Akamatsu Keiichiro, Yamagata Toshiyuki, Kida Yohei, Tanaka Hiroto, Ueda Hiroki, Ichinose Masakazu
Third Department of Internal Medicine, Wakayama Medical University, School of Medicine, Wakayama, Japan Wakayama, Japan.
COPD. 2008 Oct;5(5):269-73. doi: 10.1080/15412550802363303.
The prevalence of chronic obstructive pulmonary disease (COPD) has been increasing. However, COPD is often underdiagnosed. The objective of this study was to determine how many outpatients had persistent airflow limitation and could be diagnosed as COPD by post-bronchodilator spirometry. We also evaluated whether the newly diagnosed patients had any symptoms. All outpatients with liver or general diseases over 40 years old who regularly visited to our hospital were tested for pulmonary function by spirometry. Patients with airflow limitation by the first screening spirometry had further examinations including post-bronchodilator spirometry and chest radiograph by pulmonary specialists. A total of 288 patients accepted a first spirometry. The most common chronic diseases of these patients were chronic hepatitis (33.7%), fatty liver (26.4%), liver cirrhosis (8.3%), diabetes (3.5%) and hypertension (3.1%). Approximately half of the patients had a smoking history. 44 of 288 patients (15.3%) showed airflow limitation by pre-bronchodilator spirometry. Of these, 8 patients did not show airflow limitation by a repeat pre-bronchodilator spirometry nor did 5 patients by post-bronchodilator spirometry. The rest were diagnosed as COPD (80.6%), asthma (16.1%) and bronchiectasis (3.2%). The prevalence of COPD was 8.7%. Approximately half of the patients (13/25, 52.0%) diagnosed as COPD had never complained of any respiratory symptoms. Because symptoms such as dyspnea on exertion, cough and sputum are less sensitive for the diagnosis of COPD, the propagation of spirometry in a general practice/setting should be recommended for establishing the diagnosis rate of COPD rather than relying on the presence of respiratory symptoms.
慢性阻塞性肺疾病（COPD）的患病率一直在上升。然而，COPD常常未被充分诊断。本研究的目的是确定有多少门诊患者存在持续性气流受限，并可通过支气管扩张剂后肺功能测定被诊断为COPD。我们还评估了新诊断的患者是否有任何症状。所有40岁以上定期到我院就诊的患有肝脏疾病或其他全身性疾病的门诊患者均通过肺功能测定进行肺功能检测。首次肺功能筛查出现气流受限的患者由肺科专家进行进一步检查，包括支气管扩张剂后肺功能测定和胸部X光检查。共有288名患者接受了首次肺功能测定。这些患者中最常见的慢性病为慢性肝炎（33.7%）、脂肪肝（26.4%）、肝硬化（8.3%）、糖尿病（3.5%）和高血压（3.1%）。大约一半的患者有吸烟史。288名患者中有44名（15.3%）在支气管扩张剂前肺功能测定时出现气流受限。其中，8名患者在重复支气管扩张剂前肺功能测定时未出现气流受限，5名患者在支气管扩张剂后肺功能测定时也未出现气流受限。其余患者被诊断为COPD（80.6%）、哮喘（16.1%）和支气管扩张（3.2%）。COPD的患病率为8.7%。被诊断为COPD的患者中约一半（13/25，52.0%）从未诉说过任何呼吸道症状。由于诸如劳力性呼吸困难、咳嗽和咳痰等症状对COPD诊断的敏感性较低，因此应建议在普通诊所/环境中推广肺功能测定，以提高COPD的诊断率，而不是依赖呼吸道症状的存在。
