患者指导
对所有患者进行关于疾病病程、急性加重或失代偿时症状方面的教育。他们对疾病的预期、治疗和预后不应过于乐观。重要的是记住目前没有药物可以修复长期下降的肺功能，药物治疗的主要目标是控制症状和预防并发症。
定期内科随访对于优化治疗很有必要。如果有任何症状加重，需要立即就医。
自我管理的干预措施
针对 COPD 急性加重的行动计划可改善健康相关生存质量，并减少因呼吸系统疾病所致的入院次数。[146]Lenferink A, Brusse-Keizer M, van der Valk PD, et al. Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2017 Aug 4;(8):CD011682. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011682.pub2/full http://www.ncbi.nlm.nih.gov/pubmed/28777450?tool=bestpractice.com
自我管理计划应包括以下个性化建议：[1]Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2024 report. 2024 [internet publication]. https://goldcopd.org/2024-gold-report
呼吸困难和应激管理技巧
保存能量
消除加重因素
如何监测症状
如何管理恶化的症状
发生急性加重事件时的联系信息
研究发现，认知行为治疗（behavioural therapy, CBT）对抑郁和焦虑症状、生存质量和急诊科就诊频率等结局有益。[150]Pollok J, van Agteren JE, Esterman AJ, et al. Psychological therapies for the treatment of depression in chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2019 Mar 6;(3):CD012347. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012347.pub2/full http://www.ncbi.nlm.nih.gov/pubmed/30838649?tool=bestpractice.com [151]Ma RC, Yin YY, Wang YQ, et al. Effectiveness of cognitive behavioural therapy for chronic obstructive pulmonary disease patients: a systematic review and meta-analysis. Complement Ther Clin Pract. 2020 Feb;38:101071. http://www.ncbi.nlm.nih.gov/pubmed/31743870?tool=bestpractice.com [152]Williams MT, Johnston KN, Paquet C. Cognitive behavioral therapy for people with chronic obstructive pulmonary disease: rapid review. Int J Chron Obstruct Pulmon Dis. 2020 Apr 23;15:903-19. https://www.dovepress.com/cognitive-behavioral-therapy-for-people-with-chronic-obstructive-pulmo-peer-reviewed-fulltext-article-COPD http://www.ncbi.nlm.nih.gov/pubmed/32425516?tool=bestpractice.com
应鼓励患者：[152]Williams MT, Johnston KN, Paquet C. Cognitive behavioral therapy for people with chronic obstructive pulmonary disease: rapid review. Int J Chron Obstruct Pulmon Dis. 2020 Apr 23;15:903-19. https://www.dovepress.com/cognitive-behavioral-therapy-for-people-with-chronic-obstructive-pulmo-peer-reviewed-fulltext-article-COPD http://www.ncbi.nlm.nih.gov/pubmed/32425516?tool=bestpractice.com [154]Long H, Howells K, Peters S, et al. Does health coaching improve health-related quality of life and reduce hospital admissions in people with chronic obstructive pulmonary disease? A systematic review and meta-analysis. Br J Health Psychol. 2019 Sep;24(3):515-46. https://bpspsychub.onlinelibrary.wiley.com/doi/10.1111/bjhp.12366 http://www.ncbi.nlm.nih.gov/pubmed/31033121?tool=bestpractice.com
停止主动或被动吸烟
避免有毒烟雾的环境暴露
尽可能保持健康和活力
申请健康指导（如果有的话）
请参阅“戒烟（患者指导）”。
一位医疗保健传播学教授对动机性访谈进行了概述。
演示：一位医疗保健传播学教授与患者进行关于戒烟的动机性访谈（共 2 部分，第 1 部分）。
演示：一位医疗保健传播学教授与患者进行关于戒烟的动机性访谈（共 2 部分，第 2 部分）。
建议进行体力活动
据系统评价和荟萃分析报告：[164]Lahham A, McDonald CF, Holland AE. Exercise training alone or with the addition of activity counseling improves physical activity levels in COPD: a systematic review and meta-analysis of randomized controlled trials. Int J Chron Obstruct Pulmon Dis. 2016 Dec 8;11:3121-36. https://www.dovepress.com/exercise-training-alone-or-with-the-addition-of-activity-counseling-im-peer-reviewed-fulltext-article-COPD http://www.ncbi.nlm.nih.gov/pubmed/27994451?tool=bestpractice.com [170]Cramer H, Haller H, Klose P, et al. The risks and benefits of yoga for patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Clin Rehabil. 