有或不伴慢性阻塞性肺疾病的吸烟人群的急性加重和肺功能丧失
2017/09/29
摘要
背景：慢性阻塞性肺疾病（COPD）的急性加重增加了死亡的风险并对医疗费用造成极大负担，但AECOPD是否加速肺功能的丧失仍然存在争议。轻度COPD患者的急性加重或类似的急性呼吸道事件在没有气流阻塞的吸烟人群中是否造成肺功能下降仍未可知。
目的：在5年的随访中确定慢性阻塞性肺病急性加重（无COPD患者的急性呼吸道事件）与肺功能变化之间的关系。
方法：本研究的数据来自于入组COPDGene5年后第2次回访的前2000名患者。基线数据包括人口统计学、吸烟史和计算机断层扫描肺气肿。我们将急性加重（急性呼吸道事件）定义为需要抗生素或全身类固醇治疗的急性呼吸道症状，以及需要住院治疗的严重事件。在5年随访期间，间隔6个月对患者自我记录的急性加重事件数据进行收集。我们使用线性混合模型来拟合在急性加重事件的基础上FEV 1的下降。
结果：COPD患者急性加重与FEV 1明显下降相关，在GOLD 1级患者中表现最明显，此类患者每次急性加重可导致FEV1平均以23ml /年的速率下降（95%置信区间，2–44ml/年；P = 0.03），每次重度加重可导致FEV1以87ml /年的速率下降（95%置信区间，23–151 ml/年；P = 0.008）；在GOLD2-3级患者中急性加重与FEV1下降具有统计学有意义的相关性，但效应不明显。在无气流阻塞的受试者中急性呼吸事件与FEV 1下降无关。
结论：COPD患者，尤其是轻度患者，急性加重与加速肺功能丧失有关。需要在早期/轻度COPD患者中进行试验来测试现有的和新的治疗方法，以降低进展为晚期肺部疾病的风险。
Acute Exacerbations and Lung Function Loss in Smokers with and without Chronic Obstructive Pulmonary Disease
Mark T. Dransfield , Ken M. Kunisaki, Matthew J. Strand, Antonio Anzueto, Surya P. Bhatt , Russell P. Bowler,GerardJ.Criner,JeffreyL.Curtis,NicolaA.Hanania ,HrudayaNath ,NirupamaPutcha ,SarahE.Roark,EmilyS.Wan,George R. Washko, J. Michael Wells, Christine H. Wendt, and Barry J.
Abstract
BACKGROUND:Acute exacerbations of chronic obstructive pulmonary disease (COPD) increase the risk of death and drive healthcare costs, but whether they accelerate loss of lung function remains controversial. Whether exacerbations in subjects with mild COPD or similar acute respiratory events in smokers without airflow obstruction affect lung function decline is unknown.
OBJECTIVE:To determine the association between acute exacerbations of COPD (and acute respiratory events in smokers without COPD) and the change in lung function over 5 years of follow-up.
METHODS: We examined data on the first 2,000 subjects who returned for a second COPDGene visit 5 years after enrollment. Baseline data included demographics, smoking history, and computed tomography emphysema. We defined exacerbations (and acute respiratory events in those without established COPD) as acute respiratory symptoms requiring either antibiotics or systemic steroids, and severe events by the need for hospitalization. Throughout the 5-year follow-up period, we collected self-reported acute respiratory event data at 6-month intervals. We used linear mixed models to fit FEV 1 decline based on reported exacerbations or acute respiratory events.
RESULTS:In subjects with COPD, exacerbations were associated with excess FEV 1 decline, with the greatest effect in Global Initiative for Chronic Obstructive Lung Disease stage 1, where each exacerbation was associated with an additional 23ml/yr decline(95%confidence interval,2–44;P= 0.03), and each severe exacerbation with an additional 87 ml/yr decline (95% confidence interval, 23–151; P= 0.008); statistically significant but smaller effects were observed in Global Initiative for Chronic Obstructive Lung Disease stage 2 and 3 subjects. In subjects without airflow obstruction, acute respiratory events were not associated with additional FEV 1 decline.
CONCLUSIONS:Exacerbations are associated with accelerated lung function loss in subjects with established COPD, particularly those with mild disease. Trials are needed to test existing and novel therapies in subjects with early/mild COPD to potentially reduce the risk of progressing to more advanced lung disease.
