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基层医疗视角下的慢性阻塞性肺疾病管理。

Primary care perspective on chronic obstructive pulmonary disease management.

机构信息

National Jewish Health, Denver, CO 80206, USA.

出版信息

Postgrad Med. 2011 Mar;123(2):145-52. doi: 10.3810/pgm.2011.03.2272.

Abstract

Chronic obstructive pulmonary disease (COPD), which affects > 24 million adults in the United States, is expected to become the third leading cause of mortality by 2030. Because primary care physicians (PCPs) form the frontline in treating patients with COPD, it is vital for them to comprehend the key issues associated with COPD management. The initial step is identifying the "right patient" by making a correct diagnosis, which should involve a targeted respiratory history, physical examination, and spirometry. Following diagnosis, the patient should be treated for the "right reason," with the "right therapy." The right reasons for treating patients diagnosed with COPD include symptom relief, prevention of exacerbations and disease progression, and reduction of mortality. Treatment of patients with COPD through smoking cessation and appropriate medications can help achieve these goals. A range of therapies, such as bronchodilators (β2-agonists and anticholinergics) and inhaled corticosteroids are available for disease management. Tailoring treatment plans, which include both pharmacological and nonpharmacological therapies, to suit each patient's needs will enable PCPs to provide patients with optimal disease control and treat "the right patient for the right reason with the right therapy."

摘要

慢性阻塞性肺疾病(COPD)影响了美国超过 2400 万成年人,预计到 2030 年将成为第三大主要死因。由于初级保健医生(PCP)是治疗 COPD 患者的第一线人员,因此他们必须了解与 COPD 管理相关的关键问题。第一步是通过做出正确的诊断来确定“合适的患者”,这应包括有针对性的呼吸病史、体格检查和肺量测定。诊断后,应根据“正确的原因”对患者进行“正确的治疗”。治疗诊断为 COPD 的患者的正确原因包括缓解症状、预防恶化和疾病进展以及降低死亡率。通过戒烟和适当的药物治疗可以帮助患有 COPD 的患者实现这些目标。有多种治疗方法,如支气管扩张剂(β2-激动剂和抗胆碱能药)和吸入性皮质类固醇,可用于疾病管理。根据每个患者的需求制定治疗计划,包括药物和非药物治疗,将使 PCP 能够为患者提供最佳的疾病控制,并对“合适的患者进行合适的治疗”。

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