应基于疾病严重程度,对 COPD 患者进行定期评估。病情稳定的轻度 COPD 患者应该每 6 个月随访一次,重度频繁加重的患者和近期曾住院的患者需要每 2 周至每 1 个月随访一次。随访时,应评估患者对药物治疗方案的依从性、对治疗的反应、吸入器使用方法、治疗的不良反应以及疾病进展情况。还应评估静息和运动时呼吸困难的水平,以及加重次数。可使用 COPD 评估测试(COPD Assessment Test, CAT)一类的问卷来评估症状。在慢性阻塞性肺疾病全球倡议(Global Initiative for Chronic Obstructive Lung Disease, GOLD)指南中可以找到这些问卷。[1]Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2023 report [internet publication].
https://goldcopd.org/2023-gold-report-2
每次就诊时,应确定患者的吸烟状况和烟雾暴露情况,然后采取适当行动。[1]Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2023 report [internet publication].
https://goldcopd.org/2023-gold-report-2
GOLD 指南推荐每年至少一次使用肺量计检测 FEV1,以识别出 FEV1 快速下降的患者。[1]Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2023 report [internet publication].
https://goldcopd.org/2023-gold-report-2
应通过定时的步行试验来评估功能能力。应该监测血氧饱和度,并定期评估患者是否需要补充供氧。如果症状已经加重,可能需进行影像学检查;对于反复加重且有脓痰特征表现的患者,应检查有无支气管扩张。[1]Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2023 report [internet publication].
https://goldcopd.org/2023-gold-report-2
需要监测 COPD 患者是否出现短期和长期并发症以及合并症。还应监测患者的体重、营养状况和体力活动。恶病质和体能下降是预后不良的预测因素。
一项 Cochrane 评价发现,通过远程医疗技术进行远程监测,可降低中重度 COPD 患者再次入院的风险,并可被视为常规治疗的辅助手段。[248]Janjua S, Carter D, Threapleton CJ, et al. Telehealth interventions: remote monitoring and consultations for people with chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev. 2021 Jul 20;7:CD013196.
https://www.doi.org/10.1002/14651858.CD013196.pub2
http://www.ncbi.nlm.nih.gov/pubmed/34693988?tool=bestpractice.com