Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
Eur Respir J. 2018 Nov 15;52(5). doi: 10.1183/13993003.01261-2018. Print 2018 Nov.
Chronic obstructive pulmonary disease (COPD) is a chronic illness that can be periodically punctuated by exacerbations, characterised by acute worsening of symptoms, including increased dyspnoea, cough, sputum production and sputum purulence. COPD exacerbations are common and have important clinical and economic consequences, including lost work productivity, increased utilisation of healthcare resources, temporary or permanent reductions in lung function and exercise capacity, hospitalisation, and sometimes death. Over the past two decades, clinicians and researchers have broadened their treatment goals for COPD to extend beyond improving lung function and symptoms, and have begun to address the importance of preventing and reducing exacerbations. However, despite the best efforts of clinicians and guideline committees, current definitions of COPD exacerbations are imperfect and fraught with problems. The cardinal symptoms of a COPD exacerbation are nonspecific and can result from acute cardiorespiratory illnesses other than COPD. A proposed definition, which may be more specific than current definitions, suggests that COPD exacerbation be defined as an acute or subacute worsening of dyspnoea (≥5 on a visual analogue scale that ranges from 0 to 10) sometimes but not necessarily accompanied by increased cough, sputum volume and/or sputum purulence. Necessary laboratory criteria for an exacerbation include oxygen desaturation ≤4% below that of stable state, elevated levels of circulating blood neutrophils or eosinophils (≥9000 neutrophils·mm or ≥2% blood eosinophils) and elevated C-reactive protein (≥3 mg·L), without evidence of pneumonia or pulmonary oedema on chest radiography and with negative laboratory test results for other aetiologies. Herein, we discuss the current state of the art with respect to how we define COPD exacerbations, associated pitfalls and challenges, and opportunities for improvement.
慢性阻塞性肺疾病（COPD）是一种慢性病，其病情可能会周期性地恶化，其特征是症状急性恶化，包括呼吸困难加重、咳嗽、咳痰增加和痰液变浓稠。COPD 恶化很常见，且具有重要的临床和经济后果，包括工作生产力下降、医疗资源利用增加、肺功能和运动能力暂时或永久性降低、住院治疗，甚至有时会导致死亡。在过去的二十年中，临床医生和研究人员已经将 COPD 的治疗目标从改善肺功能和症状扩展到预防和减少恶化，从而拓宽了治疗目标。然而，尽管临床医生和指南委员会付出了最大的努力，目前 COPD 恶化的定义并不完美，并且存在许多问题。COPD 恶化的主要症状并不特异，可能是 COPD 以外的急性心肺疾病引起的。一个更具体的建议定义是，将 COPD 恶化定义为呼吸困难急性或亚急性恶化（视觉模拟量表范围为 0 至 10 时，≥5），有时但不一定伴有咳嗽、痰量和/或痰液浓稠度增加。恶化的必要实验室标准包括血氧饱和度较稳定状态下降≥4%，循环血中性粒细胞或嗜酸性粒细胞升高（中性粒细胞≥9000·mm 或血嗜酸性粒细胞≥2%）和 C 反应蛋白升高（≥3mg·L），但胸部 X 线检查无肺炎或肺水肿证据，且其他病因的实验室检查结果为阴性。在此，我们讨论了目前我们如何定义 COPD 恶化的现状、相关陷阱和挑战，以及改进的机会。
