Carlone Stefano, Balbi Bruno, Bezzi Michela, Brunori Marco, Calabro Stefano, Foschino Barbaro Maria Pia, Micheletto Claudio, Privitera Salvatore, Torchio Roberto, Schino Pietro, Vianello Andrea
Pulmonary Department, San Giovanni-Addolorata General Hospital, Rome, Italy.
Pulmonary Rehabilitation Department, IRCCS Fondazione Salvatore Maugeri, Veruno (NO), Italy.
Multidiscip Respir Med. 2014 Dec 6;9(1):63. doi: 10.1186/2049-6958-9-63. eCollection 2014.
This article deals with the prevalence and the possible reasons of COPD underestimation in the population and gives suggestions on how to overcome the obstacles and make the correct diagnosis in order to provide the patients with the appropriate therapy. COPD is diagnosed in later or very advanced stages. In Italy the rate of COPD under-diagnosis ranges between 25 and 50% and, as a consequence, the patient does not consult his doctor until the symptoms have worsened, mainly due to exacerbations. A missed diagnosis influences the timing of therapeutic intervention, thus contributing to the evolution into more severe stages of the illness. An incisive intervention to limit under-diagnosis cannot act only in remittance (passive diagnosis), but must be the promoter for a series of preventive actions: primary, secondary and rehabilitative. To reduce under-diagnosis, some actions need to be taken, such as screening programs for smokers subjects, use of questionnaires aimed to qualify and monitor the disease severity, spirometry, early diagnosis. There is a consensus regarding diagnoses based on screening of at-risk subjects and symptoms, rather than screening of the general population. In practice, all individuals over 40 years of age with risk factors should make a spirometry test. Screening actions on a national scale can be the following: compilation of questionnaires in waiting rooms of doctor's offices or performing simple maneuvers to evaluate the expiratory force at pharmacies. It is now widely recognized that COPD is a complex syndrome with several pulmonary and extrapulmonary components; as a result, the airway obstruction as assessed by FEV1 by itself does not adequately describe the complexity of the disease and FEV1 cannot be used alone for the optimal diagnosis, assessment, and management of the disease. The identification and subsequent grouping of key elements of the COPD syndrome into clinically meaningful and useful subgroups (phenotypes) can guide therapy more effectively. In conclusion, we firmly believe that an early and correct diagnosis can influence positively the progress of the disease (lowering the lung function impairment), decrease the risk of exacerbations, relieve symptoms and increase the patients' quality of life leading also to a decrease in costs associated to the exacerbations and hospitalization of the patient.
本文探讨了慢性阻塞性肺疾病（COPD）在人群中被低估的患病率及可能原因，并就如何克服障碍、做出正确诊断以给患者提供适当治疗提出了建议。COPD往往在疾病晚期或非常严重的阶段才被诊断出来。在意大利，COPD漏诊率在25%至50%之间，因此，患者直到症状加重（主要是由于病情急性加重）才去看医生。漏诊会影响治疗干预的时机，进而促使疾病发展到更严重的阶段。要有效减少漏诊，不能仅靠被动诊断（缓解期诊断），而必须推动一系列预防措施：一级预防、二级预防和康复治疗。为减少漏诊，需要采取一些措施，如对吸烟人群进行筛查、使用旨在评估和监测疾病严重程度的问卷、进行肺功能测定以及早期诊断。对于基于对高危人群和症状进行筛查而非对普通人群进行筛查来诊断COPD已达成共识。实际上，所有40岁以上有危险因素的个体都应进行肺功能测试。全国范围内的筛查措施可以是：在医生办公室候诊室发放问卷，或在药店进行简单操作以评估呼气力量。现在人们普遍认识到，COPD是一种具有多个肺部和肺外成分的复杂综合征；因此，仅通过第一秒用力呼气容积（FEV1）评估的气道阻塞并不能充分描述该疾病的复杂性，FEV1不能单独用于该疾病的最佳诊断、评估和管理。将COPD综合征的关键要素识别并随后分组为具有临床意义和有用的亚组（表型）可以更有效地指导治疗。总之，我们坚信早期正确诊断能对疾病进展产生积极影响（降低肺功能损害），降低急性加重风险，缓解症状，提高患者生活质量，还能降低与患者急性加重和住院相关的费用。
