Fox M J, Snider G L
JAMA. 1979 Mar 2;241(9):937-40. doi: 10.1001/jama.241.9.937.
The role of respiratory therapy in treating ambulatory patients with chronic obstructive pulmonary disease is becoming more clearly defined. Oxygen therapy on a continuous basis is needed for patients with arterial PO2 values below 45 mm Hg and should be considered for patients with arterial PO2 values between 45 and 55 mm Hg who have chronic cor pulmonale, erythrocytosis with hematocrit value greater than 55%, and disturbances of cognition and sleep. Concentrated bronchodilator and corticosteroid aerosols have established roles in therapy; the place of bland aerosols is less clear They may increase ease of expectoration and should be given by simple compressed-air nebulizer systems; their administration by brief periods of intermittent positive-pressure breathing is rarely justified. Three-positional, postural drainage with chest percussion and vibration may be helpful in mobilizing secretions in patients with severe disease.
呼吸治疗在慢性阻塞性肺疾病门诊患者治疗中的作用正变得愈发明确。动脉血氧分压（PO2）值低于45 mmHg的患者需要持续吸氧治疗，对于动脉血氧分压值在45至55 mmHg之间，伴有慢性肺源性心脏病、血细胞比容值大于55%的红细胞增多症以及认知和睡眠障碍的患者，也应考虑吸氧治疗。浓缩支气管扩张剂和皮质类固醇气雾剂在治疗中已确立了作用；温和气雾剂的作用尚不明确。它们可能会增加咳痰的顺畅度，应以简单的压缩空气雾化器系统给药；通过短暂的间歇正压呼吸给药很少有正当理由。对重症患者进行三体位、体位引流并辅以胸部叩击和振动可能有助于促进分泌物排出。
