Understanding low COPD exacerbation rates in Japan: a review and comparison with other countries.
Understanding low COPD exacerbation rates in Japan: a review and comparison with other countries.
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DOI：
10.2147/copd.s165187
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发表时间：
2018
影响因子：
2.8
通讯作者：
Jones P
中科院分区：
文献类型：
--
作者：
Ishii T;Nishimura M;Akimoto A;James MH;Jones P
慢性阻塞性肺病与显著发病率相关，是世界范围内死亡的主要原因之一。加重期，即症状的急性恶化，散布在疾病的整个自然病程中，可导致慢性阻塞性肺病患者的治疗负担和住院治疗增加。病情恶化的频率因国家而异，流行病学研究和随机对照试验（rct）均显示观察到的患病率存在显著差异。研究设计和医疗环境的差异可能导致急性发作频率的差异，但目前日本的急性发作感知率低于世界其他地区。本综述确定了9项队列研究和5项随机对照试验，分别报道了日本COPD年加重率在0.1-2.1和0.33-1.79之间。两项研究之间的恶化率差异似乎大于日本和西方国家之间的差异，这可能是由于环境、设计和纳入标准之间的差异。其中，只有一项（了解噻托溴铵的长期影响）在不同地区有统一的纳入标准。该研究发现，日本每位患者的加重事件年发生率为0.61，而全球安慰剂组的加重事件年发生率为0.85。本综述总结了日本和世界其他地区已公布的COPD加重率，并探讨了日本发生率可能低于其他国家的假设。这些因素包括医疗保健的可及性、相关发病率的差异、环境因素、与相关疾病的诊断交叉以及研究设计的差异（包括日本COPD加重的低报）。了解日本COPD恶化率较低的原因可以帮助临床医生认识和修改治疗行为，这可能会改善所有人群的患者预后。
COPD is associated with significant morbidity and is one of the leading causes of death worldwide. Periods of exacerbation, the acute worsening of symptoms, are interspersed throughout the disease’s natural history and can result in increased treatment burden and hospitalization for patients with COPD. The frequency of exacerbations varies between countries, with both epidemiological studies and randomized controlled trials (RCTs) showing significant differences in observed prevalence rates. Differences in study design and the healthcare setting are likely to contribute to differences in exacerbation frequency, however the perceived rate of exacerbations in Japan is currently lower then the rest of the world. This review identified nine cohort studies and five RCTs that reported COPD annual exacerbation rates in Japan in the ranges of 0.1–2.1 and 0.33–1.79, respectively. The difference in exacerbation rate between studies appeared greater than the difference between Japan and Western countries, likely because of disparities between settings, design, and inclusion criteria. Of these, only one (Understanding the Long-Term Impacts of Tiotropium) had uniform inclusion criteria across different regions. This study found that the annual rate of exacerbation events per patient in Japan was 0.61, compared with 0.85 worldwide in the placebo groups. This review summarizes the published rates of COPD exacerbations in Japan and the rest of the world and explores the hypotheses as to why rates in Japan might be lower than other countries. These include access to medical care, variance in the associated morbidity profile, environmental factors, diagnostic crossover with related diseases, and differences in study design (including the underreporting of COPD exacerbations in Japan). Understanding the reasons why COPD exacerbation rates appear lower in Japan could help clinicians to recognize and modify treatment behaviors, which may lead to improved patient outcomes in all populations.