两种方法筛查宜宾市60岁以上居民慢性阻塞性肺疾病的一致性研究

目的比较基于症状的COPD筛查问卷和慢性阻塞性肺疾病全球倡议(GOLD)2017标准在60岁以上居民COPD筛查中的一致性。方法于2019年1~12月采用多阶段抽样抽取宜宾市60岁以上居民744例,分别采用基于症状的COPD筛查问卷和肺功能检查调查COPD的患病情况,比较2种方法在诊断结果上的一致性。结果以基于症状的COPD筛查问卷评分≥16.5分(可疑)和≥19.5分(高危)为截点,诊断COPD人数分别为127例(17.1%)和86例(11.6%),不同年龄、BMI和吸烟量的可疑人数和高危人数检出率差异均有统计学意义,年龄越大、BMI越低、吸烟量越多者,检出率越高(P<0.05)。采用肺功能检查GOLD 2017标准共确诊COPD 81例,患病率为10.9%,不同年龄、BMI和吸烟量居民患病率差异有统计学意义(P<0.05)。以GOLD 2017为金标准,分别以基于症状的COPD筛查问卷评分16.5分和19.5分为截点诊断COPD,其kappa值分别为0.512和0.791,灵敏度分别为74.1%和84.0%,特异度分别为89.9%和97.3%。结论基于症状的COPD筛查问卷适用于60岁以上人群的COPD筛查,以19.5分为截点能比较准确地反映个体的肺功能状况,具有较高的一致性、灵敏度和特异度。     

沈阳市部分社区慢性阻塞性肺疾病发病情况调查分析

目的了解沈阳社区慢性阻塞性肺疾病(COPD)的流行病学特点及相关危险因素,为COPD的社区防治提供依据。方法以整群、不等比、随机抽样方法,对2003年3月至10月沈阳市东陵区3个社区,40岁以上人群入户问卷调查及肺功能检查。结果资料完整且肺功能检查质控合格者1957例,其中男725例,女1232例。年龄平均(59.37±11.61)岁。COPD患病率为8.02%,其中男性患病率(11.59%)高于女性(5.93%)(P0.01)。60～80岁COPD患病率77.70%,明显高于其他年龄组(P0.01)。Ⅱ级患者占48.41%,明显高于其他级别(P0.01)。有咳嗽、咳痰和(或)气短者仅占31.85%。吸烟与COPD患病的OR值为6.39。吸烟率56.05%均显著高于正常人群(9.61%)(P0.01)。40岁以上COPD患病率显著高于哮喘(1.58%)和(或)COPD合并哮喘患病率(1.74%)。97.45%的患者为首次接受肺功能检查,93.63%为首次诊断为COPD。结论沈阳市社区40岁以上人群COPD患病率显著高于哮喘及COPD合并哮喘者。60～80岁为高发年龄,Ⅰ、Ⅱ级患者占大多数。COPD的发病主要与吸烟相关。COPD漏诊率高,普及肺功能检查是早期诊断的关键。     

上海市嘉定区社区慢性阻塞性肺疾病防治状况调查

目的探讨上海市嘉定区2个社区卫生服务中心慢性阻塞性肺疾病(CODP)高危人群的患病情况并分析其危险因素。方法于2011年5~12月对上海市嘉定区真新及华亭2个社区卫生服务中心服务区域内常住居民中的高危人群进行肺功能检测,同时进行问卷调查。以肺功能检测结果作为COPD的诊断依据,分析COPD患者肺功能、男女比例、吸烟及治疗情况等。结果共有2008例有效对象纳入本调查,平均年龄(66.2±2.5)岁,高危人群COPD患病率达8.2%(165/2008),男性患病率为10.5%(100/956),女性为6.2%(65/1052)。其中无症状COPD患者65例,既往被诊断为慢性支气管炎、肺气肿80例,诊断为COPD者5例,80例患者未被诊断出慢性支气管炎、肺气肿或COPD,COPD患者的漏诊率为48.5%(80/165)。1年中COPD患者服用过茶碱类药物80例(48.5%),口服长效用β2受体激动剂23例(13.9%),吸入支气管扩张剂19例(11.5%),吸入糖皮质激素的仅3例(1.8%)。男有40例COPD(占24.2%)患者服用过含糖皮质激素的外地邮购药物。在73例Ⅲ、Ⅳ级COPD患者中,家庭氧疗的仅为2例。多因素分析显示,吸烟及厨房无通风设备是COPD的危险因素。结论作为诊断标准的肺功能检测在社区医院开展的不够,社区COPD患者诊断治疗严重不足,对于年龄40岁,有吸烟史,厨房无通风设备等高危因素的人群早期行肺功能检查是很有必要的。     

