Barnes N, Calverley P M A, Kaplan A, Rabe K F
GSK Stockley Park, West Uxbridge , Middlesex , United Kingdom.
Curr Med Res Opin. 2014 Apr;30(4):667-84. doi: 10.1185/03007995.2013.867842. Epub 2013 Dec 12.
This real-life, global study aimed to investigate current views of and clinical practice in the management of COPD and its exacerbations, among clinicians from both the primary and secondary care settings.
We devised an online questionnaire about COPD management and invited 13,613 general practitioners (GPs) and respiratory specialists to respond. Participating clinicians, recruited from an established research panel, treated a minimum of 10 (GPs) or 20 (respiratory specialists) patients with COPD per month. Completed responses were collected from 1400 clinicians from 14 countries.
A third of GPs and respiratory specialists reported that the main goal of COPD management was to improve patients' quality of life; only 14% of GPs thought that the prevention of exacerbations was a priority. The study showed a strong preference for inhaled corticosteroids in combination with other treatments, rather than as sole therapy, in line with global guidelines. Fewer GPs than respiratory specialists routinely recommended anticholinergics, pulmonary rehabilitation or oxygen therapy. Clinicians reported that 55% (GPs) and 57% (respiratory specialists) of their COPD patients had experienced an exacerbation in the previous 12 months. Although higher than those reported in clinical trials, these rates were lower than patients' own estimates from a corresponding patient survey, even in mild COPD patients (62%; 80% in severe patients). Despite this, 74% of GPs and 67% of respiratory physicians reported satisfaction with therapies to prevent exacerbations.
This global survey revealed that clinicians' main goal when managing COPD was to improve the lives of their patients, and that few viewed reducing exacerbations as a priority. Despite a relatively high level of adherence to treatment recommendations, it appears that clinicians, particularly GPs, underestimate the frequency and impact of exacerbations. These results suggest a need to raise awareness of exacerbations among both GPs and respiratory specialists.
这项基于现实生活的全球性研究旨在调查基层医疗和二级医疗环境中的临床医生对慢性阻塞性肺疾病（COPD）及其急性加重期管理的当前观点和临床实践。
我们设计了一份关于COPD管理的在线问卷，并邀请了13613名全科医生（GPs）和呼吸科专家进行回复。参与的临床医生来自一个既定的研究小组，每月至少治疗10名（全科医生）或20名（呼吸科专家）COPD患者。从14个国家的1400名临床医生那里收集到了完整的回复。
三分之一的全科医生和呼吸科专家报告称，COPD管理的主要目标是改善患者的生活质量；只有14%的全科医生认为预防急性加重是首要任务。该研究表明，与全球指南一致，临床医生强烈倾向于吸入性糖皮质激素与其他治疗联合使用，而非单独使用。常规推荐使用抗胆碱能药物、肺康复或氧疗的全科医生比呼吸科专家更少。临床医生报告称，他们的COPD患者中有55%（全科医生）和57%（呼吸科专家）在过去12个月中经历过急性加重。尽管这些发生率高于临床试验报告的发生率，但低于相应患者调查中患者自己的估计，即使是轻度COPD患者（62%；重度患者为80%）。尽管如此，74%的全科医生和67%的呼吸科医生报告对预防急性加重的治疗感到满意。
这项全球调查显示，临床医生在管理COPD时的主要目标是改善患者的生活，很少有人将减少急性加重视为首要任务。尽管对治疗建议的依从性相对较高，但临床医生，尤其是全科医生，似乎低估了急性加重的频率和影响。这些结果表明需要提高全科医生和呼吸科专家对急性加重的认识。
