Association between lung function and exacerbation frequency in patients with COPD.
Association between lung function and exacerbation frequency in patients with COPD.
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DOI：
10.2147/copd.s13826
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发表时间：
2010-12-09
影响因子：
2.8
通讯作者：
Molken, Maureen Rutten-van
中科院分区：
文献类型：
--
作者：
Hoogendoorn, Martine;Feenstra, Talitha L;Molken, Maureen Rutten-van
目的：量化全球慢性阻塞性肺疾病倡议 (GOLD) 阶段所表达的慢性阻塞性肺疾病 (COPD) 严重程度与 COPD 患者每年的恶化频率之间的关系。 方法：我们进行了系统性文献综述，以确定报告接受常规治疗或安慰剂的 COPD 患者的恶化频率的随机对照试验和队列研究。确定了由医疗保健使用增加（基于事件）定义的总恶化、由症状增加定义的总恶化以及由住院定义的严重恶化的年度频率。使用具有随机效应的加权对数线性回归估计研究人群的平均一秒用力呼气量 (FEV(1))% 预测与恶化频率之间的关联。将回归方程应用于每个 GOLD 阶段预测的平均 FEV(1)%，以估计每个阶段的频率。 结果：找到了 37 项相关研究，其中 43 项报告总急性加重频率（基于事件，n = 19；基于症状，n = 24），14 项报告严重急性加重频率。每个 GOLD 阶段的每年基于事件的急性加重频率估计为：轻度为 0.82（95% 置信区间为 0.46-1.49），中度为 1.17（0.93-1.50），重度为 1.61（1.51-1.74），极重度为 2.10（1.51-2.94）。每年基于症状的频率分别为 1.15（95% 置信区间 0.67-2.07）、1.44（1.14-1.87）、1.76（1.70-1.88）和 2.09（1.57-2.82）。对于严重恶化，年频率分别为 0.11（95% 置信区间 0.02-0.56）、0.16（0.07-0.33）、0.22（0.20-0.23）和 0.28（0.14-0.63）。研究持续时间或研究类型（队列与试验）对结果没有显着影响。结论：本研究提供了每个 GOLD 阶段的恶化频率的估计，可用于健康经济学和建模目的。
PURPOSE: To quantify the relationship between severity of chronic obstructive pulmonary disease (COPD) as expressed by Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage and the annual exacerbation frequency in patients with COPD.METHODS: We performed a systematic literature review to identify randomized controlled trials and cohort studies reporting the exacerbation frequency in COPD patients receiving usual care or placebo. Annual frequencies were determined for total exacerbations defined by an increased use of health care (event-based), total exacerbations defined by an increase of symptoms, and severe exacerbations defined by a hospitalization. The association between the mean forced expiratory volume in one second (FEV(1))% predicted of study populations and the exacerbation frequencies was estimated using weighted log linear regression with random effects. The regression equations were applied to the mean FEV(1)% predicted for each GOLD stage to estimate the frequency per stage.RESULTS: Thirty-seven relevant studies were found, with 43 reports of total exacerbation frequency (event-based, n = 19; symptom-based, n = 24) and 14 reports of frequency of severe exacerbations. Annual event-based exacerbation frequencies per GOLD stage were estimated at 0.82 (95% confidence interval 0.46-1.49) for mild, 1.17 (0.93-1.50) for moderate, 1.61 (1.51-1.74) for severe, and 2.10 (1.51-2.94) for very severe COPD. Annual symptom-based frequencies were 1.15 (95% confidence interval 0.67-2.07), 1.44 (1.14-1.87), 1.76 (1.70-1.88), and 2.09 (1.57-2.82), respectively. For severe exacerbations, annual frequencies were 0.11 (95% confidence interval 0.02-0.56), 0.16 (0.07-0.33), 0.22 (0.20-0.23), and 0.28 (0.14-0.63), respectively. Study duration or type of study (cohort versus trial) did not significantly affect the outcomes.CONCLUSION: This study provides an estimate of the exacerbation frequency per GOLD stage, which can be used for health economic and modeling purposes.