Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease
Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease
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DOI：
10.1164/ajrccm.161.5.9908022
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发表时间：
2000-05-01
影响因子：
24.7
通讯作者：
Wedzicha, JA
中科院分区：
文献类型：
--
作者：
Seemungal, TAR;Donaldson, GC;Wedzicha, JA
尽管慢性阻塞性肺病（COPD）的恶化与症状和生理恶化有关，但人们对这些变化的时间进程和持续时间知之甚少。我们研究了与 COPD 恶化相关的症状和肺功能变化，以确定影响恶化恢复的因素。对 101 名中度至重度 COPD 患者（平均 FEV1，预测值的 41.9%）进行了为期 2.5 年的研究，并在稳定时和恶化期间定期随访 504 例。患者在日记卡上记录每日早晨呼气峰流速（PEFR）和呼吸道症状的变化。一个由 34 名患者组成的亚组还记录了每日肺活量测定。病情加重的定义是主要症状（呼吸困难加重、脓痰增多、痰量增加）和次要症状。在病情恶化之前，呼吸困难、喉咙痛、咳嗽和普通感冒症状恶化（所有 p < 0.05），但肺功能没有恶化。 PEFR 较大下降与恶化时呼吸困难 (p = 0.014)、绳索 (p = 0.047) 或喘息增加 (p = 0.009) 症状增加相关。 PEFR 的中位恢复时间为 6（四分位距 [tQR] 1 至 14）天，每日总症状评分的中位恢复时间为 7（IQR 4 至 14）天。 PEFR 完全恢复至基线值。仅 75.2% 的 35 d 急性加重期 PEFR 未恢复，而 7.1% 的 91 d 急性加重期 PEFR 未恢复。在 91 天时 PEFR 完全恢复至基线值的 404 例急性加重中，急性加重时呼吸困难和感冒的增加与恢复时间延长相关（两种情况下 p < 0.001）。恶化期间的症状变化并不能密切反映肺功能的变化，但症状的增加可能预示着恶化，呼吸困难或感冒的特征更为严重。很大一部分 COPD 急性加重患者的恢复是不完全的。
Although exacerbations of chronic obstructive pulmonary disease (COPD) are associated with symptomatic and physiological deterioration, little is known of the time course and duration of these changes. We have studied symptoms and lung function changes associated with COPD exacerbations to determine factors affecting recovery from exacerbation. A cohort of 101 patients with moderate to severe COPD (mean FEV, 41.9% predicted) were studied over a period of 2.5 yr and regularly followed when stable and during 504 exacerbations. Patients recorded daily morning peak expiratory flow rate (PEFR) and changes in respiratory symptoms on diary cards. A subgroup of 34 patients also recorded daily spirometry. Exacerbations were defined by major symptoms (increased dyspnea, increased sputum purulence, increased sputum volume) and minor symptoms. Before onset of exacerbation there was deterioration in the symptoms of dyspnea, sore throat cough, and symptoms of a common cold (all p < 0.05), but not lung function. Larger falls in PEFR were associated with symptoms of increased dyspnea (p = 0.014), cords (p = 0.047), or increased wheeze (p = 0.009) at exacerbation. Median recovery times were 6 (interquartile range [tQR] 1 to 14) d for PEFR and 7 (IQR 4 to 14) d for daily total symptom score. Recovery of PEFR to baseline values was complete In only 75.2% of exacerbations at 35 d, whereas in 7.1% of exacerbations at 91 d PEFR recovery had not occurred. In the 404 exacerbations where recovery of PEFR to baseline values was complete at 91 d, increased dyspnea and colds at onset of exacerbation were associated with prolonged recovery times (p < 0.001 in both cases). Symptom changes during exacerbation do not closely reflect those of lung function, but their increase may predict exacerbation, with dyspnea or colds characterizing the more severe. Recovery is incomplete in a significant proportion of COPD exacerbations.