在初级保健中区分哮喘和慢性阻塞性肺疾病的重要性。
Importance of distinguishing between asthma and chronic obstructive pulmonary disease in primary care.
机构信息
Associate Professor in the Department of Family and Community Medicine at the University of Toronto in Ontario.
Professor at the University of Aberdeen in Scotland, UK, and Managing Director of the Observational and Pragmatic Research Institute in Singapore.
出版信息
Can Fam Physician. 2021 Sep;67(9):661-667. doi: 10.46747/cfp.6709661.
OBJECTIVE
To facilitate distinction between asthma and chronic obstructive pulmonary disease (COPD) in day-to-day primary care practice, and provide practical treatment strategies using spirometric cases to outline how to recognize the clinical and spirometric overlap between asthma and COPD.
SOURCES OF INFORMATION
The approaches described here were developed using evidence-based guidelines and the expertise of the authors, including research findings by the authors in the areas of asthma, COPD management, and spirometric testing in primary care.
MAIN MESSAGE
There are patients with clinical or spirometric features of both asthma and COPD. Both asthma and COPD are associated with some degree of inflammation of the respiratory tract, mediated by the increased expression of inflammatory proteins. However, there are clear differences between asthma and COPD in the pattern of inflammation that occurs in the lungs. Diagnostic confusion between COPD and asthma is most likely to arise in older patients with respiratory complaints, particularly against a background that includes cigarette smoke or workplace exposure. Both asthma and COPD are clinical diagnoses based on patient history, symptoms, physical examination findings, and objective measures of lung function. Postbronchodilator spirometry is always needed to confirm a new diagnosis of COPD and should also be performed prebronchodilator for the diagnosis of asthma. However, in many cases, the interpretation of spirometry results is not straightforward.
CONCLUSION
Understanding the nature and extent of the spirometric overlap between asthma and COPD is critical for tailoring a therapeutic strategy that is based on factors that include medical and family history, signs and symptoms, and a clear interpretation of spirometry data. This information will be leveraged differently for individual patients to arrive at the correct clinical diagnosis and to select the most appropriate therapy.
目的
在日常初级保健实践中促进哮喘和慢性阻塞性肺疾病（COPD）之间的区分，并提供实用的治疗策略，使用肺活量计病例来概述如何识别哮喘和 COPD 之间的临床和肺活量计重叠。
信息来源
此处描述的方法是使用基于证据的指南和作者的专业知识制定的，包括作者在哮喘、COPD 管理和初级保健中肺活量计测试领域的研究结果。
主要信息
有些患者既有哮喘又有 COPD 的临床或肺活量计特征。哮喘和 COPD 都与呼吸道炎症的一定程度有关，这是由炎症蛋白表达增加介导的。然而，在肺部发生的炎症模式方面，哮喘和 COPD 之间存在明显的差异。在有呼吸道症状的老年患者中，特别是在包括吸烟或工作场所暴露的背景下，最有可能出现 COPD 和哮喘之间的诊断混淆。哮喘和 COPD 都是基于患者病史、症状、体格检查结果和肺功能客观测量的临床诊断。新诊断 COPD 时总是需要支气管扩张剂后肺活量计检查，并且也应该在支气管扩张剂前进行，以诊断哮喘。然而，在许多情况下，对肺活量计结果的解释并不简单。
结论
了解哮喘和 COPD 之间肺活量计重叠的性质和程度对于制定基于包括医疗和家族史、体征和症状以及对肺活量计数据的清晰解释等因素的治疗策略至关重要。将根据个别患者的情况灵活运用这些信息，以做出正确的临床诊断并选择最合适的治疗方法。
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