本文由小咖机器人翻译整理

期刊来源：N Engl J Med

原文链接：https://doi.org/10.1056/NEJMoa2401389

摘要内容如下：

背景

许多患有慢性阻塞性肺病（COPD）或哮喘的人尚未得到诊断，因此他们的呼吸道症状在很大程度上仍未得到治疗。

方法

我们使用病例发现方法来识别社区中有呼吸道症状但未诊断为肺部疾病的成年人。通过肺活量测定发现患有未确诊的COPD或哮喘的参与者参加了一项多中心、随机、对照试验，以确定早期诊断和治疗是否会减少呼吸系统疾病的卫生保健利用并改善健康结果。参与者被分配接受干预（由肺科医生和哮喘-COPD教育者进行评估，他们被指示启动基于指南的护理）或由其初级保健医生进行常规护理。主要结果是参与者发起的呼吸系统疾病卫生保健利用的年化率。次要转归包括疾病特异性生活质量从基线到1年的变化，用圣乔治呼吸问卷（SGRQ；得分范围为0至100，得分越低表示健康状况越好）进行评估；症状负担，用COPD评估测试评估（CAT；分数范围从0到40，分数越低表示健康状况越好）；和1秒钟用力呼气容积（FEV1）。

结果

在38，353名受访者中，595人被发现患有未确诊的COPD或哮喘，508人接受了随机分组:253人被分配到干预组，255人被分配到常规护理组。干预组主要结局事件的年发生率低于常规护理组（0.53对1.12事件/人年；发病率比，0.48；95%置信区间[CI]，0.36至0.63；P<0.001）。在12个月时，干预组的SGRQ评分比基线评分低10.2分，常规护理组的SGRQ评分比基线评分低6.8分（差异，-3.5分；95%CI，-6.0至-0.9），CAT评分分别比基线评分低3.8分和2.6分（差值，-1.3分；95%置信区间，-2.4至-0.1）。干预组的FEV1增加了119ml，常规护理组增加了22ml（差值为94ml；95%置信区间，50至138）。试验组的不良事件发生率相似。

结论

在这项试验中，使用了一种策略来识别社区中患有未确诊哮喘或COPD的成年人，与接受常规护理的患者相比，接受肺科医生指导治疗的患者随后对呼吸系统疾病的医疗保健利用较少。（由加拿大卫生研究所资助；UCAP ClinicalTrials.gov编号，NCT03148210。）

英文原文如下：

Abstracts

BACKGROUND  Many persons with chronic obstructive pulmonary disease (COPD) or asthma have not received a diagnosis, so their respiratory symptoms remain largely untreated.

METHODS  We used a case-finding method to identify adults in the community with respiratory symptoms without diagnosed lung disease. Participants who were found to have undiagnosed COPD or asthma on spirometry were enrolled in a multicenter, randomized, controlled trial to determine whether early diagnosis and treatment reduces health care utilization for respiratory illness and improves health outcomes. Participants were assigned to receive the intervention (evaluation by a pulmonologist and an asthma-COPD educator who were instructed to initiate guideline-based care) or usual care by their primary care practitioner. The primary outcome was the annualized rate of participant-initiated health care utilization for respiratory illness. Secondary outcomes included changes from baseline to 1 year in disease-specific quality of life, as assessed with the St. George Respiratory Questionnaire (SGRQ; scores range from 0 to 100, with lower scores indicating better health status); symptom burden, as assessed with the COPD Assessment Test (CAT; scores range from 0 to 40, with lower scores indicating better health status); and forced expiratory volume in 1 second (FEV1).

RESULTS  Of 38,353 persons interviewed, 595 were found to have undiagnosed COPD or asthma and 508 underwent randomization: 253 were assigned to the intervention group and 255 to the usual-care group. The annualized rate of a primary-outcome event was lower in the intervention group than in the usual-care group (0.53 vs. 1.12 events per person-year; incidence rate ratio, 0.48; 95% confidence interval [CI], 0.36 to 0.63; P<0.001). At 12 months, the SGRQ score was lower than the baseline score by 10.2 points in the intervention group and by 6.8 points in the usual-care group (difference, -3.5 points; 95% CI, -6.0 to -0.9), and the CAT score was lower than the baseline score by 3.8 points and 2.6 points, respectively (difference, -1.3 points; 95% CI, -2.4 to -0.1). The FEV1 increased by 119 ml in the intervention group and by 22 ml in the usual-care group (difference, 94 ml; 95% CI, 50 to 138). The incidence of adverse events was similar in the trial groups.

CONCLUSIONS  In this trial in which a strategy was used to identify adults in the community with undiagnosed asthma or COPD, those who received pulmonologist-directed treatment had less subsequent health care utilization for respiratory illness than those who received usual care. (Funded by Canadian Institutes of Health Research; UCAP ClinicalTrials.gov number, NCT03148210.).

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