Polverino Francesca, Bhutani Mohit, Zabert Gustavo, Fernandes Frederico Leon Arrabal, Czischke Karen, Pereira Ferreira Luiz Fernando, Szabo Lian, Wisnivesky Juan P, Dalcolmo Margareth Pretti, Celedón Juan C
Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas.
Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Ann Am Thorac Soc. 2024 Nov;21(11):1463-1470. doi: 10.1513/AnnalsATS.202404-386FR.
Chronic obstructive pulmonary disease (COPD) is a major public health problem in the Americas (a region of the world comprising North, Central, and South America), although there is substantial variation in disease prevalence, morbidity, and mortality between and within nations. Across the Americas, COPD disproportionately affects vulnerable populations, including minoritized populations and impoverished persons, who are more likely to be exposed to risk factors such as tobacco use, air pollution, infections such as tuberculosis, and biomass smoke, but less likely to have adequate healthcare access. Management of COPD can be challenging across the Americas, with some barriers being specific to certain countries and others shared across the United States, Canada, and Latin America. Because most cases of COPD are undiagnosed because of suboptimal access to health care and pulmonary function testing and, thus, cannot be treated, increased access to spirometry would have a substantial impact on disease management across the Americas. For individuals who are diagnosed, access to medications and other interventions is quite variable across and within nations, even in those with universal healthcare systems, such as Canada and Brazil. This emphasizes the importance of collaborative treatment guidelines, which should be adapted for the healthcare systems and policies of each nation or region, as appropriate. To have a positive impact on COPD management in the Americas, we propose actionable items, including the need for all our respiratory societies to engage key stakeholders (e.g., patient-led organizations, professional societies, and governmental and nongovernmental agencies) while advocating for campaigns and policies to ensure clean air for all; eliminate tobacco use and enhance coverage for treatment of nicotine dependence; and improve access to early case finding, diagnosis, and treatment for all patients, including underserved and vulnerable populations.
慢性阻塞性肺疾病（COPD）是美洲地区（一个包括北美洲、中美洲和南美洲的世界区域）的一个主要公共卫生问题，尽管各国之间以及国家内部在疾病患病率、发病率和死亡率方面存在很大差异。在整个美洲地区，COPD对弱势群体的影响尤为严重，包括少数族裔群体和贫困人口，他们更有可能接触到诸如烟草使用、空气污染、结核病等感染以及生物质烟雾等风险因素，但获得充分医疗服务的可能性较小。在整个美洲地区，COPD的管理可能具有挑战性，一些障碍是特定于某些国家的，而其他一些障碍则是美国、加拿大和拉丁美洲共有的。由于大多数COPD病例因获得医疗服务和肺功能测试的机会不佳而未被诊断出来，因此无法得到治疗，增加肺活量测定的可及性将对整个美洲地区的疾病管理产生重大影响。对于已被诊断的个体，在各国之间以及国家内部，获得药物和其他干预措施的情况差异很大，即使在拥有全民医疗保健系统的国家，如加拿大和巴西也是如此。这强调了协作治疗指南的重要性，应根据每个国家或地区的医疗保健系统和政策进行适当调整。为了对美洲地区的COPD管理产生积极影响，我们提出了可采取行动的项目，包括我们所有的呼吸协会需要与关键利益相关者（如患者主导的组织、专业协会以及政府和非政府机构）合作，同时倡导开展运动和制定政策以确保所有人都能呼吸清洁空气；消除烟草使用并加强尼古丁依赖治疗的覆盖范围；以及改善所有患者，包括服务不足和弱势群体获得早期病例发现、诊断和治疗的机会。
