根據(jù)慢性阻塞性肺疾病全球創(chuàng)議(GOLD)的定義,慢性阻塞性肺疾病急性加重(AECOPD)是“在COPD的自然病程中發(fā)生的事件,氣緊、咳嗽或/和咳痰等基礎(chǔ)癥狀加重超出正常的日間變異的范圍,急性發(fā)病,可能需要改變常規(guī)的治療”[1]。AECOPD意味著對(duì)醫(yī)療衛(wèi)生資源耗用的增加,如非預(yù)約的就醫(yī)、使用藥物增加,使用抗生素或口服皮質(zhì)激素甚至住院,等等。僅僅依據(jù)是否占用衛(wèi)生資源來定義AECOPD并不適當(dāng),這一點(diǎn)還要取決于醫(yī)療衛(wèi)生資源的可獲得性,同時(shí)有研究提示部分AECOPD可以是自限性的,特別是輕度急性加重。另一方面,占用醫(yī)療衛(wèi)生資源的形式可以大致評(píng)估AECOPD的嚴(yán)重程度,如需要增加常規(guī)的吸人性藥物常常意味著輕度AECOPD,需要短程口服抗生素或糖皮質(zhì)激素意味著中度AECOPD,而需要住院者多為重度AECOPD。AECOPD是導(dǎo)致COPD患者健康狀態(tài)降低乃至死亡的主要原因,也是耗用醫(yī)療衛(wèi)生資源從而構(gòu)成COPD疾病負(fù)擔(dān)的主要部分,需要采用有力的干預(yù)措施以降低其發(fā)生率[2]。
引用本文: 劉春濤,馮玉麟. 慢性阻塞性肺疾病急性加重研究進(jìn)展. 中國呼吸與危重監(jiān)護(hù)雜志, 2007, 6(6): 413-415. doi: 復(fù)制
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2. | Seemungal TA,Donaldson GC,Bhowmik A,et al.Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease.Am J Respir Crit Care Med,2000,161:1608-1613. |
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4. | Perera WR,Hurst JR,Wilkinson TM,et al.Inflammatory changes,recovery and recurrence at COPD exacerbation.Eur Respir J,2007,29:527-534. |
5. | Seemungal T,Harper-Owen R,Bhowmik A,et al.Respiratory viruses,symptoms,and inflammatory markers in acute exacerbations and stable chronic obstructive pulmonary disease.Am J Respir Crit Care Med,2001,164:1618-1623. |
6. | Hurst JR,Wilkinson TM,Perera WR,et al.Relationships among bacteria,upper airway,lower airway,and systemic inflammation in COPD.Chest,2005,127:1219-1226. |
7. | Ram FSF,Rodriguez-Roisin R,Granado-Navarrete A,et al.Antibiotics for exacerbation of chronic obstructive pulmonary disease.Cochrane Database Syst Rev,2006,2:CD004403. |
8. | Calverley PM,Anderson JA,Celli B,et al.Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease.N Engl J Med,2007,356:775-789. |
9. | Calverley PM,Boonsawat W,Cseke Z,et al.Maintenance therapy with budesonide and formoterol in chronic obstructive pulmonary disease.Eur Respir J,2003,22:912-919. |
10. | Casanova C,Celli BR,Tost L,et al.Long-term controlled trial of nocturnal nasal positive pressure ventilation in patients with severe COPD.Chest,2000,118:1582-1590. |
- 1. Rabe KF,Hurd S,Anzueto A,et al.Global strategy for the diagnosis,management,and prevention of chronic obstructive pulmonary disease:GOLD executive summary.Am J Respir Crit Care Med,2007,176:532-555.
- 2. Seemungal TA,Donaldson GC,Bhowmik A,et al.Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease.Am J Respir Crit Care Med,2000,161:1608-1613.
- 3. O’Donnell DE,Parker CM.COPD exacerbations 3:Pathophysiology.Thorax,2006,61:354-361.
- 4. Perera WR,Hurst JR,Wilkinson TM,et al.Inflammatory changes,recovery and recurrence at COPD exacerbation.Eur Respir J,2007,29:527-534.
- 5. Seemungal T,Harper-Owen R,Bhowmik A,et al.Respiratory viruses,symptoms,and inflammatory markers in acute exacerbations and stable chronic obstructive pulmonary disease.Am J Respir Crit Care Med,2001,164:1618-1623.
- 6. Hurst JR,Wilkinson TM,Perera WR,et al.Relationships among bacteria,upper airway,lower airway,and systemic inflammation in COPD.Chest,2005,127:1219-1226.
- 7. Ram FSF,Rodriguez-Roisin R,Granado-Navarrete A,et al.Antibiotics for exacerbation of chronic obstructive pulmonary disease.Cochrane Database Syst Rev,2006,2:CD004403.
- 8. Calverley PM,Anderson JA,Celli B,et al.Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease.N Engl J Med,2007,356:775-789.
- 9. Calverley PM,Boonsawat W,Cseke Z,et al.Maintenance therapy with budesonide and formoterol in chronic obstructive pulmonary disease.Eur Respir J,2003,22:912-919.
- 10. Casanova C,Celli BR,Tost L,et al.Long-term controlled trial of nocturnal nasal positive pressure ventilation in patients with severe COPD.Chest,2000,118:1582-1590.