Exacerbation frequency and course of COPD.
Exacerbation frequency and course of COPD.
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DOI：
10.2147/copd.s34186
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发表时间：
2012
影响因子：
2.8
通讯作者：
Tashkin DP
中科院分区：
文献类型：
--
作者：
Halpin DM;Decramer M;Celli B;Kesten S;Liu D;Tashkin DP
病情加重会影响慢性阻塞性肺病 (COPD) 的发病率。我们试图利用一项大型长期试验的数据来评估急性发作频率与肺活量和健康状况随时间的变化之间的关联。这项对 4 年 UPLIFT®（了解噻托溴铵对功能的潜在长期影响）试验数据的回顾性分析将噻托溴铵与安慰剂进行了比较。根据基于恶化频率的亚组（每个患者年的事件：0、>0-1、>1-2 和 >2），使用混合效应模型分析每个时间点的年化下降率和估计平均差异。在基线时和每 6 个月进行一次肺量测定和圣乔治呼吸问卷 (SGRQ)（肺量测定也每一个月进行一次）。总共 5992 名患者（平均年龄 65 岁，75% 男性）被随机分组。较高的发作频率与较低的基线后支气管扩张剂一秒用力呼气量 (FEV1)（1.40、1.36、1.26 和 1.14 L）以及恶化的 SGRQ 评分（43.7、44.1、47.8 和 52.4 单位）相关。支气管扩张剂后 FEV1（毫升/年）的相应下降率为 40、41、43 和 48（对照），以及 34、38、48 和 49（噻托溴铵）。支气管扩张剂后用力肺活量下降的值为 45、56、74 和 83（对照），以及 43、57、83 和 95（噻托铵）。 SGRQ 总评分（单位/年）的恶化率为 0.72、1.16、1.44 和 1.99（对照），以及 0.38、1.29、1.68 和 2.86（噻托溴铵）。整个队列的死亡患者比例（意向治疗分析直至四年[1440天]）随着住院病情加重频率的增加而增加。加重频率的增加会加剧 COPD 患者肺功能和健康相关生活质量的下降速度。住院病情加重率的增加与死亡风险的增加有关。
Exacerbations affect morbidity in chronic obstructive pulmonary disease (COPD). We sought to evaluate the association between exacerbation frequency and spirometric and health status changes over time using data from a large, long-term trial. This retrospective analysis of data from the 4-year UPLIFT® (Understanding Potential Long-term Impacts on Function with Tiotropium) trial compared tiotropium with placebo. Annualized rates of decline and estimated mean differences at each time point were analyzed using a mixed-effects model according to subgroups based on exacerbation frequency (events per patient-year: 0, >0–1, >1–2, and >2). Spirometry and the St George’s Respiratory Questionnaire (SGRQ) were performed at baseline and every 6 months (also at one month for spirometry). In total, 5992 patients (mean age 65 years, 75% male) were randomized. Higher exacerbation frequency was associated with lower baseline postbronchodilator forced expiratory volume in one second (FEV1) (1.40, 1.36, 1.26, and 1.14 L) and worsening SGRQ scores (43.7, 44.1, 47.8, and 52.4 units). Corresponding rates of decline in postbronchodilator FEV1 (mL/year) were 40, 41, 43, and 48 (control), and 34, 38, 48, and 49 (tiotropium). Values for postbronchodilator forced vital capacity decline (mL/year) were 45, 56, 74, and 83 (control), and 43, 57, 83, and 95 (tiotropium). The rates of worsening in total SGRQ score (units/year) were 0.72, 1.16, 1.44, and 1.99 (control), and 0.38, 1.29, 1.68, and 2.86 (tiotropium). The proportion of patients who died (intention-to-treat analysis until four years [1440 days]) for the entire cohort increased with increasing frequency of hospitalized exacerbations. Increasing frequency of exacerbations worsens the rate of decline in lung function and health-related quality of life in patients with COPD. Increasing rates of hospitalized exacerbations are associated with increasing risk of death.