Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland; Clinic of Respiratory Medicine and Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Lancet. 2022 Sep 17;400(10356):921-972. doi: 10.1016/S0140-6736(22)01273-9. Epub 2022 Sep 5.
Despite substantial progress in reducing the global impact of many non-communicable diseases, including heart disease and cancer, morbidity and mortality due to chronic respiratory disease continues to increase. This increase is driven primarily by the growing burden of chronic obstructive pulmonary disease (COPD), and has occurred despite the identification of cigarette smoking as the major risk factor for the disease more than 50 years ago. Many factors have contributed to what must now be considered a public health emergency: failure to limit the sale and consumption of tobacco products, unchecked exposure to environmental pollutants across the life course, and the ageing of the global population (partly as a result of improved outcomes for other conditions). Additionally, despite the heterogeneity of COPD, diagnostic approaches have not changed in decades and rely almost exclusively on post-bronchodilator spirometry, which is insensitive for early pathological changes, underused, often misinterpreted, and not predictive of symptoms. Furthermore, guidelines recommend only simplistic disease classification strategies, resulting in the same therapeutic approach for patients with widely differing conditions that are almost certainly driven by variable pathophysiological mechanisms. And, compared with other diseases with similar or less morbidity and mortality, the investment of financial and intellectual resources from both the public and private sector to advance understanding of COPD, reduce exposure to known risks, and develop new therapeutics has been woefully inadequate.
尽管在降低许多非传染性疾病（包括心脏病和癌症）的全球影响方面取得了重大进展，但慢性呼吸道疾病的发病率和死亡率仍在继续上升。这种增长主要是由于慢性阻塞性肺疾病（COPD）负担的增加所致，尽管 50 多年前就已经确定吸烟是该病的主要危险因素。许多因素导致现在必须将其视为公共卫生紧急情况：未能限制烟草产品的销售和消费、在整个生命周期中不受控制地暴露于环境污染物，以及全球人口老龄化（部分原因是其他疾病的治疗效果有所改善）。此外，尽管 COPD 具有异质性，但诊断方法几十年来并未发生变化，几乎完全依赖于支气管扩张剂后肺量测定，该方法对早期病理变化不敏感、使用不足、经常被误解，并且不能预测症状。此外，指南仅推荐简单的疾病分类策略，导致具有广泛不同条件的患者采用相同的治疗方法，而这些条件几乎肯定是由不同的病理生理机制驱动的。而且，与其他发病率和死亡率相似或更低的疾病相比，公共和私营部门在推进对 COPD 的认识、减少已知风险暴露以及开发新疗法方面投入的财务和智力资源严重不足。
