Relationship between respiratory symptoms and medical treatment in exacerbations of COPID
Relationship between respiratory symptoms and medical treatment in exacerbations of COPID
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DOI：
10.1183/09031936.05.00143404
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发表时间：
2005-09-01
影响因子：
24.3
通讯作者：
Ståhl, E
中科院分区：
文献类型：
--
作者：
Calverley, P;Pauwels, R;Ståhl, E
慢性阻塞性肺疾病（COPD）加重可通过病理学或医疗保健联系人进行定义，但这些事件之间的关系尚不清楚。在一项为期1年的COPD患者布地奈德/福莫特罗联合治疗研究中收集数据，将急性加重（定义为治疗增加）与呼吸道症状、急救药物使用和呼气峰流速（PEF）的每日记录进行比较，使用不同的建模方法检查这些变量的变化与医疗事件之间的关系。468例患者首次急性加重经口服糖皮质激素和/或抗生素和/或住院治疗（基于事件）的数据可用，急性加重患者比健康患者更容易呼吸困难，更容易报告咳嗽，但基线肺功能测定无差异。根据个体症状变化定义的急性加重与基于事件的急性加重仅弱相关;然而，根据症状变化预测63%的此类事件。补救药物使用或PEF的变化是基于事件的急性加重的不良预测因子。症状的平均峰值变化与治疗开始时间密切相关。总之，基于事件的急性加重是识别慢性阻塞性肺疾病人群急性症状变化的有效方法。然而，使用当前的日记卡进行个人管理决策时，日常症状监测变化太大。
Exacerbations of chronic obstructive pulmonary disease (COPD) can be defined symptomatically or by healthcare contacts, yet the relationship between these events is unknown. Data were collected during a 1-yr study of the budesonide/formoterol combination in COPD patients, where exacerbations, defined by increases in treatment, were compared with daily records of respiratory symptoms, rescue medication use and peak expiratory flow (PEF).The relationship between changes in these variables and the medical event was examined using different modelling approaches. Data from the first exacerbation treated with oral corticosteroids and/or antibiotics and/or hospitalisation (event based) were available in 468 patients.Patients exacerbating were significantly more breathless and more likely to report cough than healthy patients, but did not differ in baseline spirometry. Exacerbations defined by changes in individual symptoms were only weakly related to event-based exacerbations; however, defined with 63% of such events being predicted from symptom changes. Changes in rescue medication use or PEF were poor predictors of event-based exacerbations. The mean peak change in symptoms was closely related to the onset of therapy.In conclusion, event-based exacerbations are a valid way of identifying acute symptom change in a chronic obstructive pulmonary disease population. However, daily symptom monitoring is too variable using the current diary cards to make individual management decisions.