慢性阻塞性肺疾病患者频繁咳嗽采用不同吸入疗法的临床特征和结局。
The clinical characteristics and outcomes of different inhaled therapies in chronic obstructive pulmonary disease patients with frequent cough.
机构信息
Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China.
出版信息
Ann Med. 2023;55(2):2304107. doi: 10.1080/07853890.2024.2304107. Epub 2024 Jan 17.
BACKGROUND
Cough is a common symptom in patients with chronic obstructive pulmonary disease (COPD). Patients with cough may exhibit various clinical characteristics and experience varying outcomes based on inhaled therapies they receive.
OBJECTIVES
This study aimed to explore the clinical characteristics and outcomes of various inhaled therapies in COPD patients with frequent cough.
METHODS
This was a multicenter, prospective cohort study. Of these patients, the median cough score in COPD assessment test (CAT) was two. Patients were classified into frequent cough group if they scored two or over in the first item of CAT and infrequent cough group otherwise. Patients with frequent cough were then divided into long-acting antimuscarinic (LAMA), long-acting beta2-agonist (LABA)/LAMA, inhaled corticosteroids (ICS)/LABA and ICS/LABA/LAMA groups. Minimum clinically important difference (MCID) (CAT scores decreased ≥2 from baseline) and the improvement of cough (cough score decreased ≥1 from baseline) were collected in the six-month follow-up. Frequent exacerbations (experiencing at least two exacerbations) were collected in the one-year follow-up.
RESULTS
Of 906 patients, 581 (64.1%) patients reported frequent cough at the initial visit. Frequent cough was associated with the current smokers and CAT scores ( < 0.05). The MCID showed no significant difference between frequent cough and infrequent cough groups in the follow-up. More patients with frequent cough experienced future frequent exacerbations compared to those with infrequent cough. After receiving inhaled therapies, 62% of patients with frequent cough got the cough improved. More patients with frequent cough treated with LABA/LAMA or ICS/LABA/LAMA attained MCID and fewer experienced exacerbations than those treated with LAMA or ICS/LABA ( < 0.05). The change in cough score showed no difference among various inhaled therapies in patients with frequent cough.
CONCLUSION
COPD patients with frequent cough were related to current smokers and higher CAT scores. These patients had a higher incidence of frequent exacerbations than those with infrequent cough. Patients with frequent cough who were treated with LABA/LAMA or ICS/LABA/LAMA were more likely to attain MCID and at a lower risk of exacerbation than those treated with LAMA or ICS/LABA.
背景
咳嗽是慢性阻塞性肺疾病（COPD）患者的常见症状。咳嗽患者根据所接受的吸入治疗可能表现出不同的临床特征和不同的结局。
目的
本研究旨在探讨 COPD 频繁咳嗽患者中各种吸入治疗的临床特征和结局。
方法
这是一项多中心、前瞻性队列研究。在这些患者中，COPD 评估测试（CAT）的中位咳嗽评分是 2 分。如果患者在 CAT 的第一项中得分为 2 或以上，则将其归类为频繁咳嗽组，否则为不频繁咳嗽组。然后，将频繁咳嗽患者分为长效抗胆碱能药物（LAMA）、长效β2-激动剂（LABA）/LAMA、吸入性皮质类固醇（ICS）/LABA 和 ICS/LABA/LAMA 组。在 6 个月的随访中收集最小临床重要差异（MCID）（CAT 评分较基线下降≥2）和咳嗽改善（咳嗽评分较基线下降≥1）。在 1 年的随访中收集频繁加重（至少经历两次加重）。
结果
在 906 名患者中，581 名（64.1%）患者在初诊时报告频繁咳嗽。频繁咳嗽与当前吸烟者和 CAT 评分相关（<0.05）。在随访中，频繁咳嗽组和不频繁咳嗽组的 MCID 无显著差异。与不频繁咳嗽患者相比，更多的频繁咳嗽患者经历了未来的频繁加重。接受吸入治疗后，62%的频繁咳嗽患者咳嗽得到改善。与 LAMA 或 ICS/LABA 相比，更多的频繁咳嗽患者接受 LABA/LAMA 或 ICS/LABA/LAMA 治疗后达到 MCID，且发生加重的患者更少（<0.05）。在频繁咳嗽患者中，各种吸入治疗的咳嗽评分变化无差异。
结论
COPD 频繁咳嗽患者与当前吸烟者和更高的 CAT 评分有关。这些患者的频繁加重发生率高于不频繁咳嗽患者。与 LAMA 或 ICS/LABA 相比，接受 LABA/LAMA 或 ICS/LABA/LAMA 治疗的频繁咳嗽患者更有可能达到 MCID，且发生加重的风险更低。
Zotero 插件