Identifying Patients with Undiagnosed COPD in Primary Care Settings: Insight from Screening Tools and Epidemiologic Studies.
Identifying Patients with Undiagnosed COPD in Primary Care Settings: Insight from Screening Tools and Epidemiologic Studies.
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在初级保健机构中识别未确诊的慢性阻塞性肺病患者：来自筛查工具和流行病学研究的见解。
DOI：
10.15326/jcopdf.2.2.2014.0152
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Martinez FJ
中科院分区：
文献类型：
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作者：
Han MK;Steenrod AW;Bacci ED;Leidy NK;Mannino DM;Thomashow BM;Barr RG;Make BJ;Bowler RP;Rennard SI;Houfek JF;Yawn BP;Meldrum CA;Walsh JW;Martinez FJ
慢性阻塞性肺疾病（COPD）是发病率和死亡率的主要原因，但研究表明，这种疾病是大大低估。本文献综述旨在总结与COPD病例发现或漏诊病例相关的最常见和最重要的变量，以帮助在初级保健中更有效地检测高危COPD患者。在PubMed和EMBASE中检索描述病例发现和流行病学研究的文章，以检测或表征COPD新发病例。2002年至2014年以英文发表的初级和非初级保健环境的国际研究符合纳入条件。排除了与COPD发生风险因素相关的研究。在确定和审查的33项研究中，21项是病例发现或筛查研究，12项是流行病学研究，包括横断面、纵向和回顾性设计。在研究中和研究之间确定了一系列变量。筛查和流行病学研究的共同变量包括年龄、吸烟状况和呼吸道症状。流行病学研究中的7个重要预测因子未出现在筛查工具中。没有研究针对发现高风险患者，如肺功能降低或急性加重风险的患者。用于识别COPD新病例或区分COPD病例和非病例的变量范围广泛（从社会人口统计学到自我报告的健康或健康史变量），可深入了解病例识别的重要因素。目前正在进行进一步的研究，以开发和测试最好的，最小的变量集，可用作筛选工具，以确定在初级保健中患有未诊断的高风险COPD的人。
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, yet research suggests this disease is greatly underdiagnosed. This literature review sought to summarize the most common and significant variables associated with case-finding or missed cases of COPD to inform more effective and efficient detection of high-risk COPD patients in primary care. PubMed and EMBASE were searched for articles describing case-finding and epidemiologic research to detect or characterize new cases of COPD. International studies in primary and non-primary care settings, published in English from 2002–2014, were eligible for inclusion. Studies related to risk factors for development of COPD were excluded. Of the 33 studies identified and reviewed, 21 were case-finding or screening and 12 were epidemiological, including cross-sectional, longitudinal, and retrospective designs. A range of variables were identified within and across studies. Variables common to both screening and epidemiological studies included age, smoking status, and respiratory symptoms. Seven significant predictors from epidemiologic studies did not appear in screening tools. No studies targeted discovery of higher risk patients such as those with reduced lung function or risks for exacerbations. Variables used to identify new cases of COPD or differentiate COPD cases and non-cases are wide- ranging, (from sociodemographic to self-reported health or health history variables), providing insight into important factors for case identification. Further research is underway to develop and test the best, smallest variable set that can be used as a screening tool to identify people with undiagnosed, high-risk COPD in primary care.