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背景若患者存在慢性阻塞性肺疾病(COPD)危险因素,便成为筛查和早期干预的重点目标。我们目的是测量因某原因而就诊于初级保健医生的个体,调查COPD的患病率,评价COPD做出诊断和未做诊断正确度,识别相关临床特性。方法将3个初级保健设施的患者纳入研究,年龄≥40岁,有吸烟史。询问参试者是否有呼吸系统症状,观察其接受支气管扩张剂后的肺活量。若1秒钟用力呼气量与最大肺活量比值(FEV1/FVC)<0.7,且FEV1<80%预计值可定义为COPD。结果 符合研究标准的1 459例患者中,有1 003例(68.7%)做了肺活量检测,其中208例有COPD,患病率为20.7%[95%CI(18.3%,23.4%)]。COPD参试者中,有205例在测量肺活量前进行过呼吸系统症状面谈,仅有67例(32.7%)患者在本研究前对其诊断有所意识。与研究前能够做出COPD正确诊断的患者比较,那些过度诊断和未能诊断COPD者的年龄、性别、当时吸烟情况以及因呼吸系统问题看初级保健医生的次数相似。结论看初级保健医生的成人患者中,1/5有已知危险因素,符合做COPD肺活量测量标准。COPD诊断不足频繁发生,因而有必要对高危个体加大筛查力度。有关COPD流行性的知识有助于制定疾病管理策略方案。
Background If patients have a risk factor for chronic obstructive pulmonary disease (COPD), they become the focus of screening and early intervention. Our aim is to measure individuals who have been referred to primary care physicians for some reason to investigate the prevalence of COPD and to evaluate the diagnostic and undiagnostic correctness of COPD and the identification of relevant clinical features. Methods Three primary care facilities were enrolled in the study, aged> 40 years, with a history of smoking. Ask the participants if they have any respiratory symptoms and observe their vital capacity after receiving bronchodilators. If the ratio of forced expiratory volume to maximal vital capacity (FEV1 / FVC) <0.7 for one second and <80% of predicted FEV1 may be defined as COPD. Results Of the 1 459 patients who met the criteria, 1 003 (68.7%) had spirometric tests, of which 208 had COPD with a prevalence of 20.7% [95% CI (18.3%, 23.4%)]. Of the 205 COPD participants, respiratory symptoms were interviewed before measuring their vital capacity, and only 67 (32.7%) were aware of their diagnosis prior to the study. Those who overdiagnosed and failed to diagnose COPD were similar in age, sex, prevailing smoking status, and number of primary care physicians due to respiratory problems, compared with those who were able to make the correct diagnosis of COPD before study. Conclusion One in five adults with primary care physicians has known risk factors and is consistent with the COPD spirometry standard. The diagnosis of COPD is not frequent, so it is necessary to increase the screening of individuals at high risk. Knowledge about the epidemiology of COPD can help develop a strategic approach to disease management.