在初级医疗中处理慢性阻塞性肺病恶化。

Q4 Medicine
Anna Moore, Hannah Hylton, Alex Long, Irem Patel
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引用次数: 0

摘要

慢性阻塞性肺病(COPD)是一种常见的肺部疾病,但诊断不足,常常得不到适当的治疗。它对最贫困社区的影响最大,因为那里的健康不平等现象最为严重。对于正在吸烟或已戒烟(或有其他风险因素)的人,新出现的呼吸困难、咳嗽、咳痰和喘息等急性症状应引起临床怀疑是否患有潜在的慢性阻塞性肺病,并在痊愈后转诊进行有质量保证的肺活量测定。基层医疗机构对慢性阻塞性肺病加重的处理包括:轻度患者使用短效支气管扩张剂,中度/重度患者使用抗生素和短期口服泼尼松龙。居家住院计划既安全又有效,对于一些在社区病情加重的患者,应考虑采用该计划;远程监控("虚拟病房")越来越多地为这些计划提供支持。新出现或恶化的缺氧是入院治疗的指征,因此血氧饱和度监测是病情恶化管理的重要组成部分;临床医生应了解有关使用脉搏血氧仪的患者安全警报。病情加重会导致健康状况恶化和肺功能下降,因此在计划复查时询问病情加重频率并采取行动减少病情加重是慢性阻塞性肺病长期护理的重要组成部分。病情加重是确保良好护理的基本要素得到解决的机会。应通过支持性自我管理计划,帮助患者了解病情加重并采取相应措施;及时治疗是有益的,但同时也应谨慎使用抗生素和皮质类固醇。不推荐使用重复处方的慢性阻塞性肺病抢救包。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Managing COPD exacerbations in primary care.

Chronic obstructive pulmonary disease (COPD) is a common but underdiagnosed lung condition that is frequently managed inappropriately. It impacts poorest communities most, where health inequalities are greatest. New acute symptoms of breathlessness, cough, sputum production and wheeze should prompt clinical suspicion of underlying COPD in someone who is a current or ex-smoker (or has exposure to other risk factors) and be followed by referral for quality-assured spirometry once recovered. Management of COPD exacerbations in primary care includes use of short-acting bronchodilators if mild, and antibiotics and a short course of oral prednisolone if moderate/severe. Hospital at home schemes are safe and effective and should be considered for some patients exacerbating in the community; these are increasingly supported by remote monitoring ('virtual wards'). New or worsening hypoxia is an indication for hospital admission and therefore oxygen saturation monitoring is an important part of exacerbation management; clinicians should be aware of patient safety alerts around use of pulse oximeters. Exacerbations drive poor health status and lung function decline and therefore asking about exacerbation frequency at planned reviews and taking action to reduce these is an important part of long-term COPD care. An exacerbation is an opportunity to ensure that fundamentals of good care are addressed. Patients should be supported to understand and act on exacerbations through a supported self-management plan; prompt treatment is beneficial but should be balanced by careful antibiotic and corticosteroid stewardship. COPD rescue packs on repeat prescription are not recommended.

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来源期刊
Drug and Therapeutics Bulletin
Drug and Therapeutics Bulletin Medicine-Pharmacology (medical)
CiteScore
0.80
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0.00%
发文量
69
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