脉冲振荡肺功能技术联合FeNo 在3岁至5岁小儿慢性咳嗽诊疗中的价值

目的分析IOS联合FeNO在3-5岁小儿慢性咳嗽患儿诊疗中的应用价值。方法选取2016年6月至2017年12月间我院收治的60例小儿慢性咳嗽患儿作为研究对象;所有患儿均行FeNO检测,后行IOS检测;以肺功能检测作为诊断金标准,分析各指标诊断价值。结果哮喘组FEV_1及X5水平显著低于非哮喘组(P 0. 05),哮喘组患儿FeNO、Fres、R5、R20水平显著高于非哮喘组(P 0. 05); FeNO诊断时阳性共29例,R5诊断时阳性共30例,Fres诊断时阳性共28例,X5诊断时阳性共28例,R20诊断时阳性共29例,平行联合诊断时阳性共38例,系列联合诊断时阳性共22例;系列联合诊断灵敏度显著高于各指标单独应用(P 0. 05),平行联合诊断特异度显著高于各指标单独应用(P 0. 05),平行联合及系列联合诊断时曲线下面积显著高于各指标单独应用。结论采用IOS联合FeNO对3-5岁小儿慢性咳嗽诊疗时具有较高的临床应用价值,可有效提高诊断灵敏度及特异度。     

老年人群慢性阻塞性肺疾病流行病学及其影响因素

目的 分析老年人群慢性阻塞性肺疾病(COPD)流行病学状况，并探讨其影响因素。方法 选取2021年1月至2022年1月于张家口地区六家医院进行常规体检的400名老年人，均进行肺功能检查，记录COPD发生情况，同时通过问卷调查了解COPD流行病学情况，多因素Logistic回归分析COPD发生的影响因素。结果 400名调查对象中发生COPD 86例(21.50%);患者发病年龄占比从低到高依次为60～69岁(22.09%)、70～79岁(33.72%)、≥80岁(44.19%);症状表现：71例慢性咳嗽，65例咳痰，24例气短或呼吸困难，18例胸闷和喘息。Logistic回归分析结果显示，男性、年龄≥70岁、吸烟、被动吸烟、使用家庭烹饪污染燃料、有职业粉尘接触史可增加老年COPD的发生率(OR>1,P<0.05)。结论 男性、高龄、吸烟、被动吸烟、使用家庭烹饪污染燃料、有职业粉尘接触史是老年COPD发生的危险因素，可采取综合性预防措施，如加强老年人群COPD预防意识、戒烟、降低家庭污染燃料等，以此降低COPD发生率。     

吸烟对COPD患者肺功能的影响

目的探讨吸烟与慢性阻塞性肺疾病（COPD）病因及肺功能受损严重程度间的关系。方法对我院住院的1013名有肺功能测定记录中肺功能异常的134例缓解期COPD患者进行研究,调查吸烟与COPD患者肺功能的关系。按2002年中华呼吸学会制定的标准进行COPD诊断与严重程度分级。结果肺功能异常134例中、轻度异常49例（36.6%）,中度44例（32.8%）,重度41例（30.6%）。在肺功能轻度异常的患者中,不吸烟人数为20人（40.8%）,吸烟人数为29人（59.2%）。在肺功能中度异常患者中,不吸烟人数为7人（17.1%）,吸烟人数为34人（82.9%）。表明吸烟者较不吸烟者肺功能更差,吸烟者较不吸烟者FEV1/FVC更低,RV%增加,TLC增加。结论吸烟与COPD发病有着密切的关系,吸烟人群中重度COPD发病人数明显增多。因此对于COPD患者应该加强戒烟教育。     

