评价 COPD 患者的加重和无症状时间。

Evaluation of Exacerbation and Symptom-Free Time in Patients with COPD.

机构信息

Health Technology and Services Research, Faculty of Behavioral, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands.

Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, Netherlands.

出版信息

COPD. 2023 Dec;20(1):9-17. doi: 10.1080/15412555.2022.2136066.

DOI:10.1080/15412555.2022.2136066

PMID:37552476

Abstract

In clinical practice, clinicians mainly focus on Chronic Obstructive Pulmonary Disease (COPD) exacerbations and symptoms, while patients may prefer to evaluate periods free of COPD exacerbations and deteriorated symptoms. The latter would suit the positive health approach that centralizes people and their beliefs. We aimed to identify patient characteristics and health outcomes relating to: 1) COPD exacerbation-free days; 2) days with no more symptoms than usual; and 3) combined COPD exacerbation and comorbid flare-up-free days (i.e. chronic heart failure, anxiety, depression flare-ups) using negative binomial regression analyzes. Data were obtained from two self-management intervention trials including COPD patients with and without comorbidities. 313 patients (mean age 66.0 years, 63.6% male, 68.7% comorbidity) were included. Better baseline chronic respiratory questionnaire (CRQ) fatigue (incidence rate ratio (IRR) = 1.03 (95% CI 1.01-1.05), = 0.02) and mastery scores (IRR = 1.03 (95% CI 1.00-1.06), = 0.04) and fewer courses of antibiotics (IRR = 0.95 (95% CI 0.94-0.96), < 0.01) were related to more COPD exacerbation-free days. Additionally, better baseline CRQ fatigue (IRR = 1.05 (95% CI 1.00-1.10), = 0.04) and mastery scores (IRR = 1.06 (95% CI 1.00-1.12), = 0.04), fewer courses of antibiotics (IRR = 0.94 (95% CI 0.91-0.96), < 0.01), and improved CRQ dyspnea scores over 12 months of follow-up (IRR = 1.07 (95% CI 1.01-1.12), < 0.01) were correlated to more days free of deteriorated symptoms. Less baseline dyspnea (modified Medical Research Council score) (IRR = 0.95 (95% CI 0.92-0.98), < 0.01) and fewer courses of antibiotics (IRR = 0.94 (95% CI 0.93-0.95), < 0.01) were associated with more combined COPD exacerbation and comorbid flare-up-free days. Healthcare professionals should be aware that less fatigue and better mastering of COPD relate to more exacerbation and symptom-free time in COPD patients.

摘要

在临床实践中，临床医生主要关注慢性阻塞性肺疾病（COPD）的加重和症状，而患者可能更愿意评估无 COPD 加重和症状恶化的时期。后者符合以人及其信念为中心的积极健康方法。我们旨在确定与以下方面相关的患者特征和健康结果：1）无 COPD 加重的天数；2）无多于通常症状的天数；3）无 COPD 加重和合并症发作的天数（即慢性心力衰竭、焦虑、抑郁发作），使用负二项式回归分析。数据来自两项自我管理干预试验，包括患有和不患有合并症的 COPD 患者。共纳入 313 名患者（平均年龄 66.0 岁，63.6%为男性，68.7%为合并症）。更好的基线慢性呼吸系统问卷（CRQ）疲劳（发病率比（IRR）= 1.03（95%CI 1.01-1.05），= 0.02）和掌握评分（IRR = 1.03（95%CI 1.00-1.06），= 0.04）和较少的抗生素疗程（IRR = 0.95（95%CI 0.94-0.96），= 0.01）与更多的 COPD 加重无天数相关。此外，更好的基线 CRQ 疲劳（IRR = 1.05（95%CI 1.00-1.10），= 0.04）和掌握评分（IRR = 1.06（95%CI 1.00-1.12），= 0.04）、较少的抗生素疗程（IRR = 0.94（95%CI 0.91-0.96），= 0.01）和改善的 CRQ 呼吸困难评分在 12 个月的随访期间（IRR = 1.07（95%CI 1.01-1.12），= 0.01）与更多无恶化症状的天数相关。较少的基线呼吸困难（改良的医学研究理事会评分）（IRR = 0.95（95%CI 0.92-0.98），= 0.01）和较少的抗生素疗程（IRR = 0.94（95%CI 0.93-0.95），= 0.01）与 COPD 加重和合并症发作天数减少相关。医疗保健专业人员应该意识到，COPD 患者的疲劳减轻和对 COPD 的掌握程度提高与更多的加重和无症状时间有关。