University of Queensland, Brisbane, QLD
COPD National Program, Lung Foundation Australia, Brisbane, QLD.
Med J Aust. 2017 Nov 20;207(10):436-442. doi: 10.5694/mja17.00686.
Chronic obstructive pulmonary disease (COPD) is characterised by persistent respiratory symptoms and chronic airflow limitation, and is associated with exacerbations and comorbidities. Advances in the management of COPD are updated quarterly in the national COPD guidelines, the COPD-X plan, published by Lung Foundation Australia in conjunction with the Thoracic Society of Australia and New Zealand and available at http://copdx.org.au. Main recommendations: Spirometry detects persistent airflow limitation (post-bronchodilator FEV1/FVC < 0.7) and must be used to confirm the diagnosis.Non-pharmacological and pharmacological therapies should be considered as they optimise function (ie, improve symptoms and quality of life) and prevent deterioration (ie, prevent exacerbations and reduce decline).Pulmonary rehabilitation and regular exercise are highly beneficial and should be provided to all symptomatic COPD patients.Short- and long-acting inhaled bronchodilators and, in more severe disease, anti-inflammatory agents (inhaled corticosteroids) should be considered in a stepwise approach.Given the wide range of inhaler devices available, inhaler technique and adherence should be checked regularly.Smoking cessation is essential, and influenza and pneumococcal vaccinations reduce the risk of exacerbations.A plan of care should be developed with the multidisciplinary team. COPD action plans reduce hospitalisations and are recommended as part of COPD self-management.Exacerbations should be managed promptly with bronchodilators, corticosteroids and antibiotics as appropriate to prevent hospital admission and delay COPD progression.Comorbidities of COPD require identification and appropriate management.Supportive, palliative and end-of-life care are beneficial for patients with advanced disease.Education of patients, carers and clinicians, and a strong partnership between primary and tertiary care, facilitate evidence-based management of COPD. Changes in management as result of the guideline: Spirometry remains the gold standard for diagnosing airflow obstruction and COPD. Non-pharmacological and pharmacological treatment should be used in a stepwise fashion to control symptoms and reduce exacerbation risk.
慢性阻塞性肺疾病（COPD）的特征是持续性呼吸道症状和慢性气流受限，并与加重和合并症相关。澳大利亚肺部基金会与澳大利亚和新西兰胸科协会联合发布的国家 COPD 指南“COPD-X 计划”每季度更新一次，可在 http://copdx.org.au 上获取。主要推荐意见：肺量计检测持续性气流受限（支气管扩张剂后 FEV1/FVC<0.7），并应用于确诊。非药物和药物治疗均应考虑，因为它们可优化功能（即改善症状和生活质量）并预防恶化（即预防加重和减少下降）。肺康复和定期运动非常有益，应提供给所有有症状的 COPD 患者。短效和长效吸入支气管扩张剂，以及在更严重的疾病中，应考虑采用抗炎药物（吸入皮质激素）的逐步治疗方法。鉴于可获得各种吸入器设备，应定期检查吸入器技术和顺应性。戒烟至关重要，流感和肺炎球菌疫苗可降低加重风险。应与多学科团队一起制定护理计划。COPD 行动计划可降低住院率，建议作为 COPD 自我管理的一部分。应根据需要及时用支气管扩张剂、皮质激素和抗生素治疗加重，以预防住院和延缓 COPD 进展。COPD 的合并症需要识别和适当管理。支持性、姑息性和临终关怀对晚期疾病患者有益。患者、照顾者和临床医生的教育，以及初级和三级保健之间的牢固伙伴关系，有助于 COPD 的循证管理。管理指南的变化：肺量计仍然是诊断气流阻塞和 COPD 的金标准。应采用非药物和药物治疗的逐步方法来控制症状和降低加重风险。
