Department of Community Medicine, University of Tromsø, General Practice Research Unit, Tromsø, Norway.
Fam Pract. 2013 Dec;30(6):621-8. doi: 10.1093/fampra/cmt055. Epub 2013 Oct 10.
To investigate the incidence of asthma and chronic obstructive pulmonary disease (COPD) exacerbations in primary care during one year and to identify risk factors for such events.
The study was carried out at seven general practice offices in Norway. Patients aged 40 years or more registered with a diagnosis of asthma and/or COPD the previous 5 years were included. After a baseline examination, the participants consulted their GP during exacerbations for the following 12 months. A questionnaire on exacerbations during the follow-up year was distributed to all. Univariable and multivariable logistic regression was performed to determine predictors of future exacerbations.
Three hundred and eighty patients attended the baseline examination and complete follow-up data were retrieved from 340 patients. COPD as defined by forced expiratory volume in the first second of expiration/forced vital capacity (FEV1/FVC) < 0.7, was found in 132 (38.8%) patients. One hundred and fifty-nine patients (46.8%) experienced one exacerbation or more and 101 (29.7%) two exacerbations or more. Patients who had an exacerbation treated with antibiotics or systemic corticosteroids or leading to hospitalization the year before baseline (N = 88) had the highest risk of getting an exacerbation during the subsequent year (odds ratio 9.2), whether the FEV1/FVC was below 0.7 or not. Increased risk of future exacerbations was also related to age ≥ 65 years and limitations in social activities, but not to the FEV1.
The study confirms that previous exacerbations strongly predict future exacerbations in patients with COPD or asthma. Identification and a closer follow-up of patients at risk of such events could promote earlier treatment when necessary and prevent a rapid deterioration of their condition.
在一年内调查初级保健中哮喘和慢性阻塞性肺疾病（COPD）恶化的发生率，并确定这些事件的危险因素。
该研究在挪威的 7 个全科医生办公室进行。年龄在 40 岁或以上，在过去 5 年内被诊断为哮喘和/或 COPD 的患者被纳入研究。在基线检查后，参与者在接下来的 12 个月内根据恶化情况咨询他们的全科医生。在随访年期间向所有参与者分发了一份关于恶化情况的问卷。采用单变量和多变量逻辑回归来确定未来恶化的预测因素。
380 名患者参加了基线检查，从 340 名患者中检索到完整的随访数据。根据呼气第一秒用力呼气量/用力肺活量（FEV1/FVC）<0.7 定义的 COPD 见于 132 名患者（38.8%）。159 名患者（46.8%）经历了一次或多次恶化，101 名患者（29.7%）经历了两次或更多次恶化。在基线前一年因恶化而接受抗生素或全身皮质激素治疗或导致住院的患者（N=88）在随后的一年中发生恶化的风险最高（比值比 9.2），无论 FEV1/FVC 是否低于 0.7。未来恶化的风险增加也与年龄≥65 岁和社会活动受限有关，但与 FEV1 无关。
该研究证实，先前的恶化强烈预测 COPD 或哮喘患者未来的恶化。识别和密切随访有发生此类事件风险的患者可以在必要时促进早期治疗，并防止病情迅速恶化。
