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首页> 美国卫生研究院文献>Multidisciplinary Respiratory Medicine >The clinical and integrated management of COPD. An official document of AIMAR (Interdisciplinary Association for Research in Lung Disease) AIPO (Italian Association of Hospital Pulmonologists) SIMER (Italian Society of Respiratory Medicine) SIMG (Italian Society of General Medicine)
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The clinical and integrated management of COPD. An official document of AIMAR (Interdisciplinary Association for Research in Lung Disease) AIPO (Italian Association of Hospital Pulmonologists) SIMER (Italian Society of Respiratory Medicine) SIMG (Italian Society of General Medicine)

机译：COPD的临床和综合管理。 AIMAR（肺疾病跨学科研究协会）AIPO（意大利医院肺科医师协会）SIMER（意大利呼吸医学学会）SIMG（意大利普通医学学会）的正式文件

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COPD is a chronic pathological condition of the respiratory system characterized by persistent and partially reversible airflow obstruction, to which variably contribute remodeling of bronchi (chronic bronchitis), bronchioles (small airway disease) and lung parenchyma (pulmonary emphysema). COPD can cause important systemic effects and be associated with complications and comorbidities. The diagnosis of COPD is based on the presence of respiratory symptoms and/or a history of exposure to risk factors, and the demonstration of airflow obstruction by spirometry. GARD of WHO has defined COPD "a preventable and treatable disease". The integration among general practitioner, chest physician as well as other specialists, whenever required, assures the best management of the COPD person, when specific targets to be achieved are well defined in a diagnostic and therapeutic route, previously designed and shared with appropriateness. The first-line pharmacologic treatment of COPD is represented by inhaled long-acting bronchodilators. In symptomatic patients, with pre-bronchodilator FEV1 < 60% predicted and ≥ 2 exacerbations/year, ICS may be added to LABA. The use of fixed-dose, single-inhaler combination may improve the adherence to treatment. Long term oxygen therapy (LTOT) is indicated in stable patients, at rest while receiving the best possible treatment, and exhibiting a PaO2 ≤ 55 mmHg (SO2 < 88%) or PaO2 values between 56 and 59 mmHg (SO2 < 89%) associated with pulmonary arterial hypertension, cor pulmonale, or edema of the lower limbs or hematocrit > 55%. Respiratory rehabilitation is addressed to patients with chronic respiratory disease in all stages of severity who report symptoms and limitation of their daily activity. It must be integrated in an individual patient tailored treatment as it improves dyspnea, exercise performance, and quality of life. Acute exacerbation of COPD is a sudden worsening of usual symptoms in a person with COPD, over and beyond normal daily variability that requires treatment modification. The pharmacologic therapy can be applied at home and includes the administration of drugs used during the stable phase by increasing the dose or modifying the route, and adding, whenever required, drugs as antibiotics or systemic corticosteroids. In case of patients who because of COPD severity and/or of exacerbations do not respond promptly to treatment at home hospital admission should be considered. Patients with "severe" or "very severe" COPD who experience exacerbations should be carried out in respiratory unit, based on the severity of acute respiratory failure. An integrated system is required in the community in order to ensure adequate treatments also outside acute care hospital settings and rehabilitation centers. This article is being simultaneously published in Sarcoidosis Vasc Diffuse Lung Dis 2014, 31(Suppl. 1);3-21.
机译：COPD是呼吸系统的慢性病理性疾病，其特征是持续的和部分可逆的气流阻塞，从而对支气管（慢性支气管炎），细支气管（小气道疾病）和肺实质（肺气肿）的重塑产生不同的影响。 COPD可引起重要的全身性影响，并伴有并发症和合并症。 COPD的诊断基于呼吸道症状的存在和/或暴露于危险因素的历史，以及通过肺活量测定法证明气流阻塞。 WHO的GARD将COPD定义为“可预防和可治疗的疾病”。如果需要在诊断和治疗途径中明确定义要实现的特定目标，并且事先设计并适当共享，则在需要时，全科医生，胸部医师以及其他专家之间的整合将确保对COPD人员进行最佳管理。吸入长效支气管扩张剂代表了COPD的一线药物治疗。对于有症状的患者，预计支气管扩张剂前FEV1 <60％，且每年加重次数≥2，可将ICS加到LABA中。使用固定剂量的单吸入器组合可以改善对治疗的依从性。长期氧气疗法（LTOT）适用于稳定的患者，在休息时会接受最佳治疗，并且PaO2≤55mmHg（SO2 <88％）或PaO2值在56至59mmHg之间（SO2 <89％）伴有肺动脉高压，肺心病或下肢浮肿或血细胞比容≥55％。呼吸系统康复适用于所有严重程度的慢性呼吸道疾病患者，这些患者报告其症状和日常活动受限。它必须被整合到针对患者的个性化治疗中，因为它可以改善呼吸困难，运动表现和生活质量。慢性阻塞性肺病的急性加重是慢性阻塞性肺病患者通常症状的突然恶化，超出正常的每日变化范围，需要调整治疗方法。药理疗法可在家中使用，包括通过增加剂量或改变途径，以及在需要时添加抗生素或全身性皮质类固醇药物，来稳定期使用药物。如果患者因COPD严重性和/或病情加重而无法对家庭治疗立即做出反应，则应考虑入院。患有急性加重期的“严重”或“非常严重” COPD患者应根据急性呼吸衰竭的严重程度在呼吸单位进行。社区需要一个集成系统，以确保急诊医院设施和康复中心外也能得到充分的治疗。本文同时发表在《结节病性血管扩散性肺癌》 2014年第31期（增刊1）； 3月21日。

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