Acute Geriatric Care Unit, Internal Medicine Department, University Hospital Mútua de Terrassa, Barcelona, Spain.
Int J Chron Obstruct Pulmon Dis. 2013;8:335-45. doi: 10.2147/COPD.S34211. Epub 2013 Jul 24.
Chronic obstructive pulmonary disease (COPD) is one of the most prevalent and debilitating diseases in adults worldwide and is associated with a deleterious effect on the quality of life of affected patients. Although it remains one of the leading causes of global mortality, the prognosis seems to have improved in recent years. Even so, the number of patients with COPD and multiple comorbidities has risen, hindering their management and highlighting the need for futures changes in the model of care. Together with standard medical treatment and therapy adherence--essential to optimizing disease control--several nonpharmacological therapies have proven useful in the management of these patients, improving their health-related quality of life (HRQoL) regardless of lung function parameters. Among these are improved diagnosis and treatment of comorbidities, prevention of COPD exacerbations, and greater attention to physical disability related to hospitalization. Pulmonary rehabilitation reduces symptoms, optimizes functional status, improves activity and daily function, and restores the highest level of independent physical function in these patients, thereby improving HRQoL even more than pharmacological treatment. Greater physical activity is significantly correlated with improvement of dyspnea, HRQoL, and mobility, along with a decrease in the loss of lung function. Nutritional support in malnourished COPD patients improves exercise capacity, while smoking cessation slows disease progression and increases HRQoL. Other treatments such as psychological and behavioral therapies have proven useful in the treatment of depression and anxiety, both of which are frequent in these patients. More recently, telehealthcare has been associated with improved quality of life and a reduction in exacerbations in some patients. A more multidisciplinary approach and individualization of interventions will be essential in the near future.
慢性阻塞性肺疾病（COPD）是全球成年人中最常见和最具致残性的疾病之一，会对受影响患者的生活质量产生有害影响。尽管它仍然是全球死亡的主要原因之一，但近年来预后似乎有所改善。即便如此，患有 COPD 和多种合并症的患者人数有所增加，这阻碍了对他们的管理，并凸显了未来需要改变护理模式。除了标准的医疗治疗和治疗依从性（对于优化疾病控制至关重要）之外，几种非药物治疗方法已被证明对这些患者的管理有用，可以改善他们的健康相关生活质量（HRQoL），而与肺功能参数无关。其中包括改善合并症的诊断和治疗、预防 COPD 加重，以及更加关注与住院相关的身体残疾。肺康复可减轻症状、优化功能状态、改善活动和日常功能，并使这些患者恢复最高水平的独立身体功能，从而进一步提高 HRQoL，甚至超过药物治疗。更大的身体活动与呼吸困难、HRQoL 和移动性的改善以及肺功能丧失的减少显著相关。对于营养不良的 COPD 患者，营养支持可改善运动能力，而戒烟可减缓疾病进展并提高 HRQoL。其他治疗方法，如心理和行为疗法，已被证明对治疗抑郁和焦虑有用，这些患者经常患有这些疾病。最近，远程医疗在某些患者中与生活质量的提高和恶化的减少有关。在不久的将来，多学科方法和干预措施的个体化将至关重要。
