早期慢性阻塞性肺疾病的认识概况

摘要/Abstract

摘要： 早期慢性阻塞性肺疾病（慢阻肺）一般是指轻或/和中度慢阻肺。肺功能损伤、持续呼吸道症状、肺气肿征象是诊断和分类早期慢阻肺的重要特征。本文通过文献综述，分析早期慢阻肺医患认知存在的问题：早期慢阻肺患者对自身疾病的认知程度低，临床医生对早期慢阻肺关注不够和认识不足，导致临床上普遍存在早期慢阻肺漏诊、诊断不足和延迟诊断的情况。早期慢阻肺具有症状以呼吸困难为著、体力活动受限和一秒率（FEV1）降低等特点。充分认识早期慢阻肺的内涵及特点，是提高慢阻肺诊治的重要前提。

关键词: 早期慢阻肺, 轻至中度慢阻肺, 认知程度, 诊断不足, 一秒率

Abstract: Early chronic obstructive pulmonary disease (COPD) generally refers to mild or/and moderate COPD. Lung function injury， persistent respiratory symptoms and emphysema are important features in the diagnosis and classification of early COPD. Through literature review， this paper analyzes the existing problems of doctor-patient cognition to early COPD： early COPD patients have low awareness of their own diseases， and clinicians do not pay enough attention to and understand the disease， leading to undiagnosis， delayed diagnosis and underdiagnosis of early COPD in clinic. Early COPD is characterized by dyspnea， limited physical activity， and reduced FEV1. To fully understand the connotation and characteristics of early COPD is an important prerequisite to manage COPD.

Key words: Early-stage COPD, Mild-moderate COPD, Cognition degree, Underdiagnosis, FEV1

. 早期慢性阻塞性肺疾病的认识概况[J]. 中国医药导刊, 2019, 21(9): 543-546.

