Weiss Gertraud, Steinacher Ina, Lamprecht Bernd, Schirnhofer Lea, Kaiser Bernhard, Sönnichsen Andreas, Studnicka Michael
University Clinic of Pneumology, Salzburg, Austria.
Respiration. 2014;87(2):136-43. doi: 10.1159/000354796. Epub 2013 Nov 28.
Chronic obstructive pulmonary disease (COPD) is a major public health burden and profoundly affects individuals suffering from the disease. However, the majority of subjects with COPD are still undiagnosed.
To evaluate COPD prevalence and detection strategies for COPD in the primary-care setting.
The study was conducted in a random sample of general practitioner (GP) offices in Salzburg (Austria). A questionnaire and post-bronchodilator (PBD) spirometry was administered to patients aged ≥ 40 years. Nonreversible airway obstruction was considered when PBD FEV1/FVC was <0.70. Severity of spirometrically defined COPD was graded according to the GOLD recommendations.
60 GP offices were randomly selected for study participation, however only 30 (50.0%) were willing to participate. 1,230 of 9,820 (12.52%) patients consented to the protocol. Quality of PBD spirometry was evaluated, and 882 (71.7%) met ATS/ERS quality criteria. 7.5% (95% CI: 5.7-9.4%) of the patients had COPD grade II+ (FEV1/FVC <0.7 and FEV1 <80% of predicted), but only 22.4% of them reported a prior physician's diagnosis of COPD. Similar results were seen for the 2005 Salzburg BOLD (Burden of Obstructive Lung Disease) sample with regard to COPD GOLD II+ prevalence (10.7%) and proportion of underdiagnosis (82.3%).
COPD in the primary-care setting is as prevalent and underdiagnosed as reported recently for the BOLD study. The surprisingly low participation rate of GPs and patients indicates that prevention of COPD is not a health priority, and that awareness for COPD has to heightened before case-finding strategies will be successful.
慢性阻塞性肺疾病（COPD）是一项重大的公共卫生负担，对患该疾病的个体产生深远影响。然而，大多数慢性阻塞性肺疾病患者仍未被诊断出来。
评估初级保健机构中慢性阻塞性肺疾病的患病率及检测策略。
该研究在奥地利萨尔茨堡的普通全科医生（GP）诊所随机抽取样本进行。对年龄≥40岁的患者进行问卷调查及支气管扩张剂后（PBD）肺功能测定。当PBD FEV1/FVC<0.70时，考虑存在不可逆性气道阻塞。根据全球慢性阻塞性肺疾病倡议（GOLD）的建议，对通过肺功能测定定义的慢性阻塞性肺疾病严重程度进行分级。
随机选择了60家全科医生诊所参与研究，但只有30家（50.0%）愿意参与。9820名患者中有1230名（12.52%）同意参与该方案。对PBD肺功能测定的质量进行了评估，882名（71.7%）符合美国胸科学会/欧洲呼吸学会的质量标准。7.5%（95%CI：5.7 - 9.4%）的患者患有Ⅱ级及以上慢性阻塞性肺疾病（FEV1/FVC<0.7且FEV1<预测值的80%），但其中只有22.4%的患者报告之前有医生诊断过慢性阻塞性肺疾病。2005年萨尔茨堡慢性阻塞性肺疾病负担（BOLD）样本在慢性阻塞性肺疾病GOLDⅡ级及以上患病率（10.7%）和未诊断比例（82.3%）方面也有类似结果。
初级保健机构中的慢性阻塞性肺疾病与最近BOLD研究报告的患病率及未诊断情况一样。全科医生和患者的参与率低得出奇，这表明慢性阻塞性肺疾病的预防并非卫生工作的重点，在病例发现策略取得成功之前，必须提高对慢性阻塞性肺疾病的认识。
