Phillips Y Y, Hnatiuk O W
Pulmonary and Critical Care Medicine Service, Walter Reed Army Medical Center, Washington, DC, USA.
Respir Care Clin N Am. 1998 Sep;4(3):371-89.
COPD is an extremely common, chronic disorder characterized by a reduction in airflow after the administration of an inhaled bronchodilator as measured by the FEV1. The diagnosis is suspected in patients with a history of several decades of cigarette smoking who present with nonspecific respiratory symptoms. The diagnosis is established by simple forced expiratory spirometry. Baseline evaluation usually includes a chest radiograph and some assessment of functional capacity, either by history or with some form of exercise testing. In patients whose initial FEV1 is more severely reduced or who have significant dyspnea, an arterial blood gas is indicated at baseline. Dyspnea, hypoxemia, or hypercarbia that is out of proportion to the measured FEV1, at either presentation or follow-up, should prompt a thorough evaluation for complicating conditions. There are important roles in health care delivery and chronic disease management strategies for RCPs, primary care providers, and specialty trained pulmonary physicians. The need for repeated, extensive, or expensive testing will be largely driven by patients symptoms but disease monitoring with periodic assessments of dyspnea, functional capacity, and spirometry can be performed without great expense.
慢性阻塞性肺疾病（COPD）是一种极为常见的慢性疾病，其特征是吸入支气管扩张剂后，通过第一秒用力呼气量（FEV1）测量的气流减少。对于有几十年吸烟史且出现非特异性呼吸道症状的患者，应怀疑患有此病。通过简单的用力呼气肺活量测定即可确诊。基线评估通常包括胸部X光检查以及通过病史或某种形式的运动测试对功能能力进行的一些评估。对于初始FEV1严重降低或有明显呼吸困难的患者，基线时需进行动脉血气分析。在就诊或随访时，若呼吸困难、低氧血症或高碳酸血症与测得的FEV1不成比例，应促使对并发情况进行全面评估。呼吸治疗师（RCP）、初级保健提供者以及经过专科培训的肺科医生在医疗服务提供和慢性病管理策略中发挥着重要作用。重复、广泛或昂贵检测的需求在很大程度上取决于患者症状，但通过定期评估呼吸困难、功能能力和肺活量测定来进行疾病监测，成本并不高。
