Halpin David Mg, Miravitlles Marc, Metzdorf Norbert, Celli Bartolomé
Department of Respiratory Medicine, Royal Devon and Exeter Hospital, Exeter, UK.
Pneumology Department, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
Int J Chron Obstruct Pulmon Dis. 2017 Oct 5;12:2891-2908. doi: 10.2147/COPD.S139470. eCollection 2017.
Severe exacerbations of COPD, ie, those leading to hospitalization, have profound clinical implications for patients and significant economic consequences for society. The prevalence and burden of severe COPD exacerbations remain high, despite recognition of the importance of exacerbation prevention and the availability of new treatment options. Severe COPD exacerbations are associated with high mortality, have negative impact on quality of life, are linked to cardiovascular complications, and are a significant burden on the health-care system. This review identified risk factors that contribute to the development of severe exacerbations, treatment options (bronchodilators, antibiotics, corticosteroids [CSs], oxygen therapy, and ventilator support) to manage severe exacerbations, and strategies to prevent readmission to hospital. Risk factors that are amenable to change have been highlighted. A number of bronchodilators have demonstrated successful reduction in risk of severe exacerbations, including long-acting muscarinic antagonist or long-acting β-agonist mono- or combination therapies, in addition to vaccination, mucolytic and antibiotic therapy, and nonpharmacological interventions, such as pulmonary rehabilitation. Recognition of the importance of severe exacerbations is an essential step in improving outcomes for patients with COPD. Evidence-based approaches to prevent and manage severe exacerbations should be implemented as part of targeted strategies for disease management.
慢性阻塞性肺疾病（COPD）的严重急性加重，即导致住院治疗的急性加重，对患者具有深远的临床影响，对社会造成重大经济后果。尽管人们认识到预防急性加重的重要性并已有新的治疗选择，但严重COPD急性加重的患病率和负担仍然很高。严重COPD急性加重与高死亡率相关，对生活质量有负面影响，与心血管并发症有关，并且是卫生保健系统的重大负担。本综述确定了导致严重急性加重发生的危险因素、治疗严重急性加重的治疗选择（支气管扩张剂、抗生素、皮质类固醇[CSs]、氧疗和呼吸机支持）以及预防再次入院的策略。已强调了可改变的危险因素。一些支气管扩张剂已证明能成功降低严重急性加重的风险，包括长效毒蕈碱拮抗剂或长效β受体激动剂单药或联合治疗，此外还有疫苗接种、黏液溶解剂和抗生素治疗以及非药物干预措施，如肺康复。认识到严重急性加重的重要性是改善COPD患者预后的关键一步。应将基于证据的预防和管理严重急性加重的方法作为疾病管理目标策略的一部分加以实施。
