慢性阻塞性肺疾病全球倡议:慢性阻塞性肺疾病诊断、管理和预防策略——亚太视角

Global Initiative for Chronic Obstructive Lung Disease strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease: an Asia-Pacific perspective.

出版信息

Respirology. 2005 Jan;10(1):9-17. doi: 10.1111/j.1440-1843.2005.00692.x.

Abstract

Chronic obstructive pulmonary disease (COPD) is a major public health problem and its prevalence and mortality are increasing throughout the world, including the Asia-Pacific region. To arrest these worldwide trends, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Expert Panel's global strategy for the diagnosis, management, and prevention of COPD was published in 2001. Based on recently published clinical trials, the GOLD statement was updated in 2003. The Asia-Pacific COPD Roundtable Group, a taskforce of expert respirologists from the Asia-Pacific region, has recently formulated a consensus statement on implementation of the GOLD strategy for COPD in the Asia-Pacific region. The key issues identified by the COPD Roundtable Group for comment are: (i) where there is no access to spirometry, diagnosis of COPD could be suspected on the basis of history, symptoms and physical signs; (ii) inhaled bronchodilators are the preferred regular treatment for COPD in the region, but oral bronchodilators may be considered if the cost of inhaled bronchodilators is a barrier to treatment; (iii) the use of a Metered Dose Inhaler with spacer in place of a nebulizer is recommended in the treatment of acute airflow obstruction in patients with COPD; (iv) influenza vaccination is recommended for all patients with COPD in communities where there is a high likelihood of Severe Acute Respiratory Syndrome; and (v) simplified pulmonary rehabilitation programmes should be established in areas where comprehensive programmes are unavailable. Physical exercise training and education on smoking cessation should be core elements of any rehabilitation program. In summary, the COPD Roundtable Group supports implementation of the GOLD strategy for the diagnosis, management and prevention of COPD in the Asia-Pacific region, subject to the additions and modifications to the guidelines suggested above.

摘要

慢性阻塞性肺疾病(COPD)是一个重大的公共卫生问题,其患病率和死亡率在全球范围内,包括亚太地区,都在不断上升。为遏制这些全球趋势,慢性阻塞性肺疾病全球倡议(GOLD)专家小组于2001年发布了关于COPD诊断、管理和预防的全球战略。基于最近发表的临床试验,GOLD声明于2003年进行了更新。亚太COPD圆桌小组是一个由亚太地区呼吸内科专家组成的特别工作组,最近就GOLD COPD战略在亚太地区的实施制定了一份共识声明。COPD圆桌小组确定的供评论的关键问题包括:(i)在无法进行肺功能测定的情况下,可根据病史、症状和体征怀疑COPD的诊断;(ii)吸入性支气管扩张剂是该地区COPD的首选常规治疗方法,但如果吸入性支气管扩张剂的费用成为治疗障碍,则可考虑使用口服支气管扩张剂;(iii)在治疗COPD患者的急性气流阻塞时,建议使用带储雾罐的定量吸入器代替雾化器;(iv)在严重急性呼吸综合征高发的社区,建议所有COPD患者接种流感疫苗;(v)在无法开展综合项目的地区应建立简化的肺康复项目。体育锻炼训练和戒烟教育应是任何康复项目的核心内容。总之,COPD圆桌小组支持在亚太地区实施GOLD COPD诊断、管理和预防战略,但需对上述指南进行补充和修改。

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