Suarez-Barcelo Manuel, Micca Joseph L, Clackum Sharon, Ferguson Gary T
aMt. Sinai Medical Center, Miami Beach, Florida bPatient Centered Healthcare, Marietta cRx Answers, LLC, Cumming, Georgia dPulmonary Research Institute of Southeast Michigan, Farmington Hills, Michigan, USA.
Curr Opin Pulm Med. 2017 Nov;23 Suppl 1:S1-S28. doi: 10.1097/MCP.0000000000000416.
: Chronic obstructive pulmonary disease (COPD) is a prevalent and disabling disorder in the United States, especially affecting older individuals, women, and those with a history of smoking. Studies show that COPD may be underrepresented, underdiagnosed, and undertreated in elderly patients residing in long-term care (LTC) facilities. The quality of care for LTC residents with COPD is heterogeneous in regard to both the facility and the patient. For LTC facilities, care should be driven by staff education, interstaff communication, and interfacility communication. From the perspective of the LTC patient, choice of medication and device should be based on appropriate diagnosis, comorbidities, ability to perform treatment, and patient preferences. Nebulization is currently underutilized in LTC settings, although it would benefit older patients with low peak inspiratory flow, cognitive impairment, and/or physical impairment, which may preclude them from using other inhalation devices. Authors developed a COPD treatment algorithm that focuses on three primary patient aspects to consider when deciding on respiratory device in patients in LTC facilities: inspiratory flow, hand dexterity and coordination, and cognitive capacity.
慢性阻塞性肺疾病（COPD）在美国是一种常见且致残的疾病，尤其影响老年人、女性以及有吸烟史的人群。研究表明，在长期护理（LTC）机构居住的老年患者中，COPD可能未得到充分体现、诊断不足和治疗不足。对于患有COPD的LTC机构居民而言，护理质量在机构和患者两方面都存在差异。对于LTC机构来说，护理应由员工教育、员工间沟通以及机构间沟通推动。从LTC患者的角度来看，药物和设备的选择应基于适当的诊断、合并症、进行治疗的能力以及患者偏好。雾化目前在LTC环境中的使用不足，尽管它对吸气峰值流量低、有认知障碍和/或身体障碍的老年患者有益，这些障碍可能使他们无法使用其他吸入设备。作者开发了一种COPD治疗算法，该算法侧重于在为LTC机构中的患者决定呼吸设备时要考虑的三个主要患者方面：吸气流量、手部灵活性和协调性以及认知能力。
