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[慢性阻塞性肺疾病]

[Chronic Obstructive Pulmonary Disease].

作者信息

García Castillo Elena, Vargas Gianna, García Guerra José Alfonso, López-Giraldo Alejandra, Alonso Pérez Tamara

机构信息

Servicio de Neumología, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria La Princesa, Universidad Autónoma de Madrid (UAM), Madrid, España. Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España.

Servicio de Neumología, Hospital Universitario Clínico San Carlos, Madrid, España.

出版信息

Open Respir Arch. 2022 Mar 2;4(2):100171. doi: 10.1016/j.opresp.2022.100171. eCollection 2022 Apr-Jun.

Abstract

Chronic Obstructive Pulmonary Disease (COPD) is related to smoking as the main etiological agent although there are other risk factors that can interact influencing the development of the disease. The definition of COPD is based on three points: the presence of persistent respiratory symptoms, exposure to risk agents, and a non-reversible obstructive spirometric ratio. Forced spirometry with a bronchodilator test is necessary to confirm the diagnosis of COPD, however, attempts are being made to develop alternative methods for screening given the current significant underdiagnosis of this pathology.In order to advance in a more personalized medicine for the patient, classification tools have been adopted such as clinical phenotypes and treatable traits, allowing treatments to be adapted according to the characteristics of the patients. Non-pharmacological treatment (smoking cessation, vaccination, physical exercise...) are essential for the management of the disease, as well as pharmacological treatment based on clinical phenotypes. Eosinophils have become a key marker when establishing treatment with inhaled glucocorticoids.In the follow-up of the disease, it is very relevant to evaluate the degree of control being a fundamental element the absence of exacerbations given their implications in mortality, morbidity and quality of life of patients. More studies are needed to better define the phenotypes of exacerbations and their biomarkers.

摘要

慢性阻塞性肺疾病(COPD)与吸烟作为主要病因相关,尽管还有其他风险因素可相互作用影响该疾病的发展。COPD的定义基于三点:持续性呼吸道症状的存在、暴露于风险因素以及不可逆的阻塞性肺量计比值。使用支气管扩张剂试验进行用力肺活量测定对于确诊COPD是必要的,然而,鉴于目前该疾病存在严重的诊断不足情况,人们正在尝试开发替代筛查方法。为了推进针对患者的更个性化医疗,已采用了临床表型和可治疗特征等分类工具,使治疗能够根据患者的特征进行调整。非药物治疗(戒烟、疫苗接种、体育锻炼等)对于疾病管理至关重要,基于临床表型的药物治疗也是如此。在确定吸入糖皮质激素治疗方案时,嗜酸性粒细胞已成为关键标志物。在疾病随访中,评估控制程度非常重要,鉴于其对患者死亡率、发病率和生活质量的影响,无急性加重是一个基本要素。需要更多研究来更好地定义急性加重的表型及其生物标志物。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/68af/10369568/47d3df4eb0e8/gr1.jpg

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