Van Schayck C P, Loozen J M C, Wagena E, Akkermans R P, Wesseling G J
Department of General Practice, Research Institute ExTra, University of Maastricht, Postbox 616, 6200 MD Maastricht, Netherlands.
BMJ. 2002 Jun 8;324(7350):1370. doi: 10.1136/bmj.324.7350.1370.
To investigate the effectiveness of case finding of patients at risk of developing chronic obstructive pulmonary disease, whether the method is suitable for use in general practice, how patients should be selected, and the time required.
Cross sectional study.
Two semirural general practices in the Netherlands.
651 smokers aged 35 to 70 years.
Short standardised questionnaire on bronchial symptoms for current smokers, lung function with a spirometer, and the quality of the spirometric curve.
Of the 201 smokers not taking drugs for a pulmonary condition, 169 produced an acceptable curve (fulfilling American Thoracic Society criteria). Of these, 30 (18%, 95% confidence interval 12% to 24%) had a forced expiratory volume in one second (FEV(1)) <80% of predicted. When smokers were preselected on the basis of chronic cough, the proportion with an FEV(1) <80% of predicted increased to 27% (17 of 64; 12% to 38%). Chronic cough was a better predictor of airflow obstruction than other symptoms, such as wheeze and dyspnoea. The presence of two symptoms was a slightly better predictor than cough only (odds ratio 3.02 (1.37 to 6.64) v 2.50 (1.14 to 5.52)). Age was also a good predictor of obstruction; smokers over 60 with cough had a 48% chance of having an obstruction. The mean time needed for spirometry was four minutes. Detecting one smoker with an FEV(1) <80% of predicted cost 5 pound sterling to 10 pound sterling.
Trained practice assistants could check all patients who smoke for chronic obstructive pulmonary disease at little cost to the practice. Cough and age are the most important predictors of the disease. By testing one smoker a day, an average practice could identify one patient at risk a week.
调查对有患慢性阻塞性肺疾病风险的患者进行病例发现的有效性，该方法是否适用于全科医疗，应如何选择患者以及所需时间。
横断面研究。
荷兰的两家半乡村全科医疗机构。
651名年龄在35至70岁的吸烟者。
针对当前吸烟者的简短标准化支气管症状问卷、用肺活量计测量的肺功能以及肺活量曲线的质量。
在201名未服用肺部疾病药物的吸烟者中，169人产生了可接受的曲线（符合美国胸科学会标准）。其中，30人（18%，95%置信区间12%至24%）一秒用力呼气量（FEV₁）<预测值的80%。当根据慢性咳嗽对吸烟者进行预先筛选时，FEV₁<预测值80%的比例增至27%（64人中的17人；12%至38%）。与喘息和呼吸困难等其他症状相比，慢性咳嗽是气流受限的更好预测指标。出现两种症状比仅咳嗽的预测稍好（比值比3.02（1.37至6.64）对2.50（1.14至5.52））。年龄也是气流受限的良好预测指标；60岁以上有咳嗽的吸烟者有48%的气流受限几率。肺活量测定所需的平均时间为4分钟。检测出一名FEV₁<预测值80%的吸烟者成本为5英镑至10英镑。
经过培训的执业助理人员可以以较低的成本对所有吸烟患者进行慢性阻塞性肺疾病检查。咳嗽和年龄是该疾病最重要的预测指标。通过每天检测一名吸烟者，一个普通诊所平均每周可以识别出一名有风险的患者。
