Joo Min J, Au David H, Lee Todd A
Department of Medicine, University of Illinois, Chicago, IL, USA.
Transl Res. 2009 Sep;154(3):103-10. doi: 10.1016/j.trsl.2009.06.003. Epub 2009 Jul 8.
Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation that is not fully reversible. In a patient presenting with respiratory symptoms and risk factors, the recommendation is to perform spirometry to determine the presence of airflow obstruction. However, only about a third of patients with a diagnosis of COPD have spirometry along with their diagnosis, although studies have shown that history and physical examination alone are neither sensitive nor specific for diagnosing COPD. Thus, in current practice, many health care providers continue to diagnose and manage COPD without an accurate diagnosis and assessment of severity based on spirometry. This can contribute to inconsistent care and outcomes, as evidenced by findings of variation in spirometry use and acute exacerbation rates of COPD across geographic regions. As there is increasing evidence that pharmacotherapy for COPD has associated risks, including poor cardiovascular outcomes and pneumonia, it is pertinent to obtain an accurate diagnosis to determine appropriate risk-benefit ratios. Previous studies have shown that spirometry has an impact on COPD management; however, there seem to be barriers to the use of spirometry at the patient, provider, and health system level. Innovative quality improvement approaches, such as the application of the various components of the Chronic Care Model, could improve spirometry use in COPD. Only with accurate diagnosis can appropriate management and evidence-based treatment strategies be applied in practice. Therefore, it is important that we continue efforts to increase the use of spirometry in the diagnosis of COPD.
慢性阻塞性肺疾病（COPD）的特征是气流受限且不完全可逆。对于出现呼吸道症状和风险因素的患者，建议进行肺功能测定以确定是否存在气流阻塞。然而，尽管研究表明仅靠病史和体格检查对诊断COPD既不敏感也不特异，但在诊断为COPD的患者中，只有约三分之一的患者在诊断时进行了肺功能测定。因此，在当前的医疗实践中，许多医疗服务提供者在没有基于肺功能测定进行准确诊断和严重程度评估的情况下，继续对COPD进行诊断和管理。这可能导致治疗的不一致以及不同的治疗结果，不同地理区域肺功能测定的使用差异和COPD急性加重率的研究结果证明了这一点。由于越来越多的证据表明COPD药物治疗存在相关风险，包括不良心血管结局和肺炎，因此进行准确诊断以确定合适的风险效益比至关重要。先前的研究表明肺功能测定对COPD管理有影响；然而，在患者、医疗服务提供者和卫生系统层面，肺功能测定的使用似乎存在障碍。创新的质量改进方法，如应用慢性病护理模式的各个组成部分，可以提高COPD患者肺功能测定的使用率。只有进行准确诊断，才能在实践中应用适当的管理和循证治疗策略。因此，我们继续努力增加肺功能测定在COPD诊断中的使用非常重要。
