Kardos Peter, Vogelmeier Claus, Worth Heinrich, Buhl Roland, Lossi Nadine S, Mailänder Claudia, Criée Carl-Peter
Group Practice and Centre for Allergy, Respiratory and Sleep Medicine, Red Cross Maingau Hospital, 60318 Frankfurt am Main, Germany.
Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL) 35043 Marburg, Germany.
Respir Med. 2017 Mar;124:57-64. doi: 10.1016/j.rmed.2017.02.007. Epub 2017 Feb 16.
DACCORD is an observational, non-interventional study being conducted in German primary and secondary care centres. The study aims to describe the impact of disease (including exacerbations) and treatments over 2 years on 'real-life' patients with chronic obstructive pulmonary disease (COPD).
Patients had a clinical and spirometry diagnosis of COPD, were aged ≥40 years and, on recruitment, were initiating or changing COPD maintenance medication. The only exclusion criteria were asthma and randomised clinical trial participation. Exacerbations data were collected every 3 months. COPD medication, COPD Assessment Test (CAT) and forced expiratory volume in 1 s (FEV) were recorded at baseline and after 1 and 2 years.
A total of 6122 patients were recruited, 3137 (51.2%) of whom completed the 2-year visit. The mean age of these patients was 65.6 years, 59% were male, 69% had mild or moderate airflow limitation, and their mean COPD Assessment Test (CAT) total score was 20.3. Overall, there was a trend towards decreasing COPD exacerbation rates over the 2-year follow-up period, with rates of 0.390 during Year 1 and 0.347 during Year 2. Rates were lower in patients with no exacerbation during the 6 months prior to entry (0.263 and 0.251 during Years 1 and 2, respectively), with 51.6% of patients having no exacerbation during the 6 months prior to entry and over the 2-year follow-up. Approximately 50% of the overall population experienced a clinically relevant improvement from baseline in CAT total score at Year 1 and 2. When assessed by treatment class (or classes), persistence to medication was high (77.8% in Year 1 and 71.4% in Year 2).
Overall, the 2-year follow-up data from DACCORD suggest that for most patients with COPD exacerbations are a rare event. For the majority of patients, the focus should be on managing symptoms, and the impact that these symptoms have on their daily lives. Even for those patients who do exacerbate, although prevention of exacerbations is an important factor, management of symptoms should be a key consideration. DACCORD also suggests that COPD disease progression is not inevitable - providing patients are receiving pharmacological treatment.
DACCORD是一项在德国初级和二级医疗中心开展的观察性、非干预性研究。该研究旨在描述疾病（包括急性加重）和治疗在两年内对慢性阻塞性肺疾病（COPD）“现实生活”患者的影响。
患者经临床和肺功能检查诊断为COPD，年龄≥40岁，在入组时开始或改变COPD维持治疗药物。唯一的排除标准是哮喘和参与随机临床试验。每3个月收集一次急性加重数据。在基线、1年和2年后记录COPD药物治疗情况、COPD评估测试（CAT）和1秒用力呼气容积（FEV）。
共招募了6122名患者，其中3137名（51.2%）完成了2年随访。这些患者的平均年龄为65.6岁，59%为男性，69%有轻度或中度气流受限，其COPD评估测试（CAT）总分平均为20.3。总体而言，在2年随访期内COPD急性加重率有下降趋势，第1年为0.390，第2年为0.347。在入组前6个月内无急性加重的患者中，急性加重率较低（第1年和第2年分别为0.263和0.251），51.6%的患者在入组前6个月和2年随访期内无急性加重。在第1年和第2年，约50%的总体人群CAT总分较基线有临床相关改善。按治疗类别评估时，药物治疗依从性较高（第1年为77.8%，第2年为71.4%）。
总体而言，DACCORD的2年随访数据表明，对于大多数COPD患者来说，急性加重是罕见事件。对于大多数患者，重点应放在管理症状以及这些症状对其日常生活的影响上。即使对于那些确实发生急性加重的患者，虽然预防急性加重是一个重要因素，但症状管理也应是关键考虑因素。DACCORD还表明，COPD疾病进展并非不可避免——前提是患者接受药物治疗。
