慢性阻塞性肺疾病的病例发现：优化靶向方法的模型。
Case finding for chronic obstructive pulmonary disease: a model for optimising a targeted approach.
机构信息
Unit of Public Health, Epidemiology & Biostatistics, Public Health Building, University of Birmingham, Edgbaston, Birmingham, UK.
出版信息
Thorax. 2010 Jun;65(6):492-8. doi: 10.1136/thx.2009.129395.
OBJECTIVES
Case finding is proposed as an important component of the forthcoming English National Clinical Strategy for chronic obstructive pulmonary disease (COPD) because of accepted widespread underdiagnosis worldwide. However the best method of identification is not known. The extent of undiagnosed clinically significant COPD in England is described and the effectiveness of an active compared with an opportunistic approach to case finding is evaluated.
METHODS
A cross-sectional analysis was carried out using using Health Survey for England (HSE) 1995-1996 data supplemented with published literature. A model comparing an active approach (mailed questionnaires plus opportunistic identification) with an opportunistic-only approach of case finding among ever smokers aged 40-79 years was evaluated. There were 20 496 participants aged >or=30 years with valid lung function measurements. The main outcome measure was undiagnosed clinically significant COPD (any respiratory symptom with both forced expiratory volume in 1 s (FEV(1))/forced vital capacity (FVC) <0.7 and FEV(1) <80% predicted).
RESULTS
971 (4.7%) had clinically significant COPD, of whom 840 (86.5%) did not report a previous diagnosis. Undiagnosed cases were more likely to be female, and smoked less. 25.3% had severe disease (FEV(1) <50% predicted), 38.5% Medical Research Council (MRC) grade 3 dyspnoea and 44.1% were current smokers. The active case-finding strategy can potentially identify 70% more new cases than opportunistic identification alone (3.8 vs 2.2 per 100 targeted). Treating these new cases could reduce hospitalisations by at least 3300 per year in England and deaths by 2885 over 3 years.
CONCLUSIONS
There is important undiagnosed clinically significant COPD in the population, and the addition of a systematic case-finding approach may be more effective in identifying these cases. The cost-effectiveness of this approach needs to be tested empirically in a prospective study.
目的
由于全球范围内广泛存在被认可的 COPD（慢性阻塞性肺疾病）诊断不足的情况，病例发现被提议作为即将出台的英国国家 COPD 临床策略的一个重要组成部分。然而，最佳的识别方法尚不清楚。本文描述了在英格兰未被诊断的具有临床意义的 COPD 的程度，并评估了主动与机会性病例发现方法相比，哪种方法更有效。
方法
利用 1995-1996 年英格兰健康调查（HSE）的数据，结合已发表的文献进行了一项横断面分析。评估了一种模型，该模型将一种主动方法（邮寄问卷加机会性识别）与仅采用机会性方法在年龄 40-79 岁的既往吸烟者中发现病例进行了比较。共有 20496 名年龄≥30 岁且肺功能测量值有效的参与者。主要结局指标为未被诊断的具有临床意义的 COPD（任何呼吸症状，同时存在 1 秒用力呼气量（FEV1）/用力肺活量（FVC）<0.7 和 FEV1<80%预计值）。
结果
971 例（4.7%）患有具有临床意义的 COPD，其中 840 例（86.5%）没有报告先前的诊断。未被诊断的病例更可能为女性，且吸烟量较少。25.3%的患者患有严重疾病（FEV1<50%预计值），38.5%的患者呼吸困难程度为 MRC 3 级，44.1%的患者为当前吸烟者。主动病例发现策略可以比仅采用机会性识别方法多发现 70%的新病例（每 100 个目标人群中发现 3.8 例 vs 2.2 例）。在英格兰，每年至少可以减少 3300 例住院治疗，3 年内死亡人数可以减少 2885 例。
结论
人群中存在大量未被诊断的具有临床意义的 COPD，添加系统的病例发现方法可能更有利于识别这些病例。这种方法的成本效益需要在一项前瞻性研究中进行实证检验。
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