Department of Clinical Medical Sciences, University of the West Indies, St. Augustine Campus, Trinidad and Tobago.
Int J Chron Obstruct Pulmon Dis. 2009;4:203-23. doi: 10.2147/copd.s3385. Epub 2009 Jun 11.
COPD is prevalent in Western society and its incidence is rising in the developing world. Acute exacerbations of COPD, about 50% of which are unreported, lead to deterioration in quality of life and contribute significantly to disease burden. Quality of life deteriorates with time; thus, most of the health burden occurs in more severe disease. COPD severity and frequent and more severe exacerbations are all related to an increased risk of mortality. Inhaled corticosteroids (ICS) have similar effects on quality of life but ICS/long-acting bronchodilator combinations and the long-acting antimuscarinic tiotropium all improve health status and exacerbation rates and are likely to have an effect on mortality but perhaps only with prolonged use. Erythromycin has been shown to decrease the rate of COPD exacerbations. Pulmonary rehabilitation and regular physical activity are indicated in all severities of COPD and improve quality of life. Noninvasive ventilation is associated with improved quality of life. Long-term oxygen therapy improves mortality but only in hypoxic COPD patients. The choice of an inhaler device is a key component of COPD therapy and this requires more attention from physicians than perhaps we are aware of. Disease management programs, characterized as they are by patient centeredness, improve quality of life and decrease hospitalization rates. Most outcomes in COPD can be modified by interventions and these are well tolerated and have acceptable safety profiles.
COPD 在西方社会中普遍存在，其发病率在发展中国家正在上升。COPD 的急性加重，其中约 50%未报告，导致生活质量恶化，并对疾病负担有重大贡献。生活质量随时间恶化；因此，大部分健康负担发生在更严重的疾病中。COPD 的严重程度、频繁和更严重的恶化都与死亡率的增加有关。吸入性皮质类固醇（ICS）对生活质量有相似的影响，但 ICS/长效支气管扩张剂联合制剂和长效抗毒蕈碱替托品都能改善健康状况和恶化率，并可能对死亡率产生影响，但可能仅在长期使用时。红霉素已被证明可降低 COPD 恶化的发生率。肺康复和定期体育锻炼适用于 COPD 的所有严重程度，并改善生活质量。无创通气与生活质量的改善有关。长期氧疗可改善死亡率，但仅在低氧性 COPD 患者中。吸入器装置的选择是 COPD 治疗的关键组成部分，这需要医生比我们意识到的更多关注。以患者为中心的疾病管理计划可改善生活质量并降低住院率。COPD 的大多数结局都可以通过干预来改变，这些干预措施耐受性良好，安全性可接受。