2019 Dec;33(12):1847-62. http://www.ncbi.nlm.nih.gov/pubmed/31353959?tool=bestpractice.com [171]Tong H, Liu Y, Zhu Y, et al. The therapeutic effects of qigong in patients with chronic obstructive pulmonary disease in the stable stage: a meta-analysis. BMC Complement Altern Med. 2019 Sep 4;19(1):239. https://bmccomplementmedtherapies.biomedcentral.com/articles/10.1186/s12906-019-2639-9 http://www.ncbi.nlm.nih.gov/pubmed/31484521?tool=bestpractice.com [172]Lu Y, Li P, Li N, et al. Effects of home-based breathing exercises in subjects with COPD. Respir Care. 2020 Mar;65(3):377-87. https://rc.rcjournal.com/content/65/3/377 http://www.ncbi.nlm.nih.gov/pubmed/31719191?tool=bestpractice.com [173]Liu X, Fu C, Hu W, et al. The effect of Tai Chi on the pulmonary rehabilitation of chronic obstructive pulmonary disease: a systematic review and meta-analysis. Ann Palliat Med. 2021 Apr;10(4):3763-82. https://apm.amegroups.org/article/view/67333/html http://www.ncbi.nlm.nih.gov/pubmed/33894710?tool=bestpractice.com [267]Iepsen UW, Jørgensen KJ, Ringbæk T, et al. A combination of resistance and endurance training increases leg muscle strength in COPD: an evidence-based recommendation based on systematic review with meta-analyses. Chron Respir Dis. 2015 May;12(2):132-45. https://journals.sagepub.com/doi/10.1177/1479972315575318 http://www.ncbi.nlm.nih.gov/pubmed/25767138?tool=bestpractice.com
运动训练本身就可改善 COPD 患者的体力活动状况；如果结合体力活动辅导，则可以获得更大的改善。
与单纯的有氧运动相比，有氧运动和力量训练相结合能更有效地增强腿部肌肉力量。
瑜伽、气功、太极和其他家庭呼吸训练可改善运动能力和肺功能。
一项 Cochrane 评价总结，通过体力活动辅导、运动训练和 COPD 药物治疗获得体力活动改善的证据有限。[169]Burge AT, Cox NS, Abramson MJ, et al. Interventions for promoting physical activity in people with chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev. 2020 Apr 16;(4):CD012626.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012626.pub2/full
http://www.ncbi.nlm.nih.gov/pubmed/32297320?tool=bestpractice.com
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Which interventions lead to increased regular physical activity for people with chronic obstructive pulmonary disease (COPD)?/cca.html?targetUrl=https://www.cochranelibrary.com/cca/doi/10.1002/cca.3155/full展示答案 该评价中所纳入的干预措施主要是通过单项研究进行评估的。改善体力活动的最佳时机、因素、持续时间和模式尚不清楚。
讨论吸入器使用技术
嘱患者携带其吸入器就诊，以便检查吸入器的使用情况。[1]Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2024 report. 2024 [internet publication]. https://goldcopd.org/2024-gold-report [158]Price D, Keininger DL, Viswanad B, et al. Factors associated with appropriate inhaler use in patients with COPD - lessons from the REAL survey. Int J Chron Obstruct Pulmon Dis. 2018 Feb 26;13:695-702. [Erratum in: Int J Chron Obstruct Pulmon Dis. 2018 Jul 25;13:2253-4.] https://www.dovepress.com/factors-associated-with-appropriate-inhaler-use-in-patients-with-copd--peer-reviewed-fulltext-article-COPD http://www.ncbi.nlm.nih.gov/pubmed/29520137?tool=bestpractice.com [159]Maricoto T, Monteiro L, Gama JMR, et al. Inhaler technique education and exacerbation risk in older adults with asthma or chronic obstructive pulmonary disease: a meta-analysis. J Am Geriatr Soc. 2019 Jan;67(1):57-66. http://www.ncbi.nlm.nih.gov/pubmed/30291745?tool=bestpractice.com [160]Jia X, Zhou S, Luo D, et al. Effect of pharmacist-led interventions on medication adherence and inhalation technique in adult patients with asthma or COPD: a systematic review and meta-analysis. J Clin Pharm Ther. 2020 Oct;45(5):904-17. https://onlinelibrary.wiley.com/doi/10.1111/jcpt.13126 http://www.ncbi.nlm.nih.gov/pubmed/32107837?tool=bestpractice.com [161]Willard-Grace R, Chirinos C, Wolf J, et al. Lay health coaching to increase appropriate inhaler use in COPD: a randomized controlled trial. Ann Fam Med. 2020 Jan;18(1):5-14. https://www.annfammed.org/content/18/1/5 http://www.ncbi.nlm.nih.gov/pubmed/31937527?tool=bestpractice.com