便携式肺功能检查在社区慢性阻塞性肺疾病早期诊断和随访中的应用

目的探讨社区COPD早期诊断和随访中便携式肺功能检查的应用价值。方法以100例健康体检者为健康组、100例吸烟无症状者为吸烟无症状组、100例吸烟有症状者为吸烟有症状组、100例不吸烟有症状者为不吸烟有症状组,对比四组各项便携式肺功能检查指标间差异,并分析COPD严重程度与吸烟指数间的相关性,同时对比中度以上COPD患者接受不同治疗方案治疗后的肺功能变化情况。结果四组间FVC比较,差异未见统计学意义(P0.05),而FEV_1%、FEV_1/FVC%、PEF%、FEF25%、FEF50%、FEF75%及MMEF%水平比较,差异具统计学意义(P0.05);吸烟有症状组FEV_1%、FEV_1/FVC%、PEF%、FEF25%、FEF50%、FEF75%及MMEF%水平低于吸烟无症状组、不吸烟有症状组及健康组(P0.05),吸烟无症状组FEV_1%、FEV_1/FVC%、PEF%、FEF25%、FEF50%、FEF75%及MMEF%水平低于健康组(P0.05),但与不吸烟有症状组相近(P0.05)。在COPD患者中,FEV_1%与吸烟指数呈显著的负向直线相关性(P0.05)。此外,中度以上COPD患者治疗3个月后,康复组FEV_1%、FEV_1/FVC%水平高于常规组(P0.05)。结论便携式肺功能仪检查有助于早期发现社区具有高危因素的COPD患者,减少漏诊,并可作为治疗效果评估的重要客观指标。     

沙美特罗丙酸氟替卡松联合缩唇呼吸对慢性阻塞性肺疾病患者血浆chemerin水平及脂代谢的影响

<正>慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)是一种常见呼吸系统疾病,以持续气流受限为主要临床特征,可预防和治疗。其病因主要是气道和肺脏对有毒颗粒或气体的慢性炎性反应增强~([1-2])。常见的临床表现为慢性咳嗽、咳痰、气短或呼吸困难等症状~([3])。按其患者临床表现的程度将COPD肺功能分为轻度、中度、重度、极重度四个级别~([4])。以沙美特罗为主要成分的沙美特罗/丙酸氟     

筛查问卷与肺功能检查在慢性阻塞性肺疾病早期诊断中的研究

目的探讨慢性阻塞性肺疾病(简称慢阻肺)患病率及危险因素,提高慢阻肺早期诊断率。方法使用统一问卷对体检中心483例体检人员进行问卷调查,然后进行肺功能检测。结果慢阻肺组得分较非慢阻肺组高(P0.01)。问卷得分与FEV1/FVC呈负相关(P0.01)。以17分为截断点时,问卷的灵敏度、特异度、假阳性率、假阴性率、正确诊断指数、约登指数、阳性似然比、阴性似然比分别为97.3%、71.3%、28.7%、2.7%、73.3%、0.69、3.39、0.04。ROC分析曲线下面积为0.919,本人群最佳截断点为19.5分。慢阻肺总患病率为7.6%,男性患病率高于女性(P0.01),随年龄增大慢阻肺患病率增大。性别、年龄、吸烟、BMI、学历与患慢阻肺危险性因素有关。结论慢阻肺筛查问卷可以用来初步筛查慢阻肺高危人群,结合肺功能检查可提高慢阻肺早期诊断率。     

血清中CEA和CA199水平及对老年早期胰腺癌的诊断意义

目的探讨血清中CEA和CA199联合(CEA+CA199)检测对老年患者早期胰腺癌的诊断意义。方法选取2012年1月至2014年12月期间我院收治的100例早期胰腺癌患者作为观察对象,同时选取同一时期100例晚期胰腺癌患者、100例胰腺炎患者和100例健康体检者。所有对象均进行血清CEA和CA199水平检测,探讨CEA、CA199和CEA+CA199诊断早期胰腺癌的价值。结果 CEA诊断胰腺癌的灵敏度为72.00%,特异度为96.50%,约登指数为0.6850;CA199诊断胰腺癌的灵敏度为91.00%,特异度为98.00%,约登指数为0.8900;CEA+CA199诊断胰腺癌的灵敏度为97.00%,特异度为96.00%,约登指数为0.9300。CEA和CA199联合检测的灵敏度和约登指数均高于单独应用。结论 CEA和CA199联合检测诊断老年患者早期胰腺癌的价值高于单独应用。     

Targeting Persons With or At High Risk for Chronic Obstructive Pulmonary Disease by State-based Surveillance

