Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Institut Respiratori (Clinic Barcelona), Càtedra Salut Respiratoria (Universitat de Barcelona), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS-Barcelona), Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), España.
Am J Respir Crit Care Med. 2023 Nov 15;208(10):1026-1041. doi: 10.1164/rccm.202209-1748SO.
Chronic obstructive pulmonary disease is a major health problem with a high prevalence, a rising incidence, and substantial morbidity and mortality. Its course is punctuated by acute episodes of increased respiratory symptoms, termed exacerbations of chronic obstructive pulmonary disease (ECOPD). ECOPD are important events in the natural history of the disease, as they are associated with lung function decline and prolonged negative effects on quality of life. The present-day therapy for ECOPD with short courses of antibiotics and steroids and escalation of bronchodilators has resulted in only modest improvements in outcomes. Recent data indicate that ECOPD are heterogeneous, raising the need to identify distinct etioendophenotypes, incorporating traits of the acute event and of patients who experience recurrent events, to develop novel and targeted therapies. These characterizations can provide a complete clinical picture, the severity of which will dictate acute pharmacological treatment, and may also indicate whether a change in maintenance therapy is needed to reduce the risk of future exacerbations. In this review we discuss the latest knowledge of ECOPD types on the basis of clinical presentation, etiology, natural history, frequency, severity, and biomarkers in an attempt to characterize these events.
慢性阻塞性肺疾病是一个主要的健康问题，具有高患病率、发病率上升以及较高的发病率和死亡率。其病程以呼吸症状加重的急性发作为特征，称为慢性阻塞性肺疾病急性加重（AECOPD）。AECOPD 是疾病自然史中的重要事件，因为它们与肺功能下降和对生活质量的长期负面影响有关。目前，AECOPD 的治疗方法是短期使用抗生素和类固醇，并升级支气管扩张剂，但仅能适度改善结局。最近的数据表明，AECOPD 具有异质性，因此需要确定不同的病因表型，将急性事件的特征和反复发生事件的患者的特征结合起来，以开发新的靶向治疗方法。这些特征可以提供完整的临床情况，其严重程度将决定急性药理治疗，并且还可能表明是否需要改变维持治疗以降低未来加重的风险。在这篇综述中，我们根据临床表现、病因、自然病史、频率、严重程度和生物标志物讨论了 AECOPD 类型的最新知识，试图对这些事件进行特征描述。
