Garcia-Aymerich J, Barreiro E, Farrero E, Marrades R M, Morera J, Antó J M
Respiratory and Environmental Health Research Unit, IMIM, Barcelona, Spain.
Eur Respir J. 2000 Dec;16(6):1037-42. doi: 10.1034/j.1399-3003.2000.16f03.x.
There is little information available concerning the extent to which chronic obstructive pulmonarv disease (COPD) patients are satisfactorily managed, especially, regards factors supposedly related to COPD exacerbation. The present study assessed the prevalence rates of potentially modifiable risk factors of COPD exacerbation in patients hospitalized for this reason. A systematic sample of one out of two patients admitted for COPD exacerbation, during 1 yr, in four tertiary hospitals in the Barcelona area, Spain, was performed. Patients answered a questionnaire and underwent anthropometric measurements, spirometric tests and arterial blood gas sampling. Prevalence rates and 95% confidence intervals (95% CI) for risk factors were obtained, and the generalized estimating equation (GEE) method was used to allow for patients to provide information on different admissions. The study recruited 353 patients (29 female) with a total of 404 admissions age (mean+/-SD) 69+/-9, median forced expiratory volume in one second (FEV1) 31% of predicted and mean partial pressure of oxygen (PO2) 63+/-13 mmHg. Of these, 28% had not received an influenza vaccination; a high number (86%) did not attend rehabilitation programmes; 28% of patients with PO2 < or =55 mmHg were not using long-term oxygen therapy (LTOT); among LTOT users, 18% used it <15 h a day; 43% of the total failed in some of the essential inhaler manoeuvres; 26% were current smokers; 21% of noncurrent smokers were exposed to passive smoking at home; current occupational exposure was low (5%). In summary, the authors found a moderate to high prevalence of potentially modifiable risk factors in a large representative sample of patients hospitalized for a chronic obstructive pulmonary disease exacerbation, suggesting unsatisfactory features in their management.
关于慢性阻塞性肺疾病（COPD）患者的管理在多大程度上令人满意，尤其是与COPD急性加重相关的因素，目前可用信息很少。本研究评估了因COPD急性加重住院的患者中，COPD急性加重潜在可改变危险因素的患病率。在西班牙巴塞罗那地区的四家三级医院，对1年内因COPD急性加重入院的患者进行系统抽样，每两名患者抽取一名。患者回答问卷，并接受人体测量、肺功能测试和动脉血气采样。获得危险因素的患病率及95%置信区间（95%CI），并使用广义估计方程（GEE）方法，以便患者提供不同入院情况的信息。该研究招募了353名患者（29名女性），共404次入院，年龄（平均±标准差）为69±9岁，一秒用力呼气容积（FEV1）中位数为预测值的31%，平均氧分压（PO2）为63±13 mmHg。其中，28%未接种流感疫苗；大量患者（86%）未参加康复计划；PO2≤55 mmHg的患者中有28%未使用长期氧疗（LTOT）；在LTOT使用者中，18%每天使用时间不足15小时；43%的患者在基本吸入操作中存在失误；26%为当前吸烟者；21%的非当前吸烟者在家中暴露于被动吸烟环境；当前职业暴露率较低（5%）。总之，作者在因慢性阻塞性肺疾病急性加重住院的大量代表性患者样本中发现，潜在可改变危险因素的患病率为中度至高度，这表明他们的管理存在不尽人意之处。
