What is a COPD exacerbation? Current definitions, pitfalls, challenges and opportunities for improvement
What is a COPD exacerbation? Current definitions, pitfalls, challenges and opportunities for improvement
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DOI：
10.1183/13993003.01261-2018
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发表时间：
2018-11-01
影响因子：
24.3
通讯作者：
Aaron, Shawn D.
中科院分区：
文献类型：
--
作者：
Kim, Victor;Aaron, Shawn D.
慢性阻塞性肺疾病 (COPD) 是一种慢性疾病，可周期性地恶化，其特征是症状急性恶化，包括呼吸困难、咳嗽、咳痰和脓痰增加。 COPD 加重很常见，会产生重要的临床和经济后果，包括工作效率下降、医疗资源利用率增加、肺功能和运动能力暂时或永久性下降、住院治疗，有时甚至死亡。在过去的二十年中，临床医生和研究人员扩大了慢性阻塞性肺病的治疗目标，不仅限于改善肺功能和症状，并开始强调预防和减少病情加重的重要性。然而，尽管临床医生和指南委员会尽了最大努力，目前 COPD 急性加重的定义仍然不完善且充满问题。慢性阻塞性肺病恶化的主要症状是非特异性的，可能是由慢性阻塞性肺病以外的急性心肺疾病引起的。拟议的定义可能比目前的定义更具体，建议将 COPD 恶化定义为呼吸困难的急性或亚急性恶化（视觉模拟量表上的 5 分，范围从 0 到 10），但不一定伴有咳嗽、痰量和/或痰脓性增加。病情加重的必要实验室标准包括氧饱和度 = 9000 中性粒细胞.mm(-3) 或 >= 2% 血液嗜酸性粒细胞）和 C 反应蛋白升高（>= 3 mg.L-1），胸部 X 线检查无肺炎或肺水肿证据，且其他病因的实验室检查结果为阴性。在此，我们讨论当前关于如何定义 COPD 恶化、相关陷阱和挑战以及改进机会的最新技术。
Chronic obstructive pulmonary disease (COPD) is a chronic illness that can be periodically punctuated by exacerbations, characterised by acute worsening of symptoms, including increased dyspnoea, cough, sputum production and sputum purulence. COPD exacerbations are common and have important clinical and economic consequences, including lost work productivity, increased utilisation of healthcare resources, temporary or permanent reductions in lung function and exercise capacity, hospitalisation, and sometimes death. Over the past two decades, clinicians and researchers have broadened their treatment goals for COPD to extend beyond improving lung function and symptoms, and have begun to address the importance of preventing and reducing exacerbations. However, despite the best efforts of clinicians and guideline committees, current definitions of COPD exacerbations are imperfect and fraught with problems. The cardinal symptoms of a COPD exacerbation are nonspecific and can result from acute cardiorespiratory illnesses other than COPD. A proposed definition, which may be more specific than current definitions, suggests that COPD exacerbation be defined as an acute or subacute worsening of dyspnoea (. 5 on a visual analogue scale that ranges from 0 to 10) sometimes but not necessarily accompanied by increased cough, sputum volume and/or sputum purulence. Necessary laboratory criteria for an exacerbation include oxygen desaturation = 9000 neutrophils.mm(-3) or >= 2% blood eosinophils) and elevated C-reactive protein (>= 3 mg.L-1), without evidence of pneumonia or pulmonary oedema on chest radiography and with negative laboratory test results for other aetiologies. Herein, we discuss the current state of the art with respect to how we define COPD exacerbations, associated pitfalls and challenges, and opportunities for improvement.