2024年GOLD慢性阻塞性肺疾病诊断、治疗、管理及预防全球策略更新要点解读

doi:10.12114/j.issn.1007-9572.2023.0867

摘要/Abstract

摘要： 慢性阻塞性肺疾病全球倡议（GOLD）2024年修订版于2023-11-13发布，总体来说其对于慢性阻塞性肺疾病（以下简称慢阻肺）的定义、诊断、评估和治疗与2023年GOLD相同，但在10个方面进行了修订/扩充，包括扩充保留比值肺功能受损（PRISm）的概念、增加肺过度充气的部分、增加吸入支气管舒张剂前进行肺功能检查的说明、增加慢阻肺目标人群筛查的部分、更新血嗜酸性粒细胞计数的说明、更新间质性肺异常部分、修订戒烟部分、对慢阻肺患者的推荐疫苗进行更新、扩充吸入性治疗的管理部分以及新增戒烟的药物治疗。本文对更新内容进行简介和解读。

关键词: 肺疾病,慢性阻塞性, 肺过度充气, 肺功能, 慢阻肺筛查, 戒烟, 指南

Abstract:

Global initiative for chronic obstructive lung disease (GOLD) 2024 report was released on November 13th, 2023. In general, the definition, diagnosis, assessment, and therapy of chronic obstructive pulmonary disease (COPD) are the same as GOLD 2023, with corresponding content added in ten aspects, including the expansion of the information about PRISm, a new section on hyperinflation, further clarification about pre-bronchodilator spirometry, a new section on screening for COPD in targeted populations, the update of blood eosinophil count, the update of interstitial lung abnormalities, the revision of the section on smoking cessation, the update of vaccination recommendations for people with COPD, the expansion of managing inhaled therapy, and the addition of pharmacotherapies for smoking cessation. The article introduces and interprets the new contents.

Key words: Pulmonary disease, chronic obstructive, Hyperinflation, Pulmonary function, Screening for COPD, Smoking cessation, Guidebooks

中图分类号:

R 563.9

陈典,隆寰宇,李姝润,等. 2024年GOLD慢性阻塞性肺疾病诊断、治疗、管理及预防全球策略更新要点解读[J]. 中国全科医学, 2024, 27(13): 1533-1543. DOI: 10.12114/j.issn.1007-9572.2023.0867.
CHEN Dian,LONG Huanyu,LI Shurun, et al. Interpretation of Global Strategy for the Diagnosis, Treatment, Management and Prevention of Chronic Obstructive Pulmonary Disease 2024 Report[J]. Chinese General Practice, 2024, 27(13): 1533-1543. DOI: 10.12114/j.issn.1007-9572.2023.0867.

图/表 5

图1 生命进程中的FEV1轨迹注：FEV1=第1秒用力呼气容积。

Figure 1 FEV1 trajectories over the life course

图2 2024年GOLD中慢阻肺的ABE分级注：GOLD=慢性阻塞性肺疾病全球倡议，FVC=用力肺活量，mMRC=改良的英国医学研究委员会呼吸困难量表，CAT=慢阻肺评估测试。

Figure 2 ABE assessment tool in 2024年GOLD

图3 慢阻肺初始阶段的药物治疗注：*单一吸入装置比多个吸入装置更简便和有效，单一吸入装置可提高治疗依从性，急性加重次数是指每年急性加重的次数；eos=血嗜酸性粒细胞计数，LABA=长效β2受体激动剂，LAMA=长效抗胆碱能拮抗剂，ICS=吸入性糖皮质激素。

Figure 3 Initial pharmacological treatment of COPD

图4 慢阻肺随访期的药物治疗注：*单一吸入装置比多个吸入装置更简便和有效；单一吸入装置可提高治疗依从性；**如果出现肺炎或其他相当的副作用，则考虑ICS降级。如果血eos≥300/μL，则降级更可能导致急性加重的发生；急性加重次数是指每年急性加重的次数。

Figure 4 Initial pharmacological treatment of COPD

图5 慢阻肺急性加重的严重程度和鉴别诊断流程注：VAS=呼吸困难视觉模拟量表，RR=呼吸频率，HR=心率，SaO2=血氧饱和度，CRP=C反应蛋白，ABG=动脉血气，PaO2=动脉氧分压。

Figure 5 Severity and differential diagnosis of COPD exacerbations

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