Gold Philip M
Department of Pulmonary and Critical Care Medicine, Loma Linda University, Loma Linda, CA 92354, USA.
Respir Care. 2009 Aug;54(8):1040-9.
Comprehensive management of chronic obstructive pulmonary disease (COPD) includes proper assessment, monitoring of disease, reduction of risk factors, the management of stable COPD, and the prevention and management of exacerbations. The 2007 COPD guidelines from the Global Initiative for Chronic Obstructive Lung Disease address each of these aspects of COPD management in detail and provide evidence-based recommendations for patients and health-care professionals. Reduction of risk factors emphasizes the importance of smoking cessation and control of environmental indoor and outdoor pollutants. The management of COPD must be individualized. Aerosol administration of bronchodilators is the most effective method of reducing the work of breathing and alleviating dyspnea. Glucocorticosteroid therapy is recommended to reduce the frequency of exacerbations and improve health-related quality of life for patients with stage 3 and 4 COPD. Pulmonary rehabilitation proves effective in relieving symptoms, improving quality of life, and increasing patients' physical and emotional participation in activities of daily life. Oxygen therapy is essential for patients with substantial hypoxia. Patients with COPD and respiratory failure may benefit from noninvasive ventilation. Surgery may play a limited role in the management of selected patients with COPD. Since exacerbations influence lung function and clinical decline in patients with COPD and contribute to the cost of caring for this disease, efforts must be directed at prevention and management of exacerbations. In addition to controlled oxygen therapy, antimicrobials, brief courses of systemic corticosteroids and, on occasion, noninvasive or invasive mechanical ventilation may play a role. The role of respiratory therapists in the prevention, diagnosis, and management of stable COPD and exacerbations is absolutely essential if the goals of the 2007 Global Initiative for Chronic Obstructive Lung Disease guidelines are to be attained.
慢性阻塞性肺疾病（COPD）的综合管理包括适当评估、疾病监测、危险因素降低、稳定期COPD的管理以及急性加重的预防和管理。慢性阻塞性肺疾病全球倡议组织（Global Initiative for Chronic Obstructive Lung Disease）2007年发布的COPD指南详细阐述了COPD管理的各个方面，并为患者和医护人员提供了循证建议。危险因素降低强调戒烟以及控制室内外环境污染物的重要性。COPD的管理必须个体化。雾化吸入支气管扩张剂是减轻呼吸功和缓解呼吸困难最有效的方法。对于3期和4期COPD患者，推荐使用糖皮质激素治疗以减少急性加重的频率并改善健康相关生活质量。肺康复被证明在缓解症状、改善生活质量以及增加患者在日常生活活动中的身体和情感参与度方面有效。氧疗对于存在严重低氧血症的患者至关重要。COPD合并呼吸衰竭的患者可能从无创通气中获益。手术在部分COPD患者的管理中可能发挥有限作用。由于急性加重会影响COPD患者的肺功能和临床病情进展，并增加该疾病的护理成本，因此必须致力于急性加重的预防和管理。除了控制性氧疗外，抗菌药物、短期全身性糖皮质激素治疗以及有时无创或有创机械通气也可能发挥作用。如果要实现2007年慢性阻塞性肺疾病全球倡议组织指南的目标，呼吸治疗师在稳定期COPD以及急性加重的预防、诊断和管理中的作用绝对至关重要。
