Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, the Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht, the Netherlands; CIRO+, Centre for Specialised Treatments Chronic Respiratory Diseases, Horn, the Netherlands.
Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, the Netherlands; CIRO+, Centre for Specialised Treatments Chronic Respiratory Diseases, Horn, the Netherlands; Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.
Respir Med. 2018 Nov;144:1-6. doi: 10.1016/j.rmed.2018.09.010. Epub 2018 Sep 17.
Exacerbations of chronic obstructive pulmonary disease are characterised by increased symptoms such as dyspnoea, cough and sputum production and/or purulence, leading to greater risk of hospitalisation and mortality. Very few studies have measured long term trends in the incidence of exacerbations of chronic obstructive pulmonary disease. We therefore investigated the incidence of moderate and severe exacerbations in the UK general population.
A population based-study including Clinical Practice Research Datalink (CPRD) patients ≥ 40 years of age with a current diagnosis of COPD within the United Kingdom from 2004 to 2013 was conducted. Individuals with a history of asthma were excluded from main analyses. We calculated the incidence rates for any, moderate, and severe exacerbations. Patients contributed time at risk from January 1st up to the date of the first outcome within each year. The incidence rate for any, moderate and severe exacerbations for COPD in each calendar year was calculated as follows: the sum of any or moderate or severe exacerbations for COPD in that year divided by the total duration of follow-up in the same calendar year from 2005 through to 2013. We then analysed these rates by gender and age categories (40-59 years, 60-79 years and ≥80 years).
Among 213,561 with incident COPD diagnosis, 86,300 patients were included in the study. From 2005 to 2013, the incidence rate of any exacerbations increased from 89 to 98 per 1000 person years (PYs) (p = 0.005). Women had significantly higher incidence rates of any exacerbation for each calendar year when compared to men (p < 0.0001). The incidence rate of any and moderate exacerbations increased with age from 2005 to 2007. For severe exacerbations incidence decreased from 2005 to 2007 before increasing from 2008 until the end of follow-up (43 per 1000 PYs (95% confidence interval, 42-45/1000PYs) in 2013). Incidence rates of severe exacerbations were similar by gender and patients aged 80 + years had a higher incidence rate of severe exacerbation from 2005 to 2008 after which their incident rate dropped in subsequent years.
This is the first study that reports the long-term changes in the incidence rates of moderate and severe exacerbations within the UK general practice. Women showed a substantially higher risk of any COPD exacerbations, and their risk is increasing. The incidence rates of any exacerbations increased during the study period, while severe exacerbations were variable. Furthermore, incidence rates varied substantially by age group.
慢性阻塞性肺疾病（COPD）的加重期以呼吸困难、咳嗽和咳痰/痰量增加和/或脓性等症状加重为特征，导致住院和死亡风险增加。很少有研究测量 COPD 加重的长期趋势。因此，我们研究了英国普通人群中 COPD 加重的发生率。
这是一项基于人群的研究，包括英国临床实践研究数据链接（CPRD）中年龄≥40 岁、当前有 COPD 诊断的患者，研究时间为 2004 年至 2013 年。主要分析排除了有哮喘病史的患者。我们计算了任何、中度和重度加重的发生率。患者从 2005 年至 2013 年每年的 1 月 1 日起至首次出现任何结局的日期止计入风险时间。每年 COPD 任何、中度和重度加重的发生率如下计算：当年 COPD 任何或中度或重度加重的总和除以同年相同日历年内从 2005 年到 2013 年的总随访时间。然后我们按性别和年龄类别（40-59 岁、60-79 岁和≥80 岁）分析这些比率。
在 213561 名新发 COPD 诊断患者中，有 86300 名患者纳入研究。2005 年至 2013 年，任何加重的发生率从 89 增加到 98/1000 人年（p=0.005）。与男性相比，女性在每个日历年均有更高的任何加重发生率（p<0.0001）。从 2005 年到 2007 年，任何和中度加重的发生率随年龄增加而增加。2005 年至 2007 年期间，重度加重的发生率下降，2008 年至随访结束时（2013 年为 43/1000 人年（95%置信区间，42-45/1000 人年））再次增加。重度加重的发生率在性别上相似，80 岁以上的患者在 2005 年至 2008 年期间重度加重的发生率较高，随后几年其发生率下降。
这是第一项报告英国普通人群中中度和重度 COPD 加重发生率长期变化的研究。女性发生任何 COPD 加重的风险明显更高，且风险在增加。研究期间，任何加重的发生率增加，而重度加重的发生率则有所波动。此外，发生率在年龄组之间有很大差异。
