Luppi Fabrizio, Franco Francesca, Beghé Bianca, Fabbri Leonardo M
Department of Respiratory Diseases, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41100 Modena, Italy.
Proc Am Thorac Soc. 2008 Dec 1;5(8):848-56. doi: 10.1513/pats.200809-101TH.
While chronic obstructive pulmonary disease (COPD) is still characterized and diagnosed by lung function measurements, there is increasing evidence that the chronic diseases that frequently develop with COPD in response to the common risk factors (smoking, aging, obesity) may contribute significantly to its clinical manifestations and severity. Considering that pharmacologic and nonpharmacologic treatments of COPD, such as pulmonary rehabilitation, are primarily symptomatic, it is reasonable to hope that a more comprehensive management of COPD that takes into account its comorbidities may improve the response to treatment and reduce mortality in patients with COPD. Thus, as comorbidities are often underdiagnosed and undertreated, it is important to search for their coexistence in COPD and in all chronic diseases, possibly by adopting recommendations for diagnosis of single diseases. This means that while careful cardiovascular, metabolic, and endocrinologic examinations should be increasingly used in assessing patients with COPD, lung function measurements may become useful in patients with chronic cardiovalscular, metabolic, and endocrinologic diseases. The increasing evidence that active treatment of comorbidities (by, e.g., statins and beta-blockers) may reduce morbidity and mortality in patients with COPD suggests the urgent need for randomized clinical trials that hopefully will provide the evidence for more comprehensive clinical guidelines for these patients.
虽然慢性阻塞性肺疾病（COPD）仍通过肺功能测量来进行特征描述和诊断，但越来越多的证据表明，因常见风险因素（吸烟、衰老、肥胖）而常与COPD共同发生的慢性疾病，可能对其临床表现和严重程度有显著影响。鉴于COPD的药物治疗和非药物治疗，如肺康复，主要是对症治疗，那么希望对COPD进行更全面的管理，将其合并症考虑在内，可能会改善治疗反应并降低COPD患者的死亡率，这是合理的。因此，由于合并症常常未得到充分诊断和治疗，在COPD以及所有慢性疾病中寻找它们的共存情况很重要，或许可以通过采用单一疾病的诊断建议来实现。这意味着，虽然在评估COPD患者时应越来越多地使用细致的心血管、代谢和内分泌检查，但肺功能测量对于患有慢性心血管、代谢和内分泌疾病的患者可能也会有用。越来越多的证据表明，对合并症进行积极治疗（例如使用他汀类药物和β受体阻滞剂）可能会降低COPD患者的发病率和死亡率，这表明迫切需要进行随机临床试验，有望为这些患者制定更全面的临床指南提供证据。
