2020年慢性阻塞性肺疾病全球倡议《COPD诊断、治疗与预防全球策略》指南解读(一)——稳定期药物管理

Interpretation of the 2020 GOLD's Global Strategy for Prevention,Diagnosis and Management of COPD(Ⅰ):Pharmacological Treatment of Stable COPD

目前,慢性阻塞性肺疾病(COPD)是世界第三大死因,仅次于缺血性心脏病和卒中。但面对COPD这个可防、可治的重大公共卫生问题,我国临床诊疗仍有诸多不足,如对患者教育不够、随访缺失、稳定期和/或急性加重期管理不规范等,以上均是患者病情频繁加重和恶化的重要原因。而病情频繁加重和恶化将导致后期治疗效果不佳和治疗难度增大,以及社会经济负担增加等。所以,加快促进COPD诊断、治疗和预防的规范化,提高诊疗精度和效度具有重要的现实意义。本文拟结合我国临床诊疗现状和疾病研究进展,从临床应用角度对2020年慢性阻塞性肺疾病全球倡议(GOLD)《COPD诊断、治疗与预防全球策略》指南(简称:指南)进行全面阐释和分析,内容包括稳定期药物管理、稳定期非药物管理和急性加重期管理。其中指南解读(一)主要涉及稳定期药物管理,内容包括诊断评估、初始治疗和后续治疗。通过对该指南的解读,以期为我国急诊科、呼吸科等临床医师的实践工作提供参考,优化临床疗效。

Chronic obstructive pulmonary disease(COPD)is now the third leading cause of death in the world,after ischemic heart disease and stroke.However,clinical practices in China still have many challenges to address COPD as an important public health issue,such as insufficient patient education,missing follow-up data,non-standardized management of stable COPD and/or acute exacerbations,which may be important causes of frequent aggravation and deterioration of conditions,leading to increased difficulties in treating and higher possibility of poor outcome after late treatment as well as increased social and economic burden of COPD.Therefore,it is of great practical significance to accelerate the standardization of prevention,diagnosis and management of COPD to improve the accuracy and effectiveness of diagnosis and treatment of COPD.To provide a reference for emergency and respiratory clinicians to better treat COPD patients clinically,in view of domestic diagnosis,treatment and studies regarding COPD,we comprehensively interpreted the 2020 GOLD's Global Strategy for Prevention,Diagnosis and Management of COPD in three parts from a clinical perspective:pharmacological and non-pharmacological treatment of stable COPD and management of exacerbations.This paper is the first part of interpretation,mainly including diagnostic evaluation,initial management and follow-up management.