The Behavioral Risk Factor Surveillance System (BRFSS) survey is used to estimate chronic obstructive pulmonary disease (COPD) prevalence and could be expanded to describe respiratory symptoms in the general population and to characterize persons with or at high risk for the disease. Tobacco duration and respiratory symptom questions were added to the 2012 South Carolina BRFSS. Data concerning sociodemographics, chronic illnesses, health behaviors, and respiratory symptoms were collected in 9438 adults ≥ 35 years-old. Respondents were categorized as having COPD, high risk, or low risk for the disease. High risk was defined as no self-reported COPD, ≥ 10 years’ tobacco use, and ≥ 1 respiratory symptom (frequent productive cough or shortness of breath (SOB), or breathing problems affecting activities). Prevalence of self-reported and high-risk COPD were 9.1% and 8.0%, respectively. Overall, 17.3%, 10.6%, and 5.2% of all respondents reported activities limited by breathing problems, frequent productive cough, and frequent SOB, respectively. The high-risk group was more likely than the COPD group to report a productive cough and breathing problems limiting activities as well as being current smokers, male, and African-American. Health impairment was more severe in the COPD than the high-risk group, and both were worse than the low-risk group.

Conclusions: Persons at high risk for COPD share many, but not all, of the characteristics of persons diagnosed with the disease. Additional questions addressing smoking duration and respiratory symptoms in the BRFSS identifies groups at high risk for having or developing COPD who may benefit from smoking cessation and case-finding interventions.     

Swimming-induced pulmonary edema: clinical presentation and serial lung function

BACKGROUND: Acute pulmonary edema has been noted in swimmers and divers, and has been termed swimming-induced pulmonary edema (SIPE). The mechanisms and consequences of SIPE are unknown, and there are currently no series of carefully evaluated patients with this condition. Herein we report the clinical presentation, incidence of recurrence, findings on physical examination, chest radiography, and oxygen saturation in 70 trainees with a diagnosis of SIPE. We also report the results of forced spirometry in a subgroup of 37 swimmers. METHODS: SIPE was diagnosed when severe shortness of breath and cough were reported during or after swimming, and were associated with evidence of pulmonary edema. During the years from 1998 to 2001, 70 cases of SIPE were documented in young healthy male subjects participating in a fitness-training program. Physical examination and pulse oximetry were performed immediately. Chest radiographs were obtained in all cases 12 to 18 h following onset of symptoms. In 37 swimmers, spirometry was performed at the time of chest radiography and again after 7 days. RESULTS: All subjects complained of severe shortness of breath. Sixty-seven of the 70 subjects (95.7%) had a prominent cough; in 63 subjects (90%), there was significant sputum production. Hemoptysis was observed in 39 subjects (55.7%). Mean arterial oxygen saturation after swimming was 88.4 +/- 6.6% breathing air, compared with 98 +/- 1.7% breathing air at rest before the start of the swimming trial (mean +/- SD) [p < 0.001]. Chest radiographs obtained 12 to 18 h after swimming were normal in all cases. Sixteen trainees (22.9%) had a recurrence of SIPE. Spirometry demonstrated restrictive lung function, which persisted for a week. CONCLUSIONS: In our trainee population, SIPE is a not uncommon, often recurrent phenomenon that significantly influences performance. It is not clear what predisposes to its occurrence or recurrence and what, if any, are its long-term effects.     

Asthma in the elderly

Asthma is common in the elderly population and the differences between younger and older asthmatics should be appreciated (Table 2). Asthma is frequently overlooked in the geriatric population. Objective measures of pulmonary function can aid in a prompt diagnosis and lead to effective treatment and improved quality of life. Because smoking is an important risk factor for asthma-like symptoms of wheezing, cough, and sputum production, asthma is frequently confused with COPD. When airflow obstruction is found, attempts to demonstrate reversibility can uncover an asthmatic component to the disease. In patients who have asthma symptoms and no airflow obstruction, methacholine testing is helpful. When a normal methacholine challenge is present, a diagnosis of asthma can be excluded and the physician can pursue other diagnostic considerations such as heart failure, chronic aspiration syndrome, pulmonary embolic disease, and carcinoma of the lung. The onset of wheezing, shortness of breath, and cough in an elderly patient is likely to cause concern. Although the adage "all that wheezes is not asthma" is true at any age, it is especially true in the elderly. Diagnosis based on objective measures is essential.     