参考文献

[1] GOLD Executive Committee. Global initiative for chronic obstructive lung disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease 2019 report [EB/OL]. [2019-06-06]. http://www.goldcopd.org.
[2] GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 disease and injuries for 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet,2018,392(10159):1789-1858.
[3] Wang C, Xu J, Yang L, et al. Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health [CPH] study): a national cross-sectional study[J]. Lancet, 2018,39(10131):1706-1717.
[4] Fang L, Gao P, Bao H, et al. Chronic obstructive pulmonary disease in China： a nationwide prevalence study[J]. Lancet Respir Med,2018,6(6):421-430.
[5] Bernd L, Joan BS, Michael S, et al. Determinants of underdiagnosis of COPD in national and international surveys[J]. Chest, 2015,148(4):971–985.
[6] Miravitlles M, Soriano JB, García-Río F, et al. Prevalence of COPD in Spain: impact of undiagnosed COPD on quality of life and daily life activities[J]. Thorax, 2009,64(10):863–868.
[7] Welte T, Vogelmeier C, Papi A. COPD: early diagnosis and treatment to slow disease progression[J]. Int J Clin Pract,2015,69(3):336–349.
[8] Kohansal R, Martinez-Camblor P, Agustí A, et al. The natural history of chronic airflow obstruction revisited: an analysis of the Framingham offspring cohort[J]. Am J Respir Crit Care Med,2009,180(1):3–10.
[9] Maltais F, Dennis N, Chan CK. Rationale for earlier treatment in COPD: a systematic review of published literature in mild-to-moderate COPD[J]. COPD, 2013,10(1):79–103.
[10] 郑劲平.慢性阻塞性肺疾病的早期诊治[J].中华全科医师杂志,2018,17(7):504-507.
[11] Rennard SI,Drummond MB. Early chronic obstructive pulmonary disease： definition, assessment, and prevention[J].Lancet,2015,385(9979):1778-1788.
[12] Welte T, Vogelmeier C, Papi A. COPD: early diagnosis and treatment to slow disease progression[J]. Int J Clin Pract,2015,69(3):336–349.
[13] Leidy NK, Kim K, Bacci ED, et al. Identifying cases of undiagnosed, clinically significant COPD in primary care: qualitative insight from patients in the target population[J]. NPJ Prim Care Respir Med,2015,25(3):15024.
[14] Llordés M, Zurdo E, Jaén Á, et al. Which is the best screening strategy for COPD among smokers in primary care?[J] COPD,2017,14(1):43–51.
[15] Gysels M, Higginson IJ. Access to services for patients with chronic obstructive pulmonary disease: the invisibility of breathlessness[J]. J Pain Symptom Manage,2008,36(5):451–460.
[16] Enocson A, Jolly K, Jordan RE, et al. Case-finding for COPD in primary care: a qualitative study of patients’ perspectives[J]. Int J Chron Obstruct Pulmon Dis,2018,13(5):1623–1632.
[17] 文富强.肺功能检查在中国慢性阻塞性肺疾病患者中的实践：挑战与对策[J].中华结核和呼吸杂志,2017,40(12):891-893.
[18] Agusti A, Calverley PA, Celli B, et al. Characterization of COPD heterogeneity in the ECLIPSE cohort[J]. Respir Res,2010,11(12):122.
[19] Almagro P, Soriano J. Under diagnosis in COPD: a battle worth fighting[J]. Lancet Respir Med,2017,5(5):367–368.
[20] Lu M, Yao WZ, Zhong NS, et al. Asymptomatic patients of chronic obstructive pulmonary disease in China[J]. Chin Med J (Engl),2010,123(12):1494–1499.
[21] Ford ES, Mannino DM, Wheaton AG, et al. Trends in the prevalence of obstructive and restrictive lung function among adults in the United States: findings from the National Health and Nutrition Examination surveys from 1988–1994 to 2007–2010[J]. Chest,2013,143(5):1395–1406.
[22] Csikesz, NG.; Gartman, EJ. New developments in the assessment of COPD: Early diagnosis is key[J]. Int. J. Chronic Obstr. Pulm. Dis,2014,9(1):277–286.
[23] Tinkelman DG, Price D, Nordyke RJ, et al. COPD screening efforts in primary care: what is the yield?[J]. Prim Care Respir J,2007,16(1):41–48.
[24] Troosters T, Sciurba F, Battaglia S et al. Physical inactivity in patients with COPD, a controlled multi-center pilot-study[J]. Respir Med,2010,104(7):1005–1011.
[25] Ofir D, Laveneziana P, Webb KA, et al. Mechanisms of dyspnea during cycle exercise in symptomatic patients with GOLD stage I chronic obstructive pulmonary disease[J]. Am J Resp Crit Care Med,2008,177(6):622–629.
[26] O’Reilly JF, Williams AE, Holt K, et al. Defining COPD exacerbations: impact on estimation of incidence and burden in primary care[J]. Prim Care Respir J,2006,15(12):346–353.
[27] Elbehairy AF, Ciavaglia CE, Webb KA, et al. Pulmonary gas exchange abnormalities in mild chronic obstructive pulmonary disease. Implications for dyspnea and exercise intolerance[J]. Am J Respir Crit Care Med, 2015,191(12):1384–1394.
[28] Jones RC, Price D, Ryan D, et al. Opportunities to diagnose chronic obstructive pulmonary disease in routine care in the UK: a retrospective study of a clinical cohort[J]. Lancet Respir Med,2014,2(4):267–276.
