Alobaidi Nowaf Y, Stockley James A, Stockley Robert A, Sapey Elizabeth
Centre for Translational Inflammation Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
Respiratory Therapy Department, College of Applied Medical Sciences, King Saud Bin Abdul-Aziz University for Health Sciences, Al Ahsa, Saudi Arabia.
Ann Thorac Med. 2020 Apr-Jun;15(2):54-63. doi: 10.4103/atm.ATM_323_19. Epub 2020 Apr 3.
Chronic obstructive pulmonary disease (COPD) is common and debilitating. Most patients with COPD experience intermittent, acute deterioration in symptoms which require additional therapy, termed exacerbations. Exacerbations are prevalent in COPD and are associated with poor clinical outcomes including death, a faster decline in lung health, and a reduced quality of life. Current guidelines highlight the need to treat exacerbations promptly and then mitigate future risk. However, exacerbations are self-reported, difficult to diagnose and are treated with pharmacological therapies which have largely been unchanged over 30 years. Recent research has highlighted how exacerbations vary in their underlying cause, with specific bacteria, viruses, and cell types implicated. This variation offers the opportunity for new targeted therapies, but to develop these new therapies requires sensitive tools to reliably identify the cause, the start, and end of an exacerbation and assess the response to treatment. Currently, COPD is diagnosed and monitored using spirometric measures, principally the forced expiratory volume in 1 s and forced vital capacity, but these tests alone cannot reliably diagnose an exacerbation. Measures of small airways' function appear to be an early marker of COPD, and some studies have suggested that these tests might also provide physiological biomarkers for exacerbations. In this review, we will discuss how exacerbations of COPD are currently defined, stratified, monitored, and treated and review the current literature to determine if tests of small airways' function might improve diagnostic accuracy or the assessment of response to treatment.
慢性阻塞性肺疾病（COPD）常见且使人衰弱。大多数COPD患者会经历症状的间歇性急性恶化，这需要额外的治疗，称为急性加重。急性加重在COPD中很常见，并且与包括死亡、肺健康更快下降和生活质量降低在内的不良临床结局相关。当前指南强调需要及时治疗急性加重，然后降低未来风险。然而，急性加重是自我报告的，难以诊断，并且使用的药物治疗在30多年来基本没有变化。最近的研究突出了急性加重在潜在病因方面的差异，涉及特定的细菌、病毒和细胞类型。这种差异为新的靶向治疗提供了机会，但要开发这些新疗法需要敏感的工具来可靠地识别急性加重的原因、开始和结束，并评估对治疗的反应。目前，COPD的诊断和监测使用肺量计测量，主要是1秒用力呼气量和用力肺活量，但仅这些测试不能可靠地诊断急性加重。小气道功能测量似乎是COPD的早期标志物，一些研究表明这些测试也可能为急性加重提供生理生物标志物。在本综述中，我们将讨论目前如何定义、分层、监测和治疗COPD急性加重，并回顾当前文献以确定小气道功能测试是否可以提高诊断准确性或对治疗反应的评估。
