Miravitlles Marc, Calle Miriam, Alvarez-Gutierrez Francisco, Gobartt Elena, López Francisco, Martín Antonio
Servei de Pneumologia, Institut Clínic del Tòrax (IDIBAPS), Red Respira RTIC 03/11 ISCIII, Hospital Clinic, Barcelona, Spain.
Qual Life Res. 2006 Apr;15(3):471-80. doi: 10.1007/s11136-005-3215-y.
Impaired health status may be a risk factor for frequent exacerbations and hospital admission and, in turn, exacerbations and admissions may further impair the health status of patients with COPD. We have investigated the variables associated with frequent exacerbations (3 or more per year) and admission, with particular interest in health status, in a cohort of ambulatory patients with moderate to severe COPD attended by chest physicians in Spain. A total of 227 investigators included 1057 patients with a mean predicted FEV1 of 41.8%. The mean total score on the St. George's Respiratory Questionnaire (SGRQ) was 47.9 units, and 300 patients (28.4%) had 3 or more exacerbations the previous year and 344 (32.6%) were admitted at least once during the same period. In multivariate analysis only the SGRQ total score was significantly associated with both frequent exacerbations (OR = 1.04; 95% CI = 1.01-2.12; p<0.0001) and admission (OR = 1.01; 95% CI = 1.00-1.02; p = 0.0008). Other variables significantly associated with frequent exacerbations were chronic mucus hypersecretion, increased baseline dyspnea, comorbidity, GOLD stage IV and treatment with inhaled corticosteroids. Variables associated with admission were lower educational level, increased number of exacerbations, use of long-term oxygen therapy and use of short acting beta-2 agonists. An impaired health status is associated with an increased number of exacerbations and with admission to hospital in the previous year. These results, together with previous studies, confirm that impairment in health status in COPD is both a marker of risk for, and a consequence of, frequent exacerbations and admissions.
健康状况受损可能是频繁急性加重和住院的危险因素，反过来，急性加重和住院可能会进一步损害慢性阻塞性肺疾病（COPD）患者的健康状况。我们在西班牙一组由胸科医生诊治的中重度COPD门诊患者中，调查了与频繁急性加重（每年3次或更多）和住院相关的变量，尤其关注健康状况。共有227名研究者纳入了1057例患者，平均预测第一秒用力呼气容积（FEV1）为41.8%。圣乔治呼吸问卷（SGRQ）的平均总分是47.9分，300例患者（28.4%）上一年有3次或更多次急性加重，344例患者（32.6%）在同一时期至少住院1次。多因素分析显示，只有SGRQ总分与频繁急性加重（比值比[OR]=1.04；95%置信区间[CI]=[1.01,2.12]；p<0.0001）和住院（OR=1.01；95%CI=[1.00,1.02]；p=0.0008）均显著相关。与频繁急性加重显著相关的其他变量包括慢性黏液高分泌、基线呼吸困难加重、合并症、慢性阻塞性肺疾病全球倡议（GOLD）IV期以及吸入糖皮质激素治疗。与住院相关的变量包括教育水平较低、急性加重次数增加、长期氧疗的使用以及短效β2受体激动剂的使用。健康状况受损与上一年急性加重次数增加和住院相关。这些结果与之前的研究一起证实，COPD患者健康状况受损既是频繁急性加重和住院的风险标志物，也是其后果。