[29] Walters JA, Hansen EC, Walters EH, et al. Under-diagnosis of chronic obstructive pulmonary disease: a qualitative study in primary care[J]. Respir Med,2008,102(5):738–743.
[30] Haroon S, Jordan RE, Fitzmaurice DA, et al. Case finding for COPD in primary care: a qualitative study of the views of health professionals[J]. Int J Chron Obstruct Pulmon Dis,2015,10(8):1711–1718.
[31] Miravitlles M, Worth H, Soler Cataluña JJ, et al. Observational study to characterize 24-hour COPD symptoms and their relationship with patient-reported outcomes: results from the ASSESS study[J]. Respir Res,2014,15(10):122.
[32] Chen C, Jian W, Gao Y, et al. Early COPD patients with lung hyperinflation associated with poorer lung function but better bronchodilator responsiveness[J]. Int J Chron Obstruct Pulmon Dis,2016,11(10):2519–2526.
[33] Mullerova H, Lu C, Li H, et al. Prevalence and burden of breathlessness in patients with chronic obstructive pulmonary disease managed in primary care[J]. PLoS One,2014,9(1): e85540.
[34] Van Remoortel H, Hornikx M, Demeyer H, et al. Daily physical activity in subjects with newly diagnosed COPD[J]. Thorax,2013,68(10):962–923.
[35] Ramón MA, Esquinas C, Barrecheguren M, et al. Self-reported daily walking time in COPD: relationship with relevant clinical and functional characteristics[J]. Int J Chron Obstruct Pulmon Dis,2017,12(4):1173–1181.
[36] Waschki B, Kirsten A, Holz O, et al. Physical activity is the strongest predictor of all-cause mortality in patients with COPD: a prospective cohort study[J]. Chest,2011,140(2):331–342.
[37] Van Remoortel H, Hornikx M, Langer D, et al. Risk factors and comorbidities in the preclinical stages of chronic obstructive pulmonary disease[J]. Am J Respir Crit Care Med,2014,189(1):30–38.
[38] Pitta F, Troosters T, Spruit MA, et al. Characteristics of physical activities in daily life in chronic obstructive pulmonary disease[J]. Am J Respir Crit Care Med,2005,171(9):972–977.
[39] Anzueto A, Miravitlles M. Pathophysiology of dyspnea in COPD[J]. Postgrad Med,2017,129(3):366–374.
[40] Perez T, Burgel PR, Paillasseur JL, et al. Modified Medical Research Council scale vs Baseline Dyspnea Index to evaluate dyspnea in chronic obstructive pulmonary disease [J]. Int J Chron Obstruct Pulmon Dis, 2015,10(8):1663-1672.
[41] Donohue JF, Jones PW, Bartels C, et al. Correlations between FEV1 and patient-reported outcomes: a pooled analysis of 23 clinical trials in patients with chronic obstructive pulmonary disease[J]. Pulm Pharmacol Ther,2018,49(4):11-19.
[42] Rennard SI, Drummond MB. Early chronic obstructive pulmonary disease: definition, assessment, and prevention[J]. Lancet,2015,385(9979):1778–1788.
[43] Burge PS, Calverley PM, Jones PW, et al. Randomized, double blind, placebo-controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial[J]. BMJ, 2000,320(7245):1297–1303.
[44] Bridevaux PO, Gerbase MW, Probst-Hensch NM, et al. Long-term decline in lung function, utilization of care and quality of life in modified GOLD stage 1 COPD[J]. Thorax, 2008,63(9):768–774.
[45] Vestbo J, Edwards LD, Scanlon PD, et al. Changes in forced expiratory volume in 1 second overtime in COPD[J]. N Engl J Med, 2011,365(13):1184–1192.
[46] Jenkins CR, Jones PW, Calverley PM et al. Efficacy of salmeterol/fluticasone propionate by GOLD stage of chronic obstructive pulmonary disease: analysis from the randomized, placebo-controlled TORCH study[J]. Respir Res,2009,10(6):59.
[47] Decramer M, Cooper CB. Treatment of COPD: the sooner the better? [J]. Thorax,2010,65(9):837–841.
[48] Jenkins CR, Jones PW, Calverley PM et al. Efficacy of salmeterol/fluticasone propionate by GOLD stage of chronic obstructive pulmonary disease: analysis from the randomized, placebo-controlled TORCH study[J]. Respir Res,2009,10(6):59.
[49] Ford ES, Mannino DM, Wheaton AG, et al. Trends in the prevalence of obstructive and restrictive lung function among adults in the United States: findings from the National Health and Nutrition Examination surveys from 1988–1994 to 2007–2010[J]. Chest,2013,143(5):1395–1406.
[50] Di Marco F, Balbo P, de Blasio F. et al. Early management of COPD: where are we now and where do we go from here? A Delphi consensus project[J]. Int J Chron Obstruct Pulmon Dis,2019,14(2):353-360.
[51] Fang L, Gao P, Bao H, et al. Chronic obstructive pulmonary disease in China: a nationwide prevalence study[J]. Lancet Res Med,2018,6(6):421-430.
[52] 钟南山.2017年慢性气道疾病防治研究进展[J].华西医学,2018,33(1):1-7.

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