Vestbo Jørgen, Vogelmeier Claus, Small Mark, Higgins Victoria
Department of Respiratory Medicine J, Odense University Hospital and University of Southern Denmark, Odense, Denmark; The University of Manchester, Manchester Academic Health Science Centre, University Hospital South Manchester NHS Foundation Trust, NIHR South Manchester Respiratory and Allergy Clinical Research Facility, Manchester, UK.
Universitätsklinikum Giessen und Marburg, Marburg, Germany.
Respir Med. 2014 May;108(5):729-36. doi: 10.1016/j.rmed.2014.03.002. Epub 2014 Mar 14.
The aim of this analysis was to understand the implications of the GOLD 2011 multidimensional system for the assessment and management of COPD, using data from a real-world observational study.
Data were drawn from the Adelphi Respiratory Disease Specific Programme, a cross-sectional survey of consulting patients in five European countries and in the U.S. undertaken between June and September 2011. Patients were classified using both the GOLD 2010 and revised GOLD 2011 criteria, and profiled with regards to demographics, disease characteristics and treatment patterns.
Information on 3813 COPD patients was collected. Disease characteristics showed a general tendency to worsen in parallel with worsening of symptoms. When comparing dual versus single risk criteria, the inclusion of exacerbation history resulted in an increase in the number of patients in high risk groups. The highest proportions of patients receiving inhaled corticosteroids (ICS) were in group D. However, a considerable proportion of patients in low risk groups were receiving ICS/long-acting β2 agonists.
Our analysis confirmed the relationship between higher symptomatic burden, increased airflow limitation and exacerbation, and further illustrated the importance of including exacerbation history in the assessment of COPD to identify patients at high risk. As based on data from current clinical practice, this study also highlighted the frequent and potentially inappropriate use of ICS and bronchodilators in patients at low risk of experiencing exacerbations.
本分析旨在利用一项真实世界观察性研究的数据，了解慢性阻塞性肺疾病（COPD）全球倡议（GOLD）2011多维系统在评估和管理COPD方面的意义。
数据来自阿德尔菲呼吸系统疾病专项计划，这是一项对2011年6月至9月期间在五个欧洲国家和美国就诊患者进行的横断面调查。患者根据GOLD 2010标准和修订后的GOLD 2011标准进行分类，并对人口统计学、疾病特征和治疗模式进行分析。
收集了3813例COPD患者的信息。疾病特征显示，总体上随着症状加重而趋于恶化。在比较双重风险标准与单一风险标准时，纳入加重病史导致高风险组患者数量增加。接受吸入性糖皮质激素（ICS）治疗的患者比例最高的是D组。然而，低风险组中有相当一部分患者正在接受ICS/长效β2受体激动剂治疗。
我们的分析证实了较高症状负担、气流受限增加与病情加重之间的关系，并进一步说明了在COPD评估中纳入加重病史以识别高风险患者的重要性。基于当前临床实践的数据，本研究还强调了在低加重风险患者中频繁且可能不适当使用ICS和支气管扩张剂的情况。
