慢性阻塞性肺疾病 (COPD)

避免烟草暴露（主动和被动措施）和有毒烟雾对COPD的初级预防非常重要。应对所有的吸烟者提供戒烟干预，包括药物治疗和咨询。尽管戒烟可能导致较轻的短期不良反应，例如体重增加和便秘，但其长期获益毋庸置疑。[45]Gratziou C. Respiratory, cardiovascular and other physiological consequences of smoking cessation. Curr Med Res Opin. 2009 Feb;25(2):535-45. http://www.ncbi.nlm.nih.gov/pubmed/19193001?tool=bestpractice.com 对于由职业暴露导致的疾病，一级预防主要是通过消除或减少工作场所的暴露实现。可以通过采取公共卫生措施来减少空气污染的危害，例如收取交通拥挤费、设置多乘员车辆车道，以及提倡步行或骑自行车。[46]Public Health England. Improving outdoor air quality and health: review of interventions. March 2020 [internet publication]. https://www.gov.uk/government/publications/improving-outdoor-air-quality-and-health-review-of-interventions

动机性访谈概述

动机性访谈：戒烟 第 1 部分

动机性访谈：戒烟 第 2 部分

根据当地指南，患者应接种流感病毒疫苗、肺炎链球菌疫苗、百日咳疫苗、水痘-带状疱疹病毒疫苗和 2019 冠状病毒病（coronavirus disease 2019, COVID-19）疫苗。[1]Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2022 report [internet publication]. https://goldcopd.org/2022-gold-reports-2 [170]Centers for Disease Control and Prevention. Lung disease including asthma and adult vaccination. Feb 2021 [internet publication]. https://www.cdc.gov/vaccines/adults/rec-vac/health-conditions/lung-disease.html

对维生素 D 水平 <25 nmol/L 的患者补充维生素 D，可降低中度/重度加重发生率。[252]Jolliffe DA, Greenberg L, Hooper RL, et al. Vitamin D to prevent exacerbations of COPD: systematic review and meta-analysis of individual participant data from randomised controlled trials. Thorax. 2019 Apr;74(4):337-45. https://www.doi.org/10.1136/thoraxjnl-2018-212092 http://www.ncbi.nlm.nih.gov/pubmed/30630893?tool=bestpractice.com [253]Li X, He J, Yu M, et al. The efficacy of vitamin D therapy for patients with COPD: a meta-analysis of randomized controlled trials. Ann Palliat Med. 2020 Mar;9(2):286-97. https://www.doi.org/10.21037/apm.2020.02.26 http://www.ncbi.nlm.nih.gov/pubmed/32156131?tool=bestpractice.com 对于 COPD 加重的住院患者，应检查维生素 D 水平，如果 <25 nmol/L，应进行补充。[1]Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2022 report [internet publication]. https://goldcopd.org/2022-gold-reports-2

冬季可考虑采取屏蔽保护措施（例如佩戴口罩、尽量减少社交接触和经常洗手），同时建立 COPD 管理，从而帮助预防 COPD 急性加重。[1]Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2022 report [internet publication]. https://goldcopd.org/2022-gold-reports-2

对于部分患者，可能需要补充钙和使用其他药物预防或治疗骨质疏松症，特别是长期接受皮质类固醇治疗的老年女性。为评估这种疾病的进展，可进行骨密度扫描。

对于所有COPD患者推荐进行体育活动。[1]Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2022 report [internet publication]. https://goldcopd.org/2022-gold-reports-2