Abstract: According to the latest research，the prevalence of chronic obstructive pulmonary disease（COPD） in Chinese population aged 20 and over is 8.6%，in those aged 40 and over is 13.7%，and in those aged 60 and over is more than 27.0%，and moreover the incidence of COPD will show a further upward trend with the aging of the population，air pollution，and smoking.However，the early diagnosis rate of COPD in primary care institutions is low，and usually the treatment is not standardized.This paper analyzed the clinical hierarchical diagnosis and treatment in the aspects of the primary prevention（causal prophylaxis），secondary prevention（early diagnosis and treatment） and tertiary prevention（clinically standard diagnosis and treatment） of COPD in recent years focusing on the updates and existing problems of GOLD 2019 that have guiding significance for the hierarchical diagnosis and treatment of COPD in primary care.

Key words: Chronic obstructive pulmonary disease, Guidebooks, Progressive patient care, General practitioners, General practice, Community health services

摘要： 最新研究显示，在我国20岁及以上人群中慢性阻塞性肺疾病（以下简称慢阻肺）的患病率为8.6%，40岁以上为13.7%，60岁以上超过27.0％，而且受人口老年化、空气污染、吸烟等因素的影响，慢阻肺的发病率将呈现进一步上升趋势，然而，在基层医疗机构，慢阻肺早期诊断率低，治疗不规范还较普遍。本文分别就慢阻肺一级预防（病因预防）、二级预防（早期诊断和早期治疗）及三级预防（临床规范诊治）方面分析了近年来全球慢性阻塞性肺疾病防治策略（GOLD）指南的演变，重点阐述了GOLD 2019对基层医疗机构慢阻肺分级诊疗具有指导意义的更新要点及存在问题。

关键词: 慢性阻塞性肺疾病, 指南, 患者分级医疗, 全科医生, 全科医学, 社区卫生服务