《慢性阻塞性肺疾病全球创议(2024版)》解读:对肺功能的关键描述

Interpretation of the Global Initiative for Chronic Obstructive Lung Disease(2024 report):key descriptions of lung function

慢性阻塞性肺疾病全球创议(GOLD)是在国际上影响力较大的慢阻肺诊治和管理指导文件,其每年都对包括病因和机制、诊断、治疗、慢病管理等众多内容,根据最新的研究证据及对临床实践有较大参考或指导价值的研究成果予以更新和推荐。本文重点关注和解读对慢阻肺的诊断、评估气流阻塞严重程度,以及治疗和预后评估发挥重要作用的肺功能检查在GOLD 2024中的主要更新或强调的内容,如一秒率正常的肺功能受损的定义、患病率、高危因素、发展趋势及其与慢阻肺的关系,推荐的肺功能预计方程,补充强调重视静态和动态过度充气;在筛查慢阻肺中支气管舒张试验的应用时机;肺功能在肺康复治疗、评估、随访中的应用等。以上更新对肺量计检查指导慢阻肺的临床诊疗具有重要的意义。在解读中对部分问题也提出作者观点供读者参考。

The Global Initiative for Chronic Obstructive Lung Disease(GOLD)is the internationally recognized guideline for the diagnosis,treatment,and management of Chronic Obstructive Pulmonary Disease(COPD).It is updated annually with recommendations based on the latest research findings and clinical practices related to various aspects of COPD including etiology,diagnosis,treatment,and management.The 2024 edition has just been released.This article focuses on and interprets the key updates or emphases related to pulmonary function testing in the diagnosis,assessment of airflow limitation severity,treatment,and prognosis evaluation of COPD in GOLD 2024.These include:the definition,prevalence,risk factors,trends and relationship with COPD of preserved ratio impaired spirometry:recommended reference equations in pulmonary function testing;supplementary emphasis on the importance of static and dynamic hyperinflation;application timing of bronchodilator responsiveness testing in COPD screening;and the application of pulmonary function in the treatment,assessment,and follow-up of pulmonary rehabilitation.The above updates are of great significance in guiding clinical diagnosis and management of COPD with pulmonary function testing.Additionally,the perspectives on select issues were provided as reference for readers.