patients with normal lung function when tested may have had well controlled asthma. New diagnoses of COPD were mainly in those with mild or moderate disease.
基层医疗中对慢性阻塞性肺疾病（COPD）的诊断重新引起了关注。基层医疗医生在区分哮喘和COPD方面存在困难。我们测试了使用肺活量测定法以及在适当情况下进行可逆性测试，以在基层医疗的哮喘登记册中识别COPD患者的可行性。我们在伦敦东部的三个市中心团体诊所进行了一项横断面研究。邀请了328名年龄在50岁及以上、在诊所哮喘登记册上的患者参加肺活量测定，并在适当情况下进行口服皮质类固醇试验。主要结局指标包括：进行肺活量测定的可行性；肺功能；COPD的严重程度；COPD的先前诊断；对皮质类固醇试验的反应；生活质量。328名患者中有168名（51%）参加了肺活量测定。根据英国胸科学会标准，58名（34%）患者在评估时肺活量测定正常；40名（24%）患有活动性哮喘，57名（34%）患有COPD。13名患者（8%）无法进行肺活量测定。在57名COPD患者中，30名（53%）为轻度，15名（26%）为中度，12名（21%）为重度疾病。在肺活量测定中诊断为COPD的57名患者中，有23名（40%）在研究前已有该诊断记录。COPD的新诊断在轻度或中度疾病患者中更常见（P<0.05）。57名COPD患者中有23名（40%）完成了皮质类固醇试验：1名显示肺功能有显著可逆性。肺活量测定是可行的，并有助于在这些市中心诊所的哮喘登记册中识别COPD患者。哮喘登记册上年龄在50岁及以上的患者肺功能范围广泛，存在相当多的诊断错误分类。一些测试时肺功能正常的患者可能患有控制良好的哮喘。COPD的新诊断主要在轻度或中度疾病患者中。
