Brusasco Vito, Barisione Giovanni, Crimi Emanuele
Department of Internal Medicine and Medical Specialities (DiMI), Genova University and San Martino University Hospital, Genova, Italy.
Respirology. 2015 Feb;20(2):209-18. doi: 10.1111/resp.12388. Epub 2014 Sep 25.
Chronic obstructive pulmonary disease (COPD) is a term that encompasses different pathological conditions having excessive airflow limitation in common. A wide body of knowledge has been accumulated over the last century explaining the mechanisms by which airway (chronic bronchitis) and parenchymal (emphysema) diseases lead to an indistinguishable spirometric abnormality. Although the definition of emphysema is anatomical, early studies showed that its presence can be inferred with good approximation from measurements of lung mechanics and gas exchange, in addition to simple spirometry. Studies using tests of ventilation distribution showed that abnormalities are present in smokers with normal spirometry, although these tests were not predictive of development of COPD. At the beginning of the third millennium, new documents and guidelines for diagnosis and treatment of COPD were developed, in which the functional diagnosis of COPD was restricted, for the sake of simplicity, to simple spirometry. In recent years, there has been a resurgence of interest in separating bronchitic from emphysematous phenotype of COPD. For this purpose, high-resolution computed tomography scanning has been added to diagnostic work-up. At the same time, methods for lung function testing have been refined and seem promising for detection of early small airways abnormalities. Among them are the forced oscillation technique and the nitrogen phase III slope analysis of the multiple-breath washout test, which may provide information on ventilation inhomogeneity. Moreover, the combined assessment of diffusing capacity for nitric oxide and carbon monoxide may be more sensitive than the latter alone for partitioning diffusive components at parenchymal level.
慢性阻塞性肺疾病（COPD）是一个涵盖多种具有共同气流受限病理状况的术语。在过去的一个世纪里，人们积累了大量知识，解释了气道疾病（慢性支气管炎）和实质疾病（肺气肿）导致难以区分的肺量计异常的机制。尽管肺气肿的定义是解剖学上的，但早期研究表明，除了简单的肺量计检查外，通过肺力学和气体交换测量也可以较好地推断其存在。使用通气分布测试的研究表明，肺量计正常的吸烟者也存在异常，尽管这些测试并不能预测慢性阻塞性肺疾病的发展。在第三个千年伊始，制定了慢性阻塞性肺疾病诊断和治疗的新文件及指南，为简化起见，其中将慢性阻塞性肺疾病的功能诊断仅限于简单的肺量计检查。近年来，人们重新燃起了将慢性阻塞性肺疾病的支气管炎型和肺气肿型进行区分的兴趣。为此，高分辨率计算机断层扫描已被纳入诊断检查流程。与此同时，肺功能测试方法得到了改进，似乎有望检测出早期小气道异常。其中包括强迫振荡技术和多次呼吸洗脱试验的氮Ⅲ期斜率分析，它们可能提供通气不均匀性的信息。此外，一氧化氮和一氧化碳弥散能力的联合评估在区分实质水平的弥散成分方面可能比单独评估一氧化碳弥散能力更敏感。
