Department of Respiratory Medicine, Whittington Hospital, London, UK.
Chron Respir Dis. 2010;7(2):91-7. doi: 10.1177/1479972310364587. Epub 2010 Mar 18.
Chronic obstructive pulmonary disease (COPD) is a common cause of acute medical hospital admission, and the prevalence of undiagnosed COPD in the community is high. The impact of undiagnosed COPD on presentation to secondary care services is not currently known. We therefore set out to characterise patients at first admission with an acute exacerbation of COPD, and to identify potential areas for improvement in earlier diagnosis and further management. A retrospective case review of patients first admitted to a district teaching hospital with an acute exacerbation of COPD over a 1-year period was carried out. Forty-one patients with a first admission with an acute exacerbation of COPD were identified, 14 (34%) of whom had not been previously diagnosed and were diagnosed with COPD as a result of the admission. At presentation, this group of patients had severe disease, with mean (SD) FEV(1) 1.02 (0.32) L, and a respiratory acidosis in eight (20%) patients, even though this was their first admission for an acute exacerbation of COPD. Missed potential opportunities to intervene in community and inpatient management were identified, including earlier diagnosis, pre-hospital corticosteroid therapy, inpatient respiratory team input, provision of smoking cessation advice and consideration of pulmonary rehabilitation. Patients with a first hospital admission with an acute exacerbation of COPD frequently have severe disease at presentation. Despite having severe disease, a diagnosis of COPD had not been made in the community prior to admission in one-third of patients. Future work should be directed at earlier identification of patients who are symptomatic from COPD and ensuring that the interventions of proven benefit in COPD are systematically offered to patients in both primary and secondary care.
慢性阻塞性肺疾病（COPD）是急性住院的常见原因，社区中未确诊 COPD 的患病率很高。目前尚不清楚未确诊 COPD 对二级保健服务就诊的影响。因此，我们着手描述首次因 COPD 急性加重而入院的患者，并确定在早期诊断和进一步管理方面可能需要改进的领域。对 1 年内因 COPD 急性加重首次入院至区教学医院的患者进行了回顾性病例复查。共确定了 41 名首次因 COPD 急性加重而入院的患者，其中 14 名（34%）患者之前未被诊断，因入院而被诊断为 COPD。在就诊时，这群患者的病情严重，平均（标准差）FEV（1）为 1.02（0.32）L，8 名（20%）患者存在呼吸性酸中毒，尽管这是他们首次因 COPD 急性加重而入院。在社区和住院管理中，错过了潜在的干预机会，包括早期诊断、院前皮质类固醇治疗、住院呼吸团队的参与、提供戒烟建议和考虑肺康复。首次因急性加重而住院的 COPD 患者就诊时常常病情严重。尽管有三分之一的患者病情严重，但在社区中，在入院前并未确诊为 COPD。未来的工作应该集中在早期识别有 COPD 症状的患者，并确保在初级和二级保健中为患者系统提供经证实对 COPD 有益的干预措施。
