Respiratory and Sleep Medicine, Austin Hospital, Melbourne, Victoria, Australia.
Intern Med J. 2013 Aug;43(8):854-62. doi: 10.1111/imj.12219.
Chronic obstructive pulmonary disease (COPD) is characterised by progressive airflow limitation in the presence of identifiable risk factors. Inflammation is the central pathological feature in the pathogenesis of COPD. In addition to its pulmonary effects, COPD is associated with significant extrapulmonary manifestations, including ischaemic heart disease, osteoporosis, stroke and diabetes. Anxiety and depression are also common. Spirometry remains the gold standard diagnostic tool. Pharmacologic and non-pharmacologic therapy can improve symptoms, quality of life and exercise capacity and, through their effects on reducing exacerbations, have the potential to modify disease progression. Bronchodilators are the mainstay of pharmacotherapy, with guidelines recommending a stepwise escalating approach. Smoking cessation is paramount in managing COPD, with promotion of physical activity and pulmonary rehabilitation being other key factors in management. Comorbidities should be actively sought and managed in their own right. Given the chronicity and progressive nature of COPD, ongoing monitoring and support with timely discussion of advanced-care planning and end-of-life issues are recommended.
慢性阻塞性肺疾病（COPD）的特征是在存在可识别的危险因素的情况下出现进行性气流受限。炎症是 COPD 发病机制中的核心病理特征。除了肺部影响外，COPD 还与显著的肺外表现有关，包括缺血性心脏病、骨质疏松症、中风和糖尿病。焦虑和抑郁也很常见。肺量测定仍然是金标准诊断工具。药物和非药物治疗可以改善症状、生活质量和运动能力，并且通过减少恶化的作用，有可能改变疾病的进展。支气管扩张剂是药物治疗的主要方法，指南建议采用逐步升级的方法。戒烟对于 COPD 的管理至关重要，促进体育活动和肺康复是管理的其他关键因素。应积极寻找并单独管理合并症。鉴于 COPD 的慢性和进行性性质，建议进行持续监测，并及时讨论高级护理计划和临终问题。