背景：慢性阻塞性肺疾病（COPD）的急性加重增加了死亡的风险并对医疗费用造成极大负担，但AECOPD是否加速肺功能的丧失仍然存在争议。轻度COPD患者的急性加重或类似的急性呼吸道事件在没有气流阻塞的吸烟人群中是否造成肺功能下降仍未可知。
目的：在5年的随访中确定慢性阻塞性肺病急性加重（无COPD患者的急性呼吸道事件）与肺功能变化之间的关系。
方法：本研究的数据来自于入组COPDGene5年后第2次回访的前2000名患者。基线数据包括人口统计学、吸烟史和计算机断层扫描肺气肿。我们将急性加重（急性呼吸道事件）定义为需要抗生素或全身类固醇治疗的急性呼吸道症状，以及需要住院治疗的严重事件。在5年随访期间，间隔6个月对患者自我记录的急性加重事件数据进行收集。我们使用线性混合模型来拟合在急性加重事件的基础上FEV 1的下降。
结果：COPD患者急性加重与FEV 1明显下降相关，在GOLD 1级患者中表现最明显，此类患者每次急性加重可导致FEV1平均以23ml /年的速率下降（95%置信区间，2–44ml/年；P = 0.03），每次重度加重可导致FEV1以87ml /年的速率下降（95%置信区间，23–151 ml/年；P = 0.008）；在GOLD2-3级患者中急性加重与FEV1下降具有统计学有意义的相关性，但效应不明显。在无气流阻塞的受试者中急性呼吸事件与FEV 1下降无关。
结论：COPD患者，尤其是轻度患者，急性加重与加速肺功能丧失有关。需要在早期/轻度COPD患者中进行试验来测试现有的和新的治疗方法，以降低进展为晚期肺部疾病的风险。
(中日友好医院呼吸科 张科文 摘译 林江涛 审校)
（Am J Respir Crit Care Med Vol 195, Iss 3, pp 324–330, Feb 1, 2017）
（Am J Respir Crit Care Med Vol 195, Iss 3, pp 324–330, Feb 1, 2017）
Acute Exacerbations and Lung Function Loss in Smokers with and without Chronic Obstructive Pulmonary Disease
Mark T. Dransfield , Ken M. Kunisaki, Matthew J. Strand, Antonio Anzueto, Surya P. Bhatt , Russell P. Bowler,GerardJ.Criner,JeffreyL.Curtis,NicolaA.Hanania ,HrudayaNath ,NirupamaPutcha ,SarahE.Roark,EmilyS.Wan,George R. Washko, J. Michael Wells, Christine H. Wendt, and Barry J.
Abstract
BACKGROUND:Acute exacerbations of chronic obstructive pulmonary disease (COPD) increase the risk of death and drive healthcare costs, but whether they accelerate loss of lung function remains controversial. Whether exacerbations in subjects with mild COPD or similar acute respiratory events in smokers without airflow obstruction affect lung function decline is unknown.
OBJECTIVE:To determine the association between acute exacerbations of COPD (and acute respiratory events in smokers without COPD) and the change in lung function over 5 years of follow-up.
METHODS: We examined data on the first 2,000 subjects who returned for a second COPDGene visit 5 years after enrollment. Baseline data included demographics, smoking history, and computed tomography emphysema. We defined exacerbations (and acute respiratory events in those without established COPD) as acute respiratory symptoms requiring either antibiotics or systemic steroids, and severe events by the need for hospitalization. Throughout the 5-year follow-up period, we collected self-reported acute respiratory event data at 6-month intervals. We used linear mixed models to fit FEV 1 decline based on reported exacerbations or acute respiratory events.
RESULTS:In subjects with COPD, exacerbations were associated with excess FEV 1 decline, with the greatest effect in Global Initiative for Chronic Obstructive Lung Disease stage 1, where each exacerbation was associated with an additional 23ml/yr decline(95%confidence interval,2–44;P= 0.03), and each severe exacerbation with an additional 87 ml/yr decline (95% confidence interval, 23–151; P= 0.008); statistically significant but smaller effects were observed in Global Initiative for Chronic Obstructive Lung Disease stage 2 and 3 subjects. In subjects without airflow obstruction, acute respiratory events were not associated with additional FEV 1 decline.
CONCLUSIONS:Exacerbations are associated with accelerated lung function loss in subjects with established COPD, particularly those with mild disease. Trials are needed to test existing and novel therapies in subjects with early/mild COPD to potentially reduce the risk of progressing to more advanced lung disease.
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慢性阻塞性肺疾病的一种特殊表型：由生物燃料烟雾引起的COPD
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成人胃食管反流性慢性咳嗽：CHEST指南和专家小组报告
