Clotet J, Gómez-Arbonés X, Ciria C, Albalad J M
Centro de Atención Primaria de Ponts and Departamento de Medicina, Universitat de Lleida, Spain.
Arch Bronconeumol. 2004 Apr;40(4):155-9. doi: 10.1016/s1579-2129(06)60207-3.
Chronic obstructive pulmonary disease (COPD) is a common disease, the early diagnosis of which allows effective management and treatment. The aim of the present study is to show the effectiveness of a screening and monitoring plan for COPD in high-risk patients in primary health care.
The subjects in this prospective observational longitudinal study comprised 164 high-risk smokers aged between 40 and 76 years. Age, sex, weight, height, and smoking habit (pack-years) were recorded and spirometry was performed according to the guidelines of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR). Patients were informed of their results and given brief advice on how to stop smoking. After 3 years, the patients underwent the same evaluation.
In 1999, 22% of the smokers were diagnosed with COPD. Three years later, an additional 16.3% were diagnosed as having COPD, and the disease had worsened in 38.8% of those already diagnosed. Of the patients with a forced expiratory volume in one second (FEV1) less than 90%, 44.8% developed COPD (relative risk: 10.54). An accelerated decrease in FEV1 was found in 18.1% of the patients (20.7% with COPD and 9.0% without COPD). Mean tobacco consumption in 1999 was 28.1 pack-years in subjects without COPD and 31.7 pack-years in those with COPD, whereas in 2002, consumption was 30.6 pack-years in patients with COPD and 31.9 pack-years in those without. In 3 years, 22.8% had stopped smoking (20.5% without COPD and 30.3% with COPD).
Many smokers managed to give up smoking after learning their spirometric results. FEV1 can identify smokers at greatest risk of developing COPD. Spirometric screening and monitoring of smokers at high risk in primary health care can identify those most susceptible to developing COPD while the disease is in an early phase. Therefore the most appropriate strategy can be adopted for each patient.
慢性阻塞性肺疾病（COPD）是一种常见疾病，早期诊断有助于进行有效的管理和治疗。本研究的目的是展示在初级卫生保健中针对高危患者的COPD筛查和监测计划的有效性。
这项前瞻性观察性纵向研究的受试者包括164名年龄在40至76岁之间的高危吸烟者。记录年龄、性别、体重、身高和吸烟习惯（吸烟包年数），并根据西班牙肺科和胸外科协会（SEPAR）的指南进行肺功能测定。向患者告知其检查结果，并就如何戒烟给予简短建议。3年后，对患者进行相同评估。
1999年，22%的吸烟者被诊断为COPD。3年后，又有16.3%被诊断患有COPD，且在已确诊的患者中有38.8%的病情恶化。在一秒用力呼气量（FEV1）低于90%的患者中，44.8%发展为COPD（相对风险：10.54）。18.1%的患者FEV1出现加速下降（COPD患者中为20.7%，无COPD患者中为9.0%）。1999年，无COPD患者的平均吸烟量为28.1包年，COPD患者为31.7包年；而在2002年，COPD患者的吸烟量为30.6包年，无COPD患者为31.9包年。3年内，22.8%的人戒烟（无COPD者中为20.5%，COPD者中为30.3%）。
许多吸烟者在得知肺功能测定结果后成功戒烟。FEV1可识别出患COPD风险最高的吸烟者。在初级卫生保健中对高危吸烟者进行肺功能筛查和监测，可在疾病早期识别出最易患COPD的人群。因此可为每位患者采用最合适的策略。
