Sethi Sanjay
Division of Pulmonary, Critical Care and Sleep Medicine, University at Buffalo, State University of New York and VA Western New York Healthcare System, Buffalo, New York, USA.
BMC Med. 2008 Oct 10;6:29. doi: 10.1186/1741-7015-6-29.
Exacerbations are a major cause of morbidity and mortality in chronic obstructive pulmonary disease. Exacerbations can be of bacterial, viral or mixed etiology, with bacteria involved in 50% of exacerbations. Consequently, current management of exacerbations frequently involves the use of antibiotics. The paper by Puhan et al published this month in BMC Medicine examines the benefit of antibiotics in placebo-controlled trials in mild to moderate outpatient exacerbations. The authors use a meta-analytic approach and rightly conclude that more trials are needed in this area. However, the heterogeneity of chronic obstructive pulmonary disease patients and exacerbations and the limited end-points in past trials do not allow firm conclusions to be drawn about antibiotic use in outpatient exacerbations based on this meta-analysis. Future trials need to take into account this heterogeneity as well as incorporate novel end-points to address this important issue.
急性加重是慢性阻塞性肺疾病发病和死亡的主要原因。急性加重可能由细菌、病毒或混合病因引起，其中50%的急性加重涉及细菌。因此，目前急性加重的治疗常常涉及使用抗生素。普汉等人本月发表在《BMC医学》上的论文研究了抗生素在轻度至中度门诊急性加重的安慰剂对照试验中的益处。作者采用荟萃分析方法，正确地得出结论，即该领域需要更多试验。然而，慢性阻塞性肺疾病患者和急性加重的异质性以及过去试验中有限的终点，使得基于该荟萃分析无法就门诊急性加重时使用抗生素得出确凿结论。未来的试验需要考虑到这种异质性，并纳入新的终点来解决这一重要问题。
