Matheson M C, Abeysena C, Raven J M, Skoric B, Johns D P, Abramson M J, Walters E H
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
Intern Med J. 2006 Feb;36(2):92-9. doi: 10.1111/j.1445-5994.2006.01011.x.
Although chronic obstructive pulmonary disease (COPD) is a main cause of disability, hospital admissions and premature deaths in Australia, little is known about the community management of COPD in relation to recently published guidelines. The aim of the article was to report on COPD management in a community based cohort.
A random sample of adults aged between 45 and 70 years drawn from the electoral roll participated in the study. They completed a detailed respiratory questionnaire, spirometry, methacholine challenge and measurement of transfer factor. COPD was defined according to the Global initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Current asthma was defined as wheeze during the last 12 months together with bronchial hyperreactivity. Subjects were classified as either COPD-only, asthma-only or both asthma and COPD.
Of 1224 subjects completing spirometry, 39 (3.5%) met the GOLD criteria for stage 2 or 3 COPD, asthma-only was found in 99 (8.9%) subjects and 40 (3.6%) subjects had both asthma and COPD. The COPD-only group was significantly older than the other two groups. More than 40% of subjects with COPD did not have a diagnosis of COPD from their doctors. Only 48.7% of subjects with COPD had ever been prescribed medication for their breathing. More than two-thirds of all subjects had seen a doctor for breathing problems, but very few had seen a general practitioner in the last 12 months and even fewer had respiratory function tests.
Most subjects with COPD are being undertreated. Diagnosis, monitoring and referral systems should be improved. Preventive activities such as influenza vaccination and smoking cessation should be intensified.
尽管慢性阻塞性肺疾病（COPD）是澳大利亚残疾、住院和过早死亡的主要原因，但对于COPD的社区管理与最近发布的指南之间的关系知之甚少。本文的目的是报告一个基于社区的队列中的COPD管理情况。
从选民名册中随机抽取45至70岁的成年人参与研究。他们完成了一份详细的呼吸问卷、肺活量测定、乙酰甲胆碱激发试验和转移因子测量。COPD根据慢性阻塞性肺疾病全球倡议（GOLD）标准定义。当前哮喘定义为过去12个月内喘息并伴有支气管高反应性。受试者被分类为仅患有COPD、仅患有哮喘或同时患有哮喘和COPD。
在1224名完成肺活量测定的受试者中，39名（3.5%）符合GOLD标准的2期或3期COPD，99名（8.9%）受试者仅患有哮喘，40名（3.6%）受试者同时患有哮喘和COPD。仅患有COPD的组比其他两组年龄显著更大。超过40%的COPD患者未被医生诊断出患有COPD。仅48.7%的COPD患者曾因呼吸问题被开过药。超过三分之二的所有受试者因呼吸问题看过医生，但在过去12个月内很少有人看过全科医生，进行呼吸功能测试的人更少。
大多数COPD患者治疗不足。应改进诊断、监测和转诊系统。应加强流感疫苗接种和戒烟等预防措施。
