Tesfaigzi Yohannes, Meek Paula, Lareau Suzanne
Lovelace Respiratory Research Institute, 2425 Ridgecrest Drive, SE, Albuquerque, NM 87108, USA.
College of Nursing, University of New Mexico, Albuquerque, NM 87131, USA.
Clin Appl Immunol Rev. 2006 Jan-Feb;6(1):21-36. doi: 10.1016/j.cair.2006.02.001. Epub 2006 Jun 28.
Chronic obstructive pulmonary disease (COPD) exacerbations are an important cause of the considerable morbidity and mortality found in COPD. COPD exacerbations increase with increasing severity of COPD, and some patients are prone to frequent exacerbations leading to hospital admission and readmission. These frequent exacerbations may have considerable impact on quality of life and activities of daily living. Factors that increase the risk for COPD exacerbations are associated with increased airway inflammation caused by common pollutants and bacterial and/or viral infections. These inflammatory responses cause mucus hypersecretion and, thereby, airway obstruction and associated exacerbations. While chronic mucus hypersecretion is a significant risk factor for frequent and severe exacerbations, patients with chronic mucus hypersecretion have a lower rate of relapse after initial treatment for acute exacerbation. The benefit of antibiotics for treatment of COPD exacerbations is small but significant. While the mechanisms of actions are not clear, mucolytic agents reduce the number of days of disability in subjects with exacerbations. Reducing mucous cell numbers in small airways could be a useful way to reduce chronic mucus hypersecretion. Our studies suggest that programmed cell death is crucial in the resolution of metaplastic mucous cells, and understanding these mechanisms may provide novel therapies to reduce the risk of COPD exacerbations.
慢性阻塞性肺疾病（COPD）急性加重是COPD患者出现高发病率和高死亡率的重要原因。COPD急性加重随着COPD严重程度的增加而增多，一些患者容易频繁急性加重，导致住院和再入院。这些频繁的急性加重可能对生活质量和日常生活活动产生重大影响。增加COPD急性加重风险的因素与常见污染物以及细菌和/或病毒感染引起的气道炎症增加有关。这些炎症反应导致黏液分泌过多，进而引起气道阻塞和相关的急性加重。虽然慢性黏液分泌过多是频繁和严重急性加重的重要危险因素，但慢性黏液分泌过多的患者在急性加重初始治疗后的复发率较低。抗生素治疗COPD急性加重的益处虽小但显著。虽然作用机制尚不清楚，但黏液溶解剂可减少急性加重患者的失能天数。减少小气道黏液细胞数量可能是减少慢性黏液分泌过多的有效方法。我们的研究表明，程序性细胞死亡在化生黏液细胞的消退中至关重要，了解这些机制可能会提供新的治疗方法以降低COPD急性加重的风险。
