Hawkins Padraig E, Alam Jamshed, McDonnell Timothy J, Kelly Emer
Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin 4, Ireland.
Expert Rev Respir Med. 2015 Jun;9(3):277-86. doi: 10.1586/17476348.2015.1046438.
Chronic obstructive pulmonary disease is a very common disease often punctuated by intermittent episodes of exacerbation. These exacerbations affect the natural history of the disease, accelerating a decline in lung function. They affect the individual in many ways and affect the health service caring for these patients. The definition of exacerbation varies and lacks clarity. The definitions used most are either symptom based, for example, breathlessness, sputum production and sputum purulence, or event driven, for example, an event causing a patient to seek healthcare input or change to medications. In this article, we discuss the importance of exacerbations, the clinical definitions, clinical trial definitions, physiological and biomarker evidence of exacerbations and the challenges associated with each of these. Application of a practical definition would aid in our clinical management of patients with chronic obstructive pulmonary disease and facilitate developments in future therapeutic advances through clinical trials.
慢性阻塞性肺疾病是一种非常常见的疾病，常伴有间歇性加重发作。这些加重发作影响疾病的自然病程，加速肺功能下降。它们在许多方面影响个体，并影响照料这些患者的医疗服务。加重发作的定义各不相同且缺乏明确性。最常用的定义要么基于症状，例如呼吸困难、咳痰和痰液脓性，要么由事件驱动，例如导致患者寻求医疗护理或改变用药的事件。在本文中，我们讨论加重发作的重要性、临床定义、临床试验定义、加重发作的生理学和生物标志物证据以及与之相关的挑战。应用实用的定义将有助于我们对慢性阻塞性肺疾病患者进行临床管理，并通过临床试验促进未来治疗进展。
