Buist A S
Pulmonary & Critical Care Medicine, Oregon Health Sciences University, Portland 97201, USA.
Respir Med. 2002 Aug;96 Suppl C:S11-6. doi: 10.1016/s0954-6111(02)80029-4.
Chronic obstructive pulmonary disease (COPD) is a respiratory condition characterized by progressive decline in lung function. It imposes a considerable burden on patients, healthcare services and society that is likely to increase in the future. It is, therefore, important to ensure that this disease is managed as effectively as possible. In many therapeutic areas, management guidelines have been developed in an attempt to ensure that physicians are aware of optimal disease management and cost-effective use of healthcare resources. Such guidelines are usually prepared by consensus among clinical experts or following a systematic review of the evidence. However, there are a number of barriers to the implementation of treatment guidelines, including the sheer weight of guidelines in all therapeutic areas, a focus on scientific knowledge rather than on clinical practice, lack of trust in the recommendations, practical considerations (e.g. time, resources, budget) and failure to include the perspective of patients. The management guidelines most likely to be implemented are those that are quick and easy to use, relevant to the user's practice and from a credible source. In COPD, over 40 guidelines have been developed, mainly by local respiratory societies as a result of local expert consensus. The guidelines developed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) are evidence-based and have the backing of international experts. Local implementation plans have been developed to help ensure that GOLD recommendations are implemented in practice. In all COPD guidelines, however, lung function measures feature prominently with limited reference to outcome measures of interest to patients and healthcare payers (e.g. frequency of exacerbations requiring hospitalization). Low expectations among physicians and patients may also impair implementation. In conclusion, guidelines may improve the management of COPD, but the main challenge is to ensure implementation.
慢性阻塞性肺疾病（COPD）是一种以肺功能进行性下降为特征的呼吸系统疾病。它给患者、医疗服务机构和社会带来了相当大的负担，且这种负担在未来可能会增加。因此，确保尽可能有效地管理这种疾病非常重要。在许多治疗领域，已经制定了管理指南，以确保医生了解最佳的疾病管理方法以及医疗资源的成本效益使用。此类指南通常是由临床专家达成共识后制定，或在对证据进行系统审查后制定。然而，治疗指南的实施存在一些障碍，包括所有治疗领域指南数量众多、侧重于科学知识而非临床实践、对建议缺乏信任、实际考虑因素（如时间、资源、预算）以及未纳入患者的观点。最有可能被实施的管理指南是那些使用快速简便、与使用者的实践相关且来源可靠的指南。在COPD领域，已经制定了40多项指南，主要是由当地呼吸学会根据当地专家共识制定的。慢性阻塞性肺疾病全球倡议组织（GOLD）制定的指南是以证据为基础的，并有国际专家的支持。已经制定了当地实施计划，以帮助确保GOLD的建议在实践中得到实施。然而，在所有COPD指南中，肺功能测量占据显著地位，而对患者和医疗支付方感兴趣的结局指标（如需要住院治疗的急性加重发作频率）提及有限。医生和患者的低期望也可能会影响实施。总之，指南可能会改善COPD的管理，但主要挑战是确保其实施。
