University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK.
Observational and Pragmatic Research Institute, Singapore, Singapore.
Eur Respir J. 2024 Oct 3;64(4). doi: 10.1183/13993003.02240-2023. Print 2024 Oct.
Prior exacerbation history is used to guide initial maintenance therapy in COPD; however, the recommendations were derived from patients already diagnosed and treated.
We assessed the rates of moderate ( treated with antibiotics and/or systemic corticosteroids) and severe ( hospitalised) exacerbations in the year following diagnosis in patients newly diagnosed with COPD according to their prior history of exacerbations, blood eosinophil count (BEC) and whether maintenance therapy was started. Data were extracted from the Optimum Patient Care Research Database.
73 189 patients were included. 61.9% had no exacerbations prior to diagnosis, 21.5% had 1 moderate, 16.5% had ≥2 moderate and 0.3% had ≥1 severe. 50% were started on maintenance therapy. In patients not started on maintenance therapy the rates of moderate exacerbations in the year after diagnosis in patients with no, 1 moderate, ≥2 moderate and ≥1 severe prior exacerbations were 0.34 (95% CI 0.33-0.35), 0.59 (95% CI 0.56-0.61), 1.18 (95% CI 1.14-1.23) and 1.21 (95% CI 0.73-1.69), respectively. Similar results were seen in patients started on maintenance therapy. BEC did not add significantly to the prediction of future exacerbation risk.
A single moderate exacerbation in the year prior to diagnosis increases the risk of subsequent exacerbations, and more frequent or severe exacerbations