Classification tree criteria of pulmonary hypertension in mixed connective tissue disease

Abstract

Tree criteria for the classification of pulmonary hypertension (PH) in mixed connective tissue disease (MCTD) were developed by stratifying patients into groups according to the physician’s diagnosis, mean pulmonary artery pressure (mPA) and prognosis, respectively. A classification tree for PH diagnosed by the physician was constructed with two criteria: dilatation of the pulmonary artery segment evident on chest roentgenography (or an accentuated pulmonic sound as a surrogate) and shortness of breath on exertion, which demonstrated a sensitivity of 96% and a specificity of 99%. A classification tree for PH diagnosed by mPA was also constructed with almost similar criteria: an accentuated pulmonic sound (or dilatation of the pulmonary artery segment evident on chest roentgenography as a surrogate) and shortness of breath on exertion, which demonstrated a sensitivity of 100% and a specificity of 100%. The prognostic classification tree was constructed with four criteria: an accentuated pulmonic sound, systolic pulsation at the left sternal border, shortness of breath on exertion and retro-sternal pain on exertion, which demonstrated a sensitivity of 62% and a specificity of 98%. The classification tree criteria for the diagnosis and prognosis of PH in MCTD were found to be accurate and useful for the screening of PH.     

How to Avoid Underdiagnosed Asthma/Chronic Obstructive Pulmonary Disease?

The prevalence of asthma and chronic obstructive pulmonary disease (COPD) is rising in most countries, including the Netherlands. It has been suggested that a majority of these cases of (self-reported) symptoms related to asthma/COPD are not diagnosed in general practice. We compared a population screening for underdiagnosed asthma/COPD with a high-risk approach by a questionnaire form with specified questions about asthma/COPD-related symptoms. A case-controlled study including a record review was performed of cases and controls. The results of a population screening were used to classify patients as (a) asthma/COPD, (b) at risk for asthma/COPD, or (c) no asthma/COPD. Eleven hundred fifty-five patients were screened. One hundred fifty-five patients reported previous asthma/COPD-related care (cases). The difference between number of cases and controls in asthma/COPD diagnosis was chosen as main outcome measure. The population screening revealed 85 subjects with a diagnosis of asthma/COPD and 154 subjects with an increased risk. Nineteen diagnoses could be made in cases, and eight diagnoses in controls. The chart review showed that only seven cases and two controls were known to the general practitioner. From this study it can be concluded that in order to reduce the number of un- and underdiagnosed patients, all listed patients in general practice should be screened. However, if screening of all patients is not feasible, active case finding by asking a few questions about shortness of breath or wheezing to all patients in the group of listed individuals is recommended.     

Classification tree criteria of pulmonary hypertension in mixed connective tissue disease

Tree criteria for the classification of pulmonary hypertension (PH) in mixed connective tissue disease (MCTD) were developed by stratifying patients into groups according to the physician’s diagnosis, mean pulmonary artery pressure (mPA) and prognosis, respectively. A classification tree for PH diagnosed by the physician was constructed with two criteria: dilatation of the pulmonary artery segment evident on chest roentgenography (or an accentuated pulmonic sound as a surrogate) and shortness of breath on exertion, which demonstrated a sensitivity of 96% and a specificity of 99%. A classification tree for PH diagnosed by mPA was also constructed with almost similar criteria: an accentuated pulmonic sound (or dilatation of the pulmonary artery segment evident on chest roentgenography as a surrogate) and shortness of breath on exertion, which demonstrated a sensitivity of 100% and a specificity of 100%. The prognostic classification tree was constructed with four criteria: an accentuated pulmonic sound, systolic pulsation at the left sternal border, shortness of breath on exertion and retro-sternal pain on exertion, which demonstrated a sensitivity of 62% and a specificity of 98%. The classification tree criteria for the diagnosis and prognosis of PH in MCTD were found to be accurate and useful for the screening of PH.     

Chronic obstructive pulmonary disease in Brazilian primary care: Diagnostic competence and case-finding.

