Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO.
Department of Family and Comunity Health, University of Minnesota, Minneapolis, MN.
Chest. 2018 Oct;154(4):980-981. doi: 10.1016/j.chest.2018.08.1023.
As seen in this CME online activity (available at http://copdcme.elsevierresource.com/, COPD is characterized by pulmonary airflow obstruction that is not completely reversible. COPD presents clinically with diverse phenotypes ranging from relatively asymptomatic people to patients with severe chronic cough, abnormal sputum production, and dyspnea with exertion. Exacerbations accelerate the downward cycle of breathing difficulties, activity avoidance, and physical decline that characterizes progressive COPD. Consequently, patients with COPD should be repeatedly assessed for symptom severity and duration, previous exacerbations, the degree of airflow limitation, and confounding comorbidities. Spirometry should be used to clarify COPD prognoses and longitudinally classify the disease from mild to very severe. Conversely, spirometry does not always capture the wide-ranging effects of COPD on patient function and quality of life, and other clinical assessment tools and evaluation strategies should be used to longitudinally monitor patients. Although COPD cannot currently be cured, all disease stages can be treated to slow progression, minimize symptoms, prevent exacerbations, and maximize function and quality of life. Importantly, all patients should participate in comprehensive pulmonary rehabilitation regardless of disease stage. Patients and providers, however, can be unaware of potential benefits or reluctant to initiate this modality. In many practice settings, finding a pulmonary rehabilitation program to accept the patient can be difficult, highlighting the need for well-defined referral pathways. Almost all patients with COPD also require pharmacotherapy to control symptoms, reduce complications, and maximize lung function. Evidence-based education that addresses individualized maintenance regimens are needed to improve long-term outcomes in COPD. Within this CME/CE Snapshot educational series, an expert pulmonologist and a primary care educator discuss how to best longitudinally evaluate patients with COPD and incorporate the principles of pulmonary rehabilitation to maximize patient function and quality of life. They explain therapeutic tailoring over the course of disease and describe the importance of engaging patients in shared decision-making to promote acceptance of the diagnosis, appropriate physical activity, and treatment adherence.
在这个 CME 在线活动中（可在 http://copdcme.elsevierresource.com/ 上获取），COPD 的特征是肺部气流阻塞，这种阻塞不是完全可逆的。COPD 在临床上表现为多种表型，从相对无症状的人群到严重慢性咳嗽、异常痰液产生以及用力时呼吸困难的患者。加重会加速呼吸困难、活动回避和身体衰退的恶性循环，这些是 COPD 进展的特征。因此，应反复评估 COPD 患者的症状严重程度和持续时间、以前的加重、气流受限程度以及合并症。肺量计应用于阐明 COPD 的预后，并从轻度到非常严重的程度对疾病进行纵向分类。相反，肺量计并不总是能捕捉到 COPD 对患者功能和生活质量的广泛影响，应使用其他临床评估工具和评估策略对患者进行纵向监测。虽然 COPD 目前无法治愈，但所有疾病阶段都可以进行治疗，以减缓疾病进展、减轻症状、预防加重，并最大限度地提高功能和生活质量。重要的是，无论疾病阶段如何，所有患者都应参与全面的肺康复。然而，患者和提供者可能不知道潜在的益处，或者不愿意开始这种治疗方式。在许多实践环境中，找到一个可以接受患者的肺康复计划可能很困难，这突出了需要明确界定的转诊途径。几乎所有 COPD 患者还需要药物治疗来控制症状、减少并发症并最大限度地提高肺功能。需要有循证教育，以解决个体化维持方案，以改善 COPD 的长期结果。在这个 CME/CE 快照教育系列中，一位专家肺病学家和一位初级保健教育者讨论了如何最好地对 COPD 患者进行纵向评估，并将肺康复原则纳入其中，以最大限度地提高患者的功能和生活质量。他们解释了疾病过程中的治疗调整，并描述了让患者参与共同决策的重要性，以促进对诊断的接受、适当的身体活动和治疗依从性。
