Yawn Barbara P, Wollan Peter C
Olmsted Medical Center, Research Department, Rochester, MN 55904, USA.
Int J Chron Obstruct Pulmon Dis. 2008;3(2):311-7. doi: 10.2147/copd.s2486.
COPD remains under-recognized and under-treated. Much of early COPD care is given by primary care physicians but only when COPD is recognized. This survey explores the attitudes, beliefs, and knowledge related to COPD recognition, diagnosis, and treatment from family physicians and nurse practitioners (NPs) and physician assistants (PAs) working in primary care.
We completed a survey of family physicians, and NPs/PAs attending one of three CME programs on five common chronic conditions including COPD.
Return rate was 62% (n = 284) including 178 physicians and 100 NPs/PAs. Fewer than half of the respondents reported knowledge of or use of COPD guidelines. The barriers to recognition and diagnosis of COPD they reported included the multiple morbidities of most COPD patients, failure of patients to report COPD symptoms, as well as lack of knowledge and inadequate training in COPD diagnosis and management. Three quarters (74%) of respondents reported use of spirometry to diagnose COPD but only 32% said they included reversibility assessment. COPD was incorrectly assessed as a disease primarily of men (78% ofrespondents) that appeared after age 60 (61%). Few respondents reported that they believed COPD treatment was useful or very useful for improving symptoms (15%) or decreasing exacerbations (3%) or that pulmonary rehabilitation was helpful (3%), but 13% reported they thought COPD treatment could extend longevity.
Primary care physicians and NPs/PAs working in primary care continue to report lack of awareness and use of COPD guidelines, as well as correct information related to COPD epidemiology or potential benefits of available treatments including pulmonary rehabilitation. It is unlikely that diagnosis and management of COPD will improve in primary care until these knowledge gaps and discrepancies with published efficacy of therapy issues are addressed.
慢性阻塞性肺疾病（COPD）仍然未得到充分认识和治疗。早期COPD护理大多由初级保健医生提供，但前提是要识别出COPD。本调查探讨了在初级保健机构工作的家庭医生、执业护士（NPs）和医师助理（PAs）对COPD识别、诊断和治疗的态度、信念及知识。
我们对参加了包括COPD在内的五种常见慢性病的三个继续医学教育项目之一的家庭医生以及NPs/PAs进行了一项调查。
回复率为62%（n = 284），其中包括178名医生和100名NPs/PAs。不到一半的受访者表示了解或使用COPD指南。他们报告的COPD识别和诊断障碍包括大多数COPD患者存在多种疾病、患者未报告COPD症状，以及在COPD诊断和管理方面知识不足和培训不够。四分之三（74%）的受访者报告使用肺活量测定法诊断COPD，但只有32%的人表示他们进行了可逆性评估。COPD被错误地认为主要是60岁以后（61%）男性（78%的受访者）患的疾病。很少有受访者表示他们认为COPD治疗对改善症状（15%）或减少急性加重（3%）有用或非常有用，或者认为肺康复有帮助（3%），但13%的人报告他们认为COPD治疗可以延长寿命。
在初级保健机构工作的初级保健医生和NPs/PAs仍然报告缺乏对COPD指南的认识和使用，以及与COPD流行病学或现有治疗（包括肺康复）潜在益处相关的正确信息。在这些知识差距以及与已发表的治疗效果问题的差异得到解决之前，初级保健机构中COPD的诊断和管理不太可能得到改善。
