Reiger Gabriele, Zwick Ralf, Lamprecht Bernd, Kähler Christian, Burghuber Otto Chris, Valipour Arschang
SKA-Rehabilitationszentrum der PVA, Weyer, Austria.
Therme Wien Med, Ambulante Pneumologische Rehabilitation, Vienna, Austria.
Wien Klin Wochenschr. 2018 Jun;130(11-12):382-389. doi: 10.1007/s00508-018-1347-7. Epub 2018 May 24.
Chronic obstructive pulmonary disease (COPD) represents a major global health problem; however, there are no data regarding clinical phenotypes of these patients in Austria.
This was an analysis from the Austrian cohort of the cross-sectional Phenotypes of COPD in Central and Eastern Europe (POPE) study, which was offered to patients with stable COPD in a real-life setting. Patients were recruited at 5 different outpatient facilities in 3 different provinces in Austria. All consecutive patients aged ≥40 years with a diagnosis of COPD confirmed by a post-bronchodilator forced expired volume in 1 s/forced vital capacity (FEV/FVC) ratio <0.7 during a stable state (≥4 weeks without exacerbation or worsening of any relevant comorbidities) were considered eligible. The primary aim of this study was to assess the prevalence of phenotypes according to predefined criteria. Secondary aims included analyses of differences in patient characteristics, symptom load, comorbidities, and pharmacological treatment.
Among 283 patients fulfilling the inclusion criteria, 49.5% were considered non-exacerbators, 21.6% were classified as exacerbators with chronic bronchitis, 21.2% exacerbators without chronic bronchitis, and 7.8% were patients with an asthma-COPD overlap. Exacerbators had significantly higher prevalence of symptoms, lower lung function and exercise capacity, and a higher prevalence of comorbidities, such as heart failure and depression, compared with the other patient phenotypes. A large majority of patients with stable COPD in this cohort received inhaled triple therapy, irrespective of exacerbation history.
There were significant differences in COPD outcome measures between predefined phenotypes of COPD in this study. The majority of patients with stable COPD in this Austrian population were not treated according to current COPD guidelines. While non-exacerbators appear to have been overtreated, patients with an asthma-COPD overlap appear to have been undertreated.
慢性阻塞性肺疾病（COPD）是一个重大的全球健康问题；然而，奥地利尚无关于这些患者临床表型的数据。
这是对中欧和东欧慢性阻塞性肺疾病横断面表型（POPE）研究奥地利队列的分析，该研究是在现实生活环境中为稳定期慢性阻塞性肺疾病患者提供的。患者在奥地利3个不同省份的5个不同门诊机构招募。所有年龄≥40岁、在稳定期（≥4周无任何相关合并症加重或恶化）经支气管扩张剂后1秒用力呼气容积/用力肺活量（FEV/FVC）比值<0.7确诊为慢性阻塞性肺疾病的连续患者被视为符合条件。本研究的主要目的是根据预定义标准评估表型的患病率。次要目的包括分析患者特征、症状负荷、合并症和药物治疗的差异。
在283例符合纳入标准的患者中，49.5%被视为非急性加重者，21.6%被分类为慢性支气管炎急性加重者，21.2%为无慢性支气管炎的急性加重者，7.8%为哮喘-慢性阻塞性肺疾病重叠患者。与其他患者表型相比，急性加重者症状患病率显著更高，肺功能和运动能力更低，合并症如心力衰竭和抑郁症的患病率更高。该队列中大多数稳定期慢性阻塞性肺疾病患者接受了吸入三联疗法，无论急性加重病史如何。
本研究中慢性阻塞性肺疾病预定义表型之间的慢性阻塞性肺疾病结局指标存在显著差异。该奥地利人群中大多数稳定期慢性阻塞性肺疾病患者未按照当前慢性阻塞性肺疾病指南进行治疗。虽然非急性加重者似乎治疗过度，但哮喘-慢性阻塞性肺疾病重叠患者似乎治疗不足。
