Smithline Howard A, Rowe Brian H, Radeos Michael S, Cydulka Rita K, Camargo Carlos A
Department of Emergency Medicine, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199, USA.
Acad Emerg Med. 2005 Aug;12(8):742-50. doi: 10.1197/j.aem.2005.03.528.
Acute exacerbations of chronic obstructive pulmonary disease are a common problem in the emergency department. Despite considerable research involving the management of this disease over the past decade, much remains unclear from an emergency medicine perspective. Increased research would better guide the management of these complex patients from the perspectives of the patient, the caregiver, and society. The major areas of research can be divided into diagnosis, therapy, and education. The reliability and validity of different definitions of acute exacerbations of chronic obstructive pulmonary disease need to be assessed. The utility and performance characteristics of diagnostic testing need to be determined for this difficult patient population. Specific diagnostic tests include measures of dyspnea, spirometry and exercise tolerance, measures of gas exchange, airway inflammation, and chest imaging. It remains unclear which patient-specific therapies (oxygen, bronchodilators, corticosteroids, antibiotics, noninvasive positive pressure ventilation, and methylxanthines) should be used and monitored. Finally, the utility of education of both health care providers and patients and how it may be applied to the acute setting need to be addressed.
慢性阻塞性肺疾病急性加重是急诊科常见的问题。尽管在过去十年里对该疾病的管理进行了大量研究，但从急诊医学角度来看，仍有许多问题尚不清楚。更多的研究将从患者、护理人员和社会的角度更好地指导对这些复杂患者的管理。主要研究领域可分为诊断、治疗和教育。需要评估慢性阻塞性肺疾病急性加重不同定义的可靠性和有效性。对于这个困难的患者群体，需要确定诊断测试的效用和性能特征。具体的诊断测试包括呼吸困难测量、肺功能测定和运动耐量、气体交换测量、气道炎症和胸部成像。目前尚不清楚应该使用和监测哪些针对患者的特定治疗方法（氧气、支气管扩张剂、皮质类固醇、抗生素、无创正压通气和甲基黄嘌呤）。最后，需要解决医疗保健提供者和患者教育的效用以及如何将其应用于急性情况。
