COPD轻度急性加重或1次中度急性加重的预后意义：一项前瞻性社区队列研究

原文

BACKGROUND: The association between frequent COPD exacerbations and poor respiratory health outcomes is well established, but the associations of only mild exacerbations and only 1 moderate exacerbation with prognosis remain controversial, especially among community participants with COPD. RESEARCH QUESTION: Are mild exacerbations and 1 moderate exacerbation associated with worse respiratory health outcomes in participants with COPD? STUDY DESIGN AND METHODS: We analyzed data from a multicenter, prospective, community-based cohort study. Moderate exacerbation was defined as new onset or worsening of respiratory symptoms requiring outpatient visit and antibiotic or oral corticosteroid treatment. Mild exacerbation was defined as new onset or worsening of respiratory symptoms requiring only home treatment with medications. The study outcomes included exacerbations and lung function decline over the 3-year follow-up. RESULTS: Of the 915 participants with COPD, 52 (6%) participants experienced frequent exacerbations, 45 (5%) participants experienced only 1 moderate exacerbation, 41 (4%) participants experienced only mild exacerbations, and 777 (85%) participants experienced no exacerbations in the previous year. Participants experiencing only mild exacerbations had more severe emphysema, and participants experiencing only 1 moderate exacerbation had more severe air trapping than those without any exacerbations. Participants with mild exacerbations (rate ratio [RR], 1.67 [95% CI, 1.11-2.51; P = .014] and 1.76 [95% CI, 1.13-2.73; P = .012], respectively) or 1 moderate exacerbation (RR, 1.89 [95% CI, 1.31-2.73; P < .001] and 2.29 [95% CI, 1.55-3.38, P < .001], respectively) showed a higher incidence of total exacerbation and moderate to severe exacerbations than those without exacerbations. No significant difference was found in the annual rate of lung function decline among these participants. INTERPRETATION: Our results show that among community-based participants with COPD, even with a low exacerbation burden, mild exacerbations and a single moderate exacerbation in the year before enrollment were associated with more severe CT imaging-defined lung structural abnormalities and a higher incidence of subsequent exacerbations over 3 years of follow-up.