Department of Internal Medicine, School of Medicine, Universidad Nacional De Colombia, Hospital Universitario Nacional De Colombia, Bogotá, Colombia.
Int J Chron Obstruct Pulmon Dis. 2019 Jul 11;14:1549-1557. doi: 10.2147/COPD.S192047. eCollection 2019.
Acute exacerbation of COPD (AECOPD) is among the most frequent causes for hospital admission, causing morbidity and mortality. Infection is the most frequent cause, and studies on pollution have shown higher hospital admission and mortality with inconsistent results. The objective was to identify if there is a change in levels of particulate matter (PM) during the days leading up to the symptom onset.
A retrospective study was carried out on medical records of patients with AECOPD from a University Hospital. PM values of the consultation day, onset symptoms, and up to three previous days were recorded. Moreover, clinical presentation, laboratory findings, treatments, and hospital outcomes were recorded.
A total of 250 medical records were included, mean age of 77 years, hospital stay mean of 6.7 days, 26.8% with no previous exposure was identified, coexistence with asthma was 5%, Obstructive Sleep Apnea Syndrome 15%, Pulmonary Hypertension 34%, antibiotic use 62%, ICU admission of 14% with non-invasive mechanical ventilation of 68%, and in-patient mortality of 2.4%. PM 2.5 of 48 hrs before onset symptoms median was 20.1 μg/m versus 15 and 16.5 for the day of symptoms and 3 days prior to onset symptoms (<0.001). PM 10 of 46.65 μg/m, versus 39 and 35.6, respectively (<0.001). Expectoration OR 4.74; Purulence OR 6.58; Pleuritic pain OR 3.62; Antibiotic use OR 2.87, and corticoids use OR 2.62, all with <0.05.
Patients with AECOPD have a higher median of particulate matter 48 hrs prior to symptomatic onset, as well as greater use of antibiotics and corticosteroids.
COPD 急性加重（AECOPD）是导致住院的最常见原因之一，会引起发病率和死亡率。感染是最常见的原因，而关于污染的研究表明，住院和死亡人数存在不一致的结果。本研究旨在确定在症状出现前的几天内，颗粒物（PM）水平是否发生变化。
对一家大学医院的 AECOPD 患者的病历进行了回顾性研究。记录了就诊日、症状出现日以及前三天的 PM 值。此外，还记录了临床表现、实验室检查结果、治疗方法和住院结局。
共纳入 250 份病历，平均年龄 77 岁，平均住院时间为 6.7 天，26.8%的患者没有既往暴露史，合并哮喘的比例为 5%，阻塞性睡眠呼吸暂停综合征为 15%，肺动脉高压为 34%，抗生素使用率为 62%，14%的患者需要入住 ICU，其中 68%使用无创机械通气，住院死亡率为 2.4%。症状出现前 48 小时 PM2.5 的中位数为 20.1μg/m³，而症状出现日和前三天的 PM2.5 中位数分别为 15μg/m³和 16.5μg/m³（<0.001）。PM10 的中位数分别为 46.65μg/m³、39μg/m³和 35.6μg/m³（<0.001）。出现咳痰的比值比（OR）为 4.74；出现脓性痰的 OR 为 6.58；出现胸痛的 OR 为 3.62；使用抗生素的 OR 为 2.87；使用皮质激素的 OR 为 2.62，均<0.05。
AECOPD 患者在症状出现前 48 小时的颗粒物中位数较高，抗生素和皮质激素的使用率也较高。
