Page 20 - 2023-05-中国全科医学

2023年2月 第26卷 第5期 http: //www.chinagp.net E-mail: zgqkyx@chinagp.net.cn ·533·

【Abstract】 The prevalence of chronic respiratory diseases is increasing，seriously threatening the health and life safety
of Chinese residents. Lung function tests are important screening and diagnostic means for chronic respiratory diseases，but have
been insufficiently valued for a long time，especially in primary care. Great emphasis should be placed on the use of these tests in
primary care，mainly due to the following two aspects：（1） The incidence of chronic obstructive pulmonary disease（COPD）
remains high in China，and it is estimated that more than 5.40 million people will die of COPD and its related diseases per year
by 2060. Chronic respiratory diseases have become a public health issue that seriously impairs the health of Chinese residents. （2）
Lung function tests are the gold standard for diagnosing chronic respiratory diseases. Carrying out these tests in primary care is
contributive to early detection and timely intensive treatment of chronic respiratory diseases，thereby delaying the decrease in lung
functions. As the major healthcare providers，general practitioner（GP） teams have many advantages to implement lung function
tests，and they can perform many tasks related to the tests：（1） Working in primary care is favorable for GP teams to implement
long-term follow-up management for chronic diseases，and the biopsychosocial model used by them is beneficial to improving
the quality of care for the patients. （2） GPs may carry out various types of heath education to enhance residents' awareness of
chronic respiratory disease prevention and control to improve their adherence to lung function tests. （3） GPs may proactively
perform early lung function tests for residents in their service area，especially those at high risk for chronic respiratory diseases，
by which the optimal treatment time will be determined，then the disease burden will be reduced. （4） GP teams can provide
contracted care services and creating a respiratory health file for chronic respiratory disease patients，and offer tiered management
services to COPD patients according to the severity of their disease. In general，GPs should provide chronic respiratory disease
patients with continuous and standardized services using a scientific and effective process，and timely and appropriate follow-up
services. In view of the unsatisfactory implementation status of lung function tests in primary care，we invited a group of experts
to give their opinions on some key questions. Professor CHEN Yan put forward recommendations on the target population to be
screened：COPD patients with dyspnea，a history of chronic cough / expectoration，recurrent lower respiratory tract infection，
a family history of COPD /childhood factors （such as low birth weight，childhood respiratory tract infection），a history of
exposure to any COPD risk factors （including tobacco smoke，fumes from burning fuel and inhalable dust），or age>40 years；
asthma patients with allergic rhinitis，gastroesophageal reflux disease，COPD，bronchiectasis，smoking，a history of exposure
to allergens and other environmental triggers，or obesity. And bronchiectasis and idiopathic pulmonary interstitial fibrosis patients
should also be concerned population for implementing lung function tests. In terms of assessing and improving the quality control
in performing lung function tests，Professor SONG Yuanlin and Professor GAI Xiaoyan proposed that during the implementation of
such tests，the respiratory rate，respiratory amplitude and respiratory gas flow rate associated with lung ventilation function of the
examinees are easily influenced by the performance of instruments and equipment，and operating skills of technicians as well as
individual physiological and pathological factors of examinees. And they put forward recommendations，for example，using smart
spirometers with built-in calibration and quality control standards in lung function tests，to reduce the operational complexity，so
that primary care workers can quickly grasp the essentials of performing lung function tests. During the discussion of a community
COPD department playing a demonstration role in the construction of early screening and intervention of respiratory disease project
in primary care，Professor CHEN Yahong pointed out the standardized respiratory disease prevention，diagnosis and management
system and capacity building program in primary care，and capabilities improvement program for early screening and intervention
for respiratory diseases in primary care，have greatly promoted the levels of standardized prevention，treatment and nursing care
of respiratory diseases，and the determination of number and quality of spirometers equipped in primary care settings. It is hoped
that this article will provide insights into the promotion of lung function tests in primary care.
【Key words】 Lung diseases；Respiratory system disease；Pulmonary disease，chronic obstructive；General
practitioners；Respiratory function tests；Pulmonary function；Primary medical and health institutions；Risk factor；Quality
control；Community

慢性阻塞性肺疾病（以下简称慢阻肺）是最常见 同样表明，吸入支气管舒张剂后，肺功能检查第 1 秒
的慢性呼吸系统疾病，2018 年中国成人肺部健康研 用力呼气容积（FEV 1 ）/ 用力肺活量（FVC）<0.7 是
究的统计数据表明，我国有近 1 亿慢阻肺患者 ［1］ 。 诊断慢阻肺的必要条件。基层医疗卫生机构的全科医
慢阻肺严重影响患者生命质量，给患者及其家庭以 生团队应积极承担起辖区居民“健康守门人”的职责，
及社会带来沉重的负担。2021 年修订的《慢性阻塞 积极推动肺功能检查技术在基层医疗卫生机构的应
性肺疾病诊治指南》指出肺功能检查是诊断慢阻肺 用，使基层医疗卫生机构真正成为我国慢性呼吸系
［2］
的“金标椎” ，《2022 版慢阻肺全球倡议（GOLD）》 统疾病防控体系的第一道防线。本文结合当前国家