Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España.
Servicio de Medicina Interna, Hospital Universitario Mutua de Tarrasa, Tarrasa, Barcelona, España.
Arch Bronconeumol. 2022 Apr;58(4):334-344. doi: 10.1016/j.arbres.2021.08.002. Epub 2021 Sep 4.
The current health care models described in GesEPOC indicate the best way to make a correct diagnosis, the categorization of patients, the appropriate selection of the therapeutic strategy and the management and prevention of exacerbations. In addition, COPD involves several aspects that are crucial in an integrated approach to the health care of these patients. The evaluation of comorbidities in COPD patients represents a healthcare challenge. As part of a comprehensive assessment, the presence of comorbidities related to the clinical presentation, to some diagnostic technique or to some COPD-related treatments should be studied. Likewise, interventions on healthy lifestyle habits, adherence to complex treatments, developing skills to recognize the signs and symptoms of exacerbation, knowing what to do to prevent them and treat them within the framework of a self-management plan are also necessary. Finally, palliative care is one of the pillars in the comprehensive treatment of the COPD patient, seeking to prevent or treat the symptoms of a disease, the side effects of treatment, and the physical, psychological and social problems of patients and their caregivers. Therefore, the main objective of this palliative care is not to prolong life expectancy, but to improve its quality. This chapter of GesEPOC 2021 presents an update on the most important comorbidities, self-management strategies, and palliative care in COPD, and includes a recommendation on the use of opioids for the treatment of refractory dyspnea in COPD.
GesEPOC 中描述的当前医疗保健模式表明了做出正确诊断、对患者进行分类、适当选择治疗策略以及管理和预防恶化的最佳方法。此外，COPD 涉及几个方面，这些方面在这些患者的医疗保健综合方法中至关重要。COPD 患者共病的评估是医疗保健的一个挑战。作为全面评估的一部分，应研究与临床表型、某些诊断技术或某些与 COPD 相关的治疗方法相关的共病的存在。同样，干预健康的生活方式习惯、坚持复杂的治疗、培养识别恶化迹象和症状的技能、了解如何预防和在自我管理计划框架内治疗这些症状也是必要的。最后，姑息治疗是 COPD 患者综合治疗的支柱之一，旨在预防或治疗疾病症状、治疗副作用以及患者及其照顾者的身体、心理和社会问题。因此，姑息治疗的主要目标不是延长预期寿命，而是提高其质量。GesEPOC 2021 的这一章介绍了 COPD 中最重要的共病、自我管理策略和姑息治疗的最新进展，并就使用阿片类药物治疗 COPD 难治性呼吸困难提出了建议。
