Veramed Ltd, Twickenham, UK.
GlaxoSmithKline plc, Brentford, UK.
Respir Res. 2020 Jan 6;21(1):5. doi: 10.1186/s12931-019-1262-0.
BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) are at risk of exacerbations and pneumonia; how the risk factors interact is unclear. METHODS: This post-hoc, pooled analysis included studies of COPD patients treated with inhaled corticosteroid (ICS)/long-acting β agonist (LABA) combinations and comparator arms of ICS, LABA, and/or placebo. Backward elimination via Cox's proportional hazards regression modelling evaluated which combination of risk factors best predicts time to first (a) pneumonia, and (b) moderate/severe COPD exacerbation. RESULTS: Five studies contributed: NCT01009463, NCT01017952, NCT00144911, NCT00115492, and NCT00268216. Low body mass index (BMI), exacerbation history, worsening lung function (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage), and ICS treatment were identified as factors increasing pneumonia risk. BMI was the only pneumonia risk factor influenced by ICS treatment, with ICS further increasing risk for those with BMI <25 kg/m. The modelled probability of pneumonia varied between 3 and 12% during the first year. Higher exacerbation risk was associated with a history of exacerbations, poorer lung function (GOLD stage), female sex and absence of ICS treatment. The influence of the other exacerbation risk factors was not modified by ICS treatment. Modelled probabilities of an exacerbation varied between 31 and 82% during the first year. CONCLUSIONS: The probability of an exacerbation was considerably higher than for pneumonia. ICS reduced exacerbations but did not influence the effect of risks associated with prior exacerbation history, GOLD stage, or female sex. The only identified risk factor for ICS-induced pneumonia was BMI <25 kg/m. Analyses of this type may help the development of COPD risk equations.
背景:患有慢性阻塞性肺疾病(COPD)的患者有发生加重和肺炎的风险,但是这些风险因素是如何相互作用的尚不清楚。
方法:这是一项事后的、汇总分析,纳入了接受吸入性皮质类固醇(ICS)/长效β激动剂(LABA)联合制剂治疗的 COPD 患者的研究,以及 ICS、LABA 和/或安慰剂的对照臂。通过 Cox 比例风险回归模型的向后消除法,评估哪些风险因素组合能最好地预测首次发生(a)肺炎和(b)中重度 COPD 加重的时间。
结果:共有五项研究纳入:NCT01009463、NCT01017952、NCT00144911、NCT00115492 和 NCT00268216。低体重指数(BMI)、加重史、肺功能恶化(慢性阻塞性肺疾病全球倡议[GOLD]分期)和 ICS 治疗被确定为增加肺炎风险的因素。BMI 是唯一受 ICS 治疗影响的肺炎风险因素,对于 BMI<25kg/m2 的患者,ICS 进一步增加了风险。第一年期间,肺炎的模型预测概率在 3%至 12%之间变化。较高的加重风险与加重史、较差的肺功能(GOLD 分期)、女性和缺乏 ICS 治疗有关。ICS 治疗并未改变其他加重风险因素的影响。第一年期间,加重的模型预测概率在 31%至 82%之间变化。
结论:加重的概率明显高于肺炎。ICS 减少了加重,但并未影响与既往加重史、GOLD 分期或女性有关的风险因素的影响。唯一被确定为 ICS 引起肺炎的风险因素是 BMI<25kg/m2。这种类型的分析可能有助于 COPD 风险方程的开发。
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