AIMS: The developing world is particularly at risk of an increasing health burden due to an increased prevalence of Chronic Obstructive Pulmonary Disease (COPD) secondary to increasing tobacco consumption. However, research is scarce. The objectives of this study were to assess the current competence for diagnosing COPD in primary care in a resource-limited setting in Brazil, and to develop a local patient profile for case-finding. METHODS: 34 general practitioners (GPs) in five areas of northern Brazil recruited adult patients with principal complaints of cough and/or shortness of breath who then had spirometry (n = 142). RESULTS: For the dichotomous variable 'COPD' the degree of agreement between GP diagnosis (n = 64, 18.3%) and spirometric outcome (n = 36, 25.4%) was poor, with Kappa = 0.055 (SE 0.087) and DOR = 1.35. False-positive and false-negative diagnosis proportions were 19.8% and 75%, respectively. Independent risk factors were 'smoking history of more than five pack years' and 'presence of both dyspnoea and cough'. It requires the testing of 2.2 smokers with more than five pack years to detect one patient at risk. CONCLUSIONS: COPD is a common yet underdiagnosed disease in Brazilian primary care. Spirometry improves diagnostic competence and case-finding substantially. If applied in a pre-selected high-risk population, we believe spirometry can be a cost-effective diagnostic tool for case-finding in the resource-limited setting. This study provides important baseline information for effective guideline implementation.     

重度粪类圆线虫感染1例

本文报道1例因咳嗽、气喘而行常规痰标本涂片检查发现的重度粪类圆线虫感染患者,旨在提高临床医师对粪类圆线虫病的认识,避免和减少误诊、漏诊。     

Development of a population-based screening questionnaire for COPD

COPD is commonly under-diagnosed, in part because people at risk are unaware of the relevant risk factors and do not recognize related symptoms. Providing this information might permit earlier disease identification but the questions chosen should identify those with spirometrically defined airflow obstruction. Using a population-based data set, we have determined which questions identify persons most likely to have airflow obstruction. Potential questions were selected by review of COPD risk factors and clinical features. Validation was by retrospective analysis of the NHANES III data set, a population-based U.S. household survey that included spirometry. We examined the predictive ability of individual questions in a multi-variate framework to correctly discriminate between persons with and without spirometric airway obstruction (defined as FEV1/FVC < 0.70). We then tested the discriminatory ability of the questions in combination. The following items showed significant predictive ability: increased age, smoking status, pack-years, cough, wheeze, and prior diagnosis of asthma or COPD. The best performing combination was age, smoking status, pack-years smoked, wheeze, phlegm, body mass index, and prior diagnosis of obstructive lung disease. Using this combination in a population of current and former smokers aged 40 and over, we achieved a sensitivity of 85% and specificity of 45%, with a positive predictive value of 38% and a negative predictive value of 88%. Performance of this tool is comparable to other screening methods designed for use in a general population. Symptom-based questionnaires can be a viable method to identify persons likely to have COPD in the general population. Dissemination of such tools should raise awareness among at-risk persons and help identify COPD patients in the primary care setting.     

Low awareness of COPD among physicians

Introduction: Early identification of patients with chronic obstructive pulmonary disease (COPD) in the health care system followed by successful smoking cessation may prevent rapid lung function deterioration, development of severe COPD and respiratory failure. Objectives: The aim of this study was to determine the frequency of under‐diagnosed chronic obstructive lung diseases among current smokers. Materials and methods: The under‐diagnosis of COPD among smokers was determined in subjects who participated in a screening procedure aimed at recruiting COPD patients for a smoking cessation programme. In order to identify current smokers, a questionnaire was sent out to persons who had been on sick leave for various reasons certified by a physician for more than 2 weeks. Subjects who stated that they currently smoked more than eight cigarettes per day were invited to perform a lung function test. Results: A total of 3887 subjects performed spirometry, i.e. forced expiratory volume in 1 s and forced expirations, and among these, 674 (17.3%) had COPD according to the European Respiratory Society (ERS) consensus guidelines. Of those, 103 (17.3%) had physician‐diagnosed COPD. Productive cough was reported by 16.6% of the COPD subjects. Despite the fact that smokers were on sick leave certified by a physician, more than 80% of those with COPD had no previous diagnosis. As the COPD diagnosis cannot be based on reported symptoms, a spirometry on persons at risk must be performed. Conclusion: The awareness of COPD among primary care physicians has to increase and smokers above the age of 40, with and without respiratory symptoms, have to undergo spirometry if it is regarded important to establish the COPD diagnosis at an early stage. Please cite this paper as: Sundblad B‐M, Larsson K and Nathell L. Low awareness of COPD among physicians. The Clinical Respiratory Journal 2008; 2: 11–16.