Agrawal Ritwick, Moghtader Shahram, Ayyala Uma, Bandi Venkata, Sharafkhaneh Amir
Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Section of Pulmonary, Critical Care, and Sleep Medicine, Medical Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA.
J Thorac Dis. 2019 Sep;11(Suppl 14):S1800-S1809. doi: 10.21037/jtd.2019.06.12.
Chronic obstructive pulmonary disease (COPD) is a major chronic debilitating condition with significant impact on quality of life, symptoms, comorbidity, health care utilization and longevity. The main pathophysiological hallmark of COPD is expiratory flow limitation which impairs the ability of respiratory system to adequately and properly ventilate. To be able to prognosticate and manage patients with COPD, various societies have developed classifications of disease severity. Current classification schemes combine three elements that include lung function, patient reported symptoms (shortness of breath) and frequency of exacerbations. Global Initiative for Obstructive Lung Disease (GOLD), an international guideline for diagnosis and management of COPD, started using this approach since the 2011 revision. Management according to this scheme has been developed and is in use. Comprehensive COPD management is multifaceted. It includes pharmacologic management, patient education, smoking cessation, influenza and pneumococcal vaccinations, depression and anxiety management, pulmonary rehabilitation, and if indicated, home oxygen therapy. The following chapter will review management recommendations currently in use for stable COPD. We intend to make the chapter to the point and practical and avoid an exhaustive review of the literature.
慢性阻塞性肺疾病(COPD)是一种主要的慢性衰弱性疾病,对生活质量、症状、合并症、医疗保健利用和寿命有重大影响。COPD的主要病理生理特征是呼气气流受限,这损害了呼吸系统充分且正常通气的能力。为了能够对COPD患者进行预后评估和管理,各个学会制定了疾病严重程度分类。当前的分类方案结合了三个要素,包括肺功能、患者报告的症状(呼吸急促)和急性加重的频率。慢性阻塞性肺疾病全球倡议(GOLD)是COPD诊断和管理的国际指南,自2011年修订以来开始采用这种方法。根据该方案的管理方法已经制定并在使用。全面的COPD管理是多方面的。它包括药物管理、患者教育、戒烟、流感和肺炎球菌疫苗接种、抑郁和焦虑管理、肺康复,以及在有指征时进行家庭氧疗。以下章节将回顾目前用于稳定期COPD的管理建议。我们打算使本章切中要点且实用,避免对文献进行详尽的综述。