Nascimento O A, Camelier A, Rosa F W, Menezes A M B, Pérez-Padilla R, Jardim J R
Disciplina de Pneumologia e Centro de Reabilitação Pulmonar, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
Braz J Med Biol Res. 2007 Jul;40(7):887-95. doi: 10.1590/s0100-879x2006005000133.
Chronic obstructive pulmonary disease (COPD) is a common disease in adults over 40 years of age and has a great social and economic impact. It remains little recognized and undertreated even in developed countries. However, there are no data about its diagnosis and treatment in Brazil. The objectives of the present study were to evaluate the proportion of COPD patients who had never been diagnosed and to determine if the COPD patients who had been identified were receiving appropriate treatment. The Latin American Project for the Investigation of Obstructive Lung Disease (PLATINO) was a randomized epidemiological study of adults over 40 years living in five metropolitan areas, including São Paulo. The studied sample was randomly selected from the population after a division of the metropolitan area of São Paulo in clusters according to social characteristics. All subjects answered a standardized questionnaire on respiratory symptoms, history of smoking, previous diagnosis of lung disease, and treatments. All subjects performed spirometry. The criterion for the diagnosis of COPD was defined by a post-bronchodilator FEV1/FVC ratio lower than 0.7. A total of 918 subjects were evaluated and 144 (15.8%) met the diagnostic criterion for COPD. However, 126 individuals (87.5%) had never been diagnosed. This undiagnosed group of COPD patients had a lower proportion of subjects with respiratory symptoms than the previously diagnosed patients (88.9 vs 54.8%) and showed better lung function with greater FEV1 (86.8 +/- 20.8 vs 68.5 +/- 23.6% predicted) and FVC (106.6 +/- 22.4 vs 92.0 +/- 24.1% predicted). Among the COPD patients, only 57.3% were advised to stop smoking and 30.6% received the influenza vaccine. In addition, 82.3% did not receive any pharmacological treatment. In conclusion, COPD is underdiagnosed and a large number of COPD patients are not treated appropriately.
慢性阻塞性肺疾病（COPD）是40岁以上成年人中的常见疾病，具有重大的社会和经济影响。即使在发达国家，它仍然鲜为人知且治疗不足。然而，巴西尚无关于其诊断和治疗的数据。本研究的目的是评估从未被诊断出的COPD患者的比例，并确定已确诊的COPD患者是否正在接受适当的治疗。拉丁美洲阻塞性肺病调查项目（PLATINO）是一项针对居住在包括圣保罗在内的五个大都市地区的40岁以上成年人的随机流行病学研究。在根据社会特征将圣保罗大都市区划分为多个集群后，从人群中随机选取研究样本。所有受试者均回答了一份关于呼吸道症状、吸烟史、既往肺病诊断和治疗情况的标准化问卷。所有受试者均进行了肺功能测定。COPD的诊断标准定义为支气管扩张剂后FEV1/FVC比值低于0.7。总共评估了918名受试者，其中144名（15.8%）符合COPD的诊断标准。然而，126人（87.5%）从未被诊断出。这组未被诊断出的COPD患者出现呼吸道症状的比例低于先前诊断出的患者（88.9%对54.8%），并且肺功能更好，FEV1（预测值的86.8±20.8%对68.5±23.6%）和FVC（预测值的106.6±22.4%对92.0±24.1%）更高。在COPD患者中，只有57.3%被建议戒烟，30.6%接种了流感疫苗。此外，82.3%未接受任何药物治疗。总之，COPD诊断不足，大量COPD患者未得到适当治疗。
