Bhatia Ankit, Prakash Ved, Kant Surya, Verma Ajay Kumar
Department of Pulmonary Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India.
Lung India. 2016 Nov-Dec;33(6):600-604. doi: 10.4103/0970-2113.192877.
Acute exacerbations are a significant source of morbidity and mortality associated with chronic obstructive pulmonary disease (COPD). Some patients suffer an inordinate number of exacerbations while others remain relatively protected. The aim of this study was to evaluate the potentially modifiable precipitating parameters of frequent severe exacerbations requiring hospital admission in COPD.
Consecutive patients admitted with acute exacerbation of COPD for a period of one year in a tertiary care hospital were evaluated prospectively. Data regarding the number of exacerbations in the previous year, current comorbidities, medications, and clinical and functional status of COPD patients were evaluated.
We included 98 COPD patients (81.63% men) admitted consecutively with exacerbations in our department. The mean number of severe exacerbations was (2.42 per patient/per year), and 65% of the patients had frequent severe exacerbations. Multivariate analysis indicated that serum uric acid, serum total IgE, depression and anxiety, gastroesophageal reflux disease symptoms, air pollution, poor adherence to inhaled therapy, and irregular outpatient followup visits were independent predictors of frequent severe exacerbations.
COPD patients with frequent exacerbations should be carefully assessed for modifiable confounding risk factors regardless of poor lung function to decrease exacerbation frequency and related poor prognosis. Raised serum total IgE levels may point towards atopy as an additional comorbidity in COPD while uric acid can have a clinically useful role in risk stratification in a primary care setting.
急性加重是慢性阻塞性肺疾病（COPD）发病和死亡的重要原因。一些患者急性加重的次数过多，而另一些患者则相对不易发病。本研究的目的是评估COPD中频繁发生的需要住院治疗的严重急性加重的潜在可改变诱发因素。
对一家三级医院连续一年因COPD急性加重入院的患者进行前瞻性评估。评估了COPD患者前一年的急性加重次数、当前的合并症、用药情况以及临床和功能状态。
我们纳入了98例在我科连续因急性加重入院的COPD患者（男性占81.63%）。严重急性加重的平均次数为（每位患者每年2.42次），65%的患者有频繁的严重急性加重。多因素分析表明，血清尿酸、血清总IgE、抑郁和焦虑、胃食管反流病症状、空气污染、吸入治疗依从性差以及门诊随访不规律是频繁严重急性加重的独立预测因素。
无论肺功能如何，对于频繁急性加重的COPD患者，都应仔细评估可改变的混杂风险因素，以降低急性加重频率和相关的不良预后。血清总IgE水平升高可能提示特应性是COPD的另一种合并症，而尿酸在基层医疗环境中的风险分层中可能具有临床实用价值。
