Prevalence and underdiagnosis of chronic obstructive pulmonary disease among patients at risk in primary care
Prevalence and underdiagnosis of chronic obstructive pulmonary disease among patients at risk in primary care
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DOI：
10.1503/cmaj.091784
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发表时间：
2010-04-20
影响因子：
14.6
通讯作者：
Stanbrook, Matthew B.
中科院分区：
文献类型：
--
作者：
Hill, Kylie;Goldstein, Roger S.;Stanbrook, Matthew B.
背景：具有已知慢性阻塞性肺疾病（COPD）危险因素的人是筛查和早期干预的重要目标。我们试图测量这些因任何原因就诊于初级保健医生的人中慢性阻塞性肺病的患病率。我们还评估了之前诊断或未诊断 COPD 的准确性，并确定了相关的临床特征。方法：我们从三个初级保健机构招募了 40 岁或以上且有至少 20 包年吸烟史的患者。参与者被询问了呼吸道症状并接受了支气管扩张剂后肺量测定。 COPD 的定义为呼气第一秒用力呼气量与用力肺活量 (FEV1/FVC) 之比低于 0.7，且 FEV1 低于预测值的 80%。 结果：在符合研究标准的 1459 名患者中，1003 名 (68.7%) 完成了肺活量测定测试。其中，208 人被发现患有 COPD，患病率为 20.7%（95% 置信区间 18.3%-23.4%）。在 205 名慢性阻塞性肺病参与者中，他们在肺活量测定前完成了有关呼吸道症状的访谈，其中只有 67 名 (32.7%) 在研究前知道自己的诊断结果。与研究前正确诊断慢性阻塞性肺病的患者相比，慢性阻塞性肺病被过度诊断或未诊断的患者在年龄、性别、当前吸烟状况以及因呼吸问题就诊初级保健医生的次数方面相似。解释：在就诊初级保健医生的成年患者中，多达五分之一的已知危险因素符合慢性阻塞性肺病的肺量测定标准。慢性阻塞性肺病的诊断不足的情况很常见，这表明需要对高危人群进行更广泛的筛查。了解慢性阻塞性肺病的患病率将有助于规划疾病管理策略。
Background: People with known risk factors for chronic obstructive pulmonary disease (COPD) are important targets for screening and early intervention. We sought to measure the prevalence of COPD among such individuals visiting a primary care practitioner for any reason. We also evaluated the accuracy of prior diagnosis or nondiagnosis of COPD and identified associated clinical characteristics.Methods: We recruited patients from three primary care sites who were 40 years or older and had a smoking history of at least 20 pack-years. Participants were asked about respiratory symptoms and underwent postbronchodilator spirometry. COPD was defined as a ratio of forced expiratory volume in the first second of expiration to forced vital capacity (FEV1/FVC) of less than 0.7 and an FEV1 of less than 80% predicted.Results: Of the 1459 patients who met the study criteria, 1003 (68.7%) completed spirometry testing. Of these, 208 were found to have COPD, for a prevalence of 20.7% (95% confidence interval 18.3%-23.4%). Of the 205 participants with COPD who completed the interview about respiratory symptoms before spirometry, only 67 (32.7%) were aware of their diagnosis before the study. Compared with patients in whom COPD had been correctly diagnosed before the study, those in whom COPD had been over-diagnosed or undiagnosed were similar in terms of age, sex, current smoking status and number of visits to a primary care practitioner be cause of a respiratory problem.Interpretation: Among adult patients visiting a primary care practitioner, as many as one in five with known risk factors met spirometric criteria for COPD. Underdiagnosis of COPD was frequent, which suggests a need for greater screening of at-risk individuals. Knowledge of the prevalence of COPD will help plan strategies for disease management.