Chuang Chan
HealthCare Partners Medical Group, Torrance, CA 90502, USA.
Hosp Pract (1995). 2012 Feb;40(1):176-85. doi: 10.3810/hp.2012.02.958.
Hospitalists play an important role in treating current and preventing future acute exacerbations of chronic obstructive pulmonary disease (AECOPD), which are associated with high rates of medical resource use and morbidity. Comprehensive admission screening and diagnostic tests are important in enabling hospitalists to reliably identify patients with AECOPD, the severity of the episode, and related issues that may prolong patients' hospital length of stay. Recurring exacerbations, especially those that require repeated acute care, can reduce physical activity and accelerate pulmonary decline and risk of death. Recommended pharmacotherapies for AECOPD should include short-acting bronchodilators, systemic corticosteroids, and appropriate antibiotics in cases of suspected bacterial infection. Patients with demonstrable hypoxemia or respiratory failure may benefit from oxygen and/or ventilatory support. Long-term disease management with the goal of preventing future exacerbations should include ongoing emphasis toward smoking cessation and up-to-date vaccination, in addition to prescribing maintenance pharmacotherapies in accordance with respiratory treatment guidelines. Additional benefits may be derived from nonpharmacologic therapies, such as pulmonary rehabilitation, weight-loss recommendations, and treatment of obstructive sleep dyspnea when present. Effective communication among members of the inpatient and outpatient health care teams, the patient, and his or her caregivers is an important aspect of care transitions. Hospital discharge summaries should be transmitted to the patient's primary care physician and be readily available at the first follow-up visit. Discharge coaches and other allied health care providers can aid hospitalists in reinforcing self-management skills and patient education, and in emphasizing the importance of follow-up visits. Recent findings suggest that health and cost benefits are associated with improved COPD management. This article focuses on the pivotal role of the hospitalist in promoting and facilitating the steps toward improving quality outcomes and transitions of care for patients with COPD.
住院医师在治疗慢性阻塞性肺疾病（AECOPD）的当前发作和预防未来急性加重方面发挥着重要作用，AECOPD与高医疗资源使用率和发病率相关。全面的入院筛查和诊断测试对于住院医师可靠地识别AECOPD患者、发作的严重程度以及可能延长患者住院时间的相关问题至关重要。反复发作，尤其是那些需要反复接受急性治疗的发作，会减少体力活动并加速肺功能衰退和死亡风险。AECOPD的推荐药物治疗应包括短效支气管扩张剂、全身性皮质类固醇，以及在怀疑有细菌感染时使用适当的抗生素。有明显低氧血症或呼吸衰竭的患者可能受益于吸氧和/或通气支持。以预防未来加重为目标的长期疾病管理除了根据呼吸治疗指南开具维持药物治疗外，还应持续强调戒烟和最新的疫苗接种。非药物治疗，如肺康复、减肥建议以及存在阻塞性睡眠呼吸暂停时的治疗，可能会带来额外益处。住院和门诊医疗团队成员、患者及其护理人员之间的有效沟通是护理过渡的一个重要方面。医院出院小结应发送给患者的初级保健医生，并在首次随访时 readily available 。出院指导人员和其他相关医疗服务提供者可以帮助住院医师加强自我管理技能和患者教育，并强调随访的重要性。最近的研究结果表明，改善慢性阻塞性肺疾病管理与健康和成本效益相关。本文重点关注住院医师在促进和推动改善慢性阻塞性肺疾病患者的质量结果和护理过渡步骤方面的关键作用。 （注：“readily available”此处翻译存疑，原英文表述不太准确，推测可能是“随时可用”之类意思，需结合更准确英文内容进一步确认准确译法。）
