Karel Daphne J
Medical University of South Carolina Montgomery Center for Family Medicine, 155 Academy Ave, Greenwood, SC 29646.
FP Essent. 2016 Sep;448:20-8.
Chronic obstructive pulmonary disease (COPD) is defined as persistent airflow limitation due to irritant-induced chronic inflammation. A postbronchodilator forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) ratio of 0.7 or less is diagnostic in a patient with dyspnea, chronic cough or sputum production, and a history of irritant exposure. Tobacco smoking is the most significant etiology, and smoking cessation is the only intervention shown to slow disease progression. Long-acting beta2-agonists and long-acting muscarinic antagonists are first-line treatments for patients with persistently symptomatic COPD with an FEV1 of 80% or less of predicted. When COPD is uncontrolled with a long-acting bronchodilator, combination therapy with a long-acting muscarinic antagonist-long-acting beta2-agonist or long-acting beta2-agonist-inhaled corticosteroid should be prescribed. Patients with COPD and reduced exercise tolerance should undergo pulmonary rehabilitation and be evaluated for supplemental oxygen therapy. Other treatment options for persistently symptomatic COPD include inhaler triple therapy (ie, long-acting muscarinic antagonist, long-acting beta2-agonist, inhaled corticosteroid), phosphodiesterase type 4 inhibitors, oxygen, and surgical interventions.
慢性阻塞性肺疾病（COPD）定义为因刺激性物质诱导的慢性炎症导致的持续性气流受限。对于有呼吸困难、慢性咳嗽或咳痰，以及有刺激性物质暴露史的患者，支气管扩张剂使用后1秒用力呼气容积与用力肺活量（FEV1/FVC）比值小于或等于0.7可作为诊断标准。吸烟是最重要的病因，戒烟是唯一被证明能减缓疾病进展的干预措施。长效β2受体激动剂和长效毒蕈碱拮抗剂是FEV1低于预测值80%的持续有症状COPD患者的一线治疗药物。当使用长效支气管扩张剂无法控制COPD时，应开具长效毒蕈碱拮抗剂-长效β2受体激动剂或长效β2受体激动剂-吸入性糖皮质激素的联合治疗方案。COPD且运动耐力下降的患者应接受肺康复治疗，并评估是否需要补充氧气治疗。持续有症状的COPD的其他治疗选择包括吸入三联疗法（即长效毒蕈碱拮抗剂、长效β2受体激动剂、吸入性糖皮质激素）、磷酸二酯酶4抑制剂、氧气和手术干预。
