Schermer T R J, Saris C G J, van den Bosch W J H M, Chavannes N H, van Schayck C P, Dekhuijzen P N R, van Weel C
Department of General Practice, Radboud University Nijmegen Medical Centre, The Netherlands.
Monaldi Arch Chest Dis. 2006 Sep;65(3):133-40. doi: 10.4081/monaldi.2006.558.
Acute exacerbations are a characteristic clinical expression of chronic obstructive pulmonary disease (COPD). The objective of this study was to investigate the occurrence rate, management, and healthcare costs of exacerbations in patients with COPD in Dutch general practice.
Baseline data set from the COPD on Primary Care Treatment (COOPT) trial was used. Details on the occurrence and management of exacerbations were collected by systematic medical record review for the 2-year period preceding trial inclusion.
The mean age of the 286 study subjects involved was 59.2 (SD 9.6) years, postbronchodilator FEV1 67.1% (SD 16.2) of predicted. Following ERS criteria, subjects suffered from: no (26%); mild (19%); moderate (40%); or severe (15%) airflow obstruction. The overall mean and median annual exacerbation rates were 0.88 (SD 0.79) and 0.5 (IQR 1.0), respectively. Exacerbation rate was not related to severity of airflow obstruction (p=0.628). Mean annual exacerbation costs per subject were 40 Euro, 53 Euro, 61 Euro and 92 Euro for the respective severity subgroups (p=0.012). The increase of costs in the more severe subgroups was mainly attributable to more physician consultations, diagnostic procedures, and prescription of reliever medication (e.g., bronchodilators, cough preparations).
Occurrence of exacerbations did not depend on the severity of airflow obstruction, whereas the healthcare cost associated with exacerbations increased along with the severity of the disease.
急性加重是慢性阻塞性肺疾病（COPD）的典型临床表现。本研究的目的是调查荷兰全科医疗中COPD患者急性加重的发生率、管理情况及医疗费用。
使用来自初级保健治疗COPD（COOPT）试验的基线数据集。通过对纳入试验前2年的系统病历审查，收集急性加重发生和管理的详细信息。
所纳入的286名研究对象的平均年龄为59.2（标准差9.6）岁，支气管扩张剂后FEV1为预测值的67.1%（标准差16.2）。根据欧洲呼吸学会（ERS）标准，受试者存在：无（26%）；轻度（19%）；中度（40%）；或重度（15%）气流受限。总体年急性加重率的均值和中位数分别为0.88（标准差0.79）和0.5（四分位间距1.0）。急性加重率与气流受限的严重程度无关（p = 0.628）。各严重程度亚组中，每位受试者的年急性加重费用均值分别为40欧元、53欧元、61欧元和92欧元（p = 0.012）。病情较重亚组费用的增加主要归因于更多的医生诊疗、诊断程序以及缓解药物（如支气管扩张剂、止咳制剂）的处方。
急性加重的发生并不取决于气流受限的严重程度，而与急性加重相关的医疗费用随疾病严重程度增加而上升。
