Yawn Barbara P
Research Department, Olmsted Medical Center, Rochester, MN 55904, USA.
South Med J. 2011 Feb;104(2):121-7. doi: 10.1097/SMJ.0b013e3181fa5d05.
Diagnosis of chronic obstructive pulmonary disease (COPD) in primary care is complex, as many clinical symptoms are similar to asthma and heart disease, which may lead to misdiagnosis and suboptimal disease management. Spirometry is the best method for diagnosing COPD and distinguishing between COPD, asthma, and cardiovascular diseases. Airway obstruction is fully reversible in asthma, but not in COPD, and can be confirmed when the postbronchodilator ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) is <0.7. Knowledge of COPD treatment guidelines and a proactive attitude toward disease management by primary care physicians are key to improving symptom control and patients' quality of life. Identification of the appropriate drug/inhaler combination, patient education, training on inhaler use followed by regular monitoring, and pulmonary rehabilitation are also vital to successful COPD management. This review outlines steps to aid physicians in devising and implementing an optimal management plan for COPD patients.
在初级保健中诊断慢性阻塞性肺疾病（COPD）很复杂，因为许多临床症状与哮喘和心脏病相似，这可能导致误诊和疾病管理不佳。肺功能测定是诊断COPD以及区分COPD、哮喘和心血管疾病的最佳方法。哮喘中的气道阻塞是完全可逆的，但COPD中则不然，当支气管扩张剂后一秒用力呼气量（FEV1）与用力肺活量（FVC）的比值<0.7时可得到证实。了解COPD治疗指南以及初级保健医生对疾病管理的积极态度是改善症状控制和患者生活质量的关键。确定合适的药物/吸入器组合、患者教育、吸入器使用培训并定期监测，以及肺康复对于COPD的成功管理也至关重要。本综述概述了帮助医生为COPD患者制定和实施最佳管理计划的步骤。