演示吸入器使用方法，并在随后的就诊中复查使用技巧；使用安慰剂装置教授≥65 岁成人吸入器使用技术是最有效的。
药剂师主导的干预措施和通俗的健康指导可改善患者的吸入器使用技术和依从性。
患者偏好研究报告了首选的吸入器装置属性（例如，体积小、症状缓解迅速）。[162]Navaie M, Dembek C, Cho-Reyes S, et al. Inhaler device feature preferences among patients with obstructive lung diseases: a systematic review and meta-analysis. Medicine (Baltimore). 2020 Jun 19;99(25):e20718. https://journals.lww.com/md-journal/fulltext/2020/06190/inhaler_device_feature_preferences_among_patients.56.aspx http://www.ncbi.nlm.nih.gov/pubmed/32569208?tool=bestpractice.com [163]Tervonen T, Hawken N, Hanania NA, et al. Maintenance inhaler therapy preferences of patients with asthma or chronic obstructive pulmonary disease: a discrete choice experiment. Thorax. 2020 Sep;75(9):735-43. https://thorax.bmj.com/content/75/9/735 http://www.ncbi.nlm.nih.gov/pubmed/32631932?tool=bestpractice.com
多数患者在使用吸入器时至少犯一次错误，并且错误使用吸入器与疾病控制能力下降有关。[155]Cho-Reyes S, Celli BR, Dembek C, et al. Inhalation technique errors with metered-dose inhalers among patients with obstructive lung diseases: a systematic review and meta-analysis of US Studies. Chronic Obstr Pulm Dis. 2019 Jul 24;6(3):267-80. https://journal.copdfoundation.org/jcopdf/id/1241/Inhalation-Technique-Errors-with-Metered-Dose-Inhalers-Among-Patients-with-Obstructive-Lung-Diseases-A-Systematic-Review-and-Meta-Analysis-of-US-Studies http://www.ncbi.nlm.nih.gov/pubmed/31342732?tool=bestpractice.com [156]Melani AS, Bonavia M, Cilenti V, et al. Inhaler mishandling remains common in real life and is associated with reduced disease control. Respir Med. 2011 Jun;105(6):930-8. https://www.resmedjournal.com/article/S0954-6111(11)00009-6/fulltext http://www.ncbi.nlm.nih.gov/pubmed/21367593?tool=bestpractice.com 当患者使用多种装置或从未接受过吸入器装置使用方法培训时，更可能使用不当。[157]Rootmensen GN, van Keimpema AR, Jansen HM, et al. Predictors of incorrect inhalation technique in patients with asthma or COPD: a study using a validated videotaped scoring method. J Aerosol Med Pulm Drug Deliv. 2010 Oct;23(5):323-8. http://www.ncbi.nlm.nih.gov/pubmed/20804428?tool=bestpractice.com
一位主管药剂师向患者展示如何使用定量吸入器，并讨论改善吸入器使用技术的方法。
一位主管药剂师向患者展示如何使用定量吸入器加储雾罐，并讨论改善吸入器使用技术的方法。
一位主管药剂师向患者展示如何使用干粉装置，并讨论改善吸入器使用技术的方法。
一位主管药剂师向患者展示如何使用软雾吸入器，并讨论改善吸入器使用技术的方法。
膳食建议和口服补充剂
研究发现，膳食建议和口服补充剂可改善体重、生存质量、呼吸肌力量和 6 分钟步行距离。[174]Collins PF, Elia M, Stratton RJ. Nutritional support and functional capacity in chronic obstructive pulmonary disease: a systematic review and meta-analysis. Respirology. 2013 May;18(4):616-29. https://onlinelibrary.wiley.com/doi/10.1111/resp.12070 http://www.ncbi.nlm.nih.gov/pubmed/23432923?tool=bestpractice.com [175]Ferreira IM, Brooks D, White J, et al. Nutritional supplementation for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2012 Dec 12;(12):CD000998. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000998.pub3/full http://www.ncbi.nlm.nih.gov/pubmed/23235577?tool=bestpractice.com
但营养支持并不一定能够改善肺功能。[175]Ferreira IM, Brooks D, White J, et al. Nutritional supplementation for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2012 Dec 12;(12):CD000998. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000998.pub3/full http://www.ncbi.nlm.nih.gov/pubmed/23235577?tool=bestpractice.com
航空旅行准备
在航空旅行之前改善患者病情，并评估他们是否需要在飞行途中吸氧。建议患者：[206]British Thoracic Society. Air travel. Mar 2022 [internet publication]. https://www.brit-thoracic.org.uk/quality-improvement/clinical-statements/air-travel
咨询有关静脉血栓栓塞的预防措施，尤其是长途飞行前
随身携带所有药品和储雾罐装置
准备好飞行途中可立即取用的紧急药品
考虑在飞行途中增加氧气流量（如果是接受持续氧疗）
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