鉴于慢性阻塞性肺疾病(COPD)的气流受限特点是进行性发展，而且不能完全可逆，同时COPD带来沉重的社会经济负担，成为劳动力丧失和死亡的重要原因之一。因而近年来国外一些学者主张早期干预COPD，并且提出许多理由，诸如早期干预COPD可以减少症状，减少动态过度充气，改善肺功能，提高生命质量等。然而，必须看到COPD的早期干预是一项很艰难的系统工程，有许多问题需要大家认真思考和讨论，尤其是在我国这个问题尤为重要和复杂。故愿就我国COPD的早期干预问题谈一些不成熟的看法，以就正于同道。
Objectives To evaluate pulmonary physicians’knowledge level about prevention and treatment of chronic obstructive pulmonary disease( COPD) in some urban areas in China. Methods A total of 258 pulmonary physicians were interviewed face-to-face in 24 hospitals from July to October in 2006. The questionnaire included the knowledge of COPD, prescriptions at initial visit and follow-up, pulmonary function test monitoring, assessment and intervention in stable COPD, knowledge and evaluation of the commonly used medicines, the effects of smoking cessation and adopted measures, as well as the knowledge of treatment prospects and patients’ education. Results Eighty-eight percent of pulmonary physicians considered themselves knowledgeable on COPD, and 95% were familiar with the severity classification. Most of them knew about GOLD and Chinese Guideline of Prevention and Treatment to COPD, and paid attention to chest X-ray and pulmonary function test during diagnosis. The standards in evaluation of stable COPD patients were not well understood, and 92% of physicians claimed for pulmonary function test in stable stage. Seventy-nine percent of physicians actively suggested the patients quit smoking. The prescription for COPD patients at iniative and maintenance therapy met the guideline on the whole, but the mucolytic agents were appreciated too much and used too frequently. Thirty-three percent of physicians took it necessary to treat stable COPD,and 69% believed that pharmacotherapy for stable COPD could rersult in satisfactory quality of life.Conclusions In some big cities in China, the pulmonary physicians have good knowledge about COPD. But long-term prevention and intervention, especially in pharmacotherapy, are still unsatisfactory.
长期以来人们一直将吸烟, 包括吸烟成瘾看作是一种习惯, 并没有将其视为一种疾病。这样使得戒烟变得很困难和复杂。吸烟之所以长期广泛流行并造成十分严重的社会经济危害, 原因包括一系列生物、心理、社会因素, 其中最重要的原因是由于香烟烟雾中的尼古丁是一种可以使人成瘾的物质, 使得吸烟人产生烟草依赖。1998 年世界卫生组织正式提出烟草依赖是一种慢性病, 列入国际疾病分类( ICD-10,F17. 2) 。这在吸烟与控烟历史上具有划时代的意义, 将会使控烟工作从此进入一个与以往不同的时代。