Therapy with proton-pump inhibitors for gastroesophageal reflux disease does not reduce the risk for severe exacerbations in COPD
Therapy with proton-pump inhibitors for gastroesophageal reflux disease does not reduce the risk for severe exacerbations in COPD
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DOI：
10.1111/resp.12758
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发表时间：
2016-07-01
期刊：
影响因子：
6.9
通讯作者：
Stolz, Daiana
中科院分区：
文献类型：
--
作者：
Baumeler, Luzia;Papakonstantinou, Eleni;Stolz, Daiana
背景和目的胃食道反流病(GERD)的症状与慢性阻塞性肺疾病(COPD)恶化的风险高相关。我们假设质子泵抑制剂治疗可以降低稳定期COPD患者病情恶化的风险。方法我们前瞻性地评估了638例COPD稳定期患者，这些患者在8个欧洲国家的三级医院寻求慢性阻塞性肺疾病全球倡议II-IV治疗，病情稳定6周，吸烟10包年，使用严重恶化的系统标志物预测预后。在基线、病情加重和一年两次的访问中评估包括相关医疗治疗在内的合并症。中位观察时间为24个月。结果85例(13.3%)COPD患者接受了抗GERD治疗。这些患者的年和严重恶化发生率较高(P=0.009和P=0.002)，生活质量下降(SF-36：活动评分P=0.004，圣乔治呼吸问卷：身体功能P=0.013，社会功能P=0.007)，较高的体质量气流障碍、呼吸困难和运动能力指数(P=0.033)和改良医学研究理事会评分(P=0.002)、较短的6分钟步行距离(P=0.0004)和较高的调整后Charlson评分(P=0.05)。
Background and objectiveGastroesophageal reflux disease (GERD) symptoms are associated with a higher risk of chronic obstructive pulmonary disease (COPD) exacerbation. We hypothesize that treatment with proton pump inhibitors reduces the risk of exacerbation in patients with stable COPD.MethodsA total of 638 patients with stable COPD for 6weeks, 10pack-years of smoking and Global Initiative for Chronic Obstructive Lung Disease II-IV seeking care in tertiary hospitals in eight European countries in the Predicting Outcome using Systemic Markers in Severe Exacerbations-COPD cohort was prospectively evaluated by us. Comorbidities including associated medical treatment were assessed at baseline, at exacerbation and at biannual visits. Median observation time was 24months. The primary study outcomes were exacerbation and/or death.ResultsA total of 85 (13.3%) of COPD patients were on anti-GERD therapy. These patients had higher annual and higher severe exacerbation rates (P=0.009 and P=0.002), decreased quality of life (SF-36: activity score P=0.004, St. George's Respiratory Questionnaire: physical functioning P=0.013 and social functioning P=0.007), higher body mass airflow obstruction, dyspnea and exercise capacity index (P=0.033) and Modified Medical Research Council scores (P=0.002), shorter 6-min walking distance (P=0.0004) and a higher adjusted Charlson score (P