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[慢性阻塞性肺疾病老年患者的非药物干预措施特点。戒烟、肺康复、营养管理及患者教育]

[Characteristics of non-pharmacological interventions in the elderly with COPD. Smoking cessation, pulmonary rehabilitation, nutritional management and patient education].

作者信息

Guilleminault L, Rolland Y, Didier A

机构信息

Airway center, Larrey hospital, CHU de Toulouse, 31059 Toulouse, France; STROMALab, université de Toulouse, CNRS ERL 5311, EFS, INP-ENVT, Inserm, UPS, 31100 Toulouse, France.

Gerontopole, CHU de Toulouse, 31059 Toulouse, France; UMR Inserm 1027, université de Toulouse III, 31000 Toulouse, France.

出版信息

Rev Mal Respir. 2018 Jun;35(6):626-641. doi: 10.1016/j.rmr.2017.12.004. Epub 2018 Jun 22.

Abstract

Chronic obstructive pulmonary disease (COPD) is a respiratory disorder responsible for a high mortality and disability. People older than 65 years are more commonly affected than younger people and tend to present with more symptoms and a greater level of disability. Non-pharmacological interventions play an important role in the management of all patients with COPD and this is particularly true in the elderly. Given the improvement in quality of life and risk of hospitalization, smoking cessation should be promoted to patients of all ages. Increased physical activity is associated with reduced respiratory symptoms. Tests such as the "Short Physical Performance Battery" can be useful in frailer older people with COPD, while walking tests such as the 6-minute walk test are used as an assessment before pulmonary rehabilitation. Increased physical activity should be combined with nutritional management. Screening for undernutrition by questionnaire, body mass index and albumin quantification is recommended in the elderly. In case of undernutrition, oral supplementation seems to reduce the risk of re-admission. All these measures must be included in an education program adapted to the elderly comorbidities (hearing loss, isolation…).

摘要

慢性阻塞性肺疾病(COPD)是一种导致高死亡率和残疾率的呼吸系统疾病。65岁以上的人群比年轻人更易患病,且往往症状更多、残疾程度更高。非药物干预在所有COPD患者的管理中都起着重要作用,这在老年人中尤为如此。考虑到生活质量的改善和住院风险,应向所有年龄段的患者推广戒烟。增加体力活动与呼吸道症状减轻相关。诸如“简短体能测试组合”等测试对身体较为虚弱的老年COPD患者可能有用,而诸如6分钟步行测试等步行测试则用于肺康复前的评估。增加体力活动应与营养管理相结合。建议通过问卷调查、体重指数和白蛋白定量对老年人进行营养不良筛查。如存在营养不良,口服补充剂似乎可降低再次入院的风险。所有这些措施都必须纳入一个适应老年人合并症(听力丧失、孤独感等)的教育项目中。

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