University of Texas Health Science Center at San Antonio, Department of Medicine, Pulmonary/Critical Care, South Texas Veterans Health Care System, San Antonio, Texas, USA.
Pneumology Department, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
Am J Med. 2018 Sep;131(9S):15-22. doi: 10.1016/j.amjmed.2018.05.003. Epub 2018 May 17.
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality, with exacerbations contributing strongly to the overall severity and burden of disease at the individual level. Many patients with COPD are managed predominantly in the primary care setting; therefore, primary care physicians (PCPs) must be aware of and understand the causes, effects, and management of COPD exacerbations. This review offers practical information about how exacerbations are defined in the treatment setting, pathogenic and environmental causes, options for exacerbation treatment and prevention, and suggestions for improving care in the clinic. Exacerbations have a strong negative effect on patients and are associated with an increased risk of further exacerbations and decreases in lung function. Thus, it is important that exacerbations not requiring hospitalization be identified and confidently managed in the clinical setting. Understanding treatment options for acute exacerbations and maintenance treatment to prevent future exacerbations may help PCPs better understand what they can do to support their patients. This review aims to provide useful guidance for PCPs to identify exacerbations and adjust their practice for optimal management of exacerbations in patients with COPD. It also aims to encourage PCPs that they have an important task in integrating effective COPD management into the primary care setting.
慢性阻塞性肺疾病(COPD)是发病率和死亡率的主要原因,其加重对个体层面疾病的总体严重程度和负担有很大影响。许多 COPD 患者主要在初级保健环境中接受管理;因此,初级保健医生(PCP)必须了解并理解 COPD 加重的原因、影响和管理。这篇综述提供了有关治疗环境中如何定义加重、发病和环境原因、加重治疗和预防的选择以及改善临床护理的建议等实用信息。加重对患者有强烈的负面影响,并与进一步加重和肺功能下降的风险增加相关。因此,重要的是在临床环境中识别不需要住院的加重并自信地进行管理。了解急性加重的治疗选择和预防未来加重的维持治疗可以帮助 PCP 更好地理解他们可以为支持患者做些什么。本综述旨在为 PCP 提供有用的指导,以识别加重并调整其实践,以实现 COPD 患者加重的最佳管理。它还旨在鼓励 PCP 将有效的 COPD 管理整合到初级保健环境中,这是他们的一项重要任务。