Patient Factors and Clinical Efficacy of Early Identification and Treatment of Chronic Obstructive Pulmonary Disease and Asthma.

Objectives: To determine if the benefits of early diagnosis and treatment were greater in individuals with more advanced disease or in individuals with asthma as opposed to COPD.

目标：确定早期诊断和治疗的好处是否在疾病更晚期的个体或患有哮喘而非COPD的个体中更大。

We also assessed whether pulmonologist-directed care benefited asthma and COPD subgroups equally.

我们还评估了肺科医生指导的护理是否对哮喘和慢性阻塞性肺疾病（COPD）亚组同样有益。

Methods: Case finding was used to identify adults with undiagnosed chronic respiratory symptoms in the community.

方法：使用病例发现方法来识别社区中未被诊断的慢性呼吸系统症状的成年人。

A total of 508 newly diagnosed participants with COPD or asthma were randomized to receive pulmonologist-care intervention or usual care.

共有508名新诊断的慢性阻塞性肺疾病（COPD）或哮喘患者被随机分配接受肺科医生干预或常规护理。

Low and high disease burden categories for the St. George's Respiratory Questionnaire (SGRQ) and COPD Assessment Test were defined using a median-split of baseline scores, and minimal clinically important difference thresholds were used to define significant responses.

使用基线评分的中位数分割法定义了圣乔治呼吸问卷（SGRQ）和慢性阻塞性肺疾病评估测试（CAT）的低疾病负担和高疾病负担类别，并使用最小临床重要差异阈值来定义显著反应。

Benefits of pulmonologist care were assessed by evaluating treatment effects within subgroups and by assessing treatment-by-subgroup interactions.

通过评估治疗效果在亚组中的差异以及治疗与亚组之间的相互作用来评估肺科医生护理的好处。

Measurements and Main Results: Patients with higher disease burden at diagnosis were more likely to benefit from early diagnosis and treatment compared with those with lower disease burden.

测量和主要结果：与疾病负担较低的患者相比，诊断时疾病负担较高的患者更有可能从早期诊断和治疗中受益。

A total of 71% of those with high disease burden showed an improvement in COPD Assessment Test score by ⩾2 points over 12 months compared with 47% with low disease burden (odds ratio, 2.78; 95% confidence interval, 1.90-4.07; P < 0.001).

在高疾病负担的患者中，有71%的人在12个月内COPD评估测试评分提高了至少2分，而在低疾病负担的患者中这一比例为47%（比值比，2.78；95%置信区间，1.90-4.07；P < 0.001）。

Similar results were seen for SGRQ and FEV1 improvements.

SGRQ和FEV1的改善也显示出类似的结果。

In contrast, responses to early diagnosis and treatment were similar for those with asthma versus COPD.

相比之下，对于早期诊断和治疗的反应，在哮喘患者和COPD患者之间是相似的。

Individuals with asthma randomized to undergo pulmonologist-directed care showed greater 1-year improvements in COPD Assessment Test score, SGRQ score, 36-item Short Form score, and FEV1 compared with individuals randomized to receive primary care.

随机接受肺科医生指导护理的哮喘患者，在COPD评估测试评分、SGRQ评分、36项简短形式评分和FEV1方面，与随机接受初级保健的患者相比，1年内的改善更为显著。

However, individuals with COPD experienced similar improvements regardless of whether their treatment was managed by a pulmonologist or primary care provider.

然而，无论慢性阻塞性肺疾病（COPD）患者的治疗是由肺科医生还是初级保健提供者管理，他们的改善情况相似。

Treatment-by-disease interaction terms were not statistically significant.

治疗与疾病的交互作用项在统计上不显著。

Conclusions: Patients with greater disease burden who exhibited more advanced and symptomatic asthma and COPD at the time of diagnosis benefited more from earlier diagnosis and treatment.

结论：在诊断时表现出更严重和有症状的哮喘和COPD的疾病负担更大的患者，从早期诊断和治疗中受益更多。

Patients with asthma tended to derive greater benefit from pulmonologist-directed care than patients with COPD.

哮喘患者往往从肺科医生指导的护理中获得比COPD患者更大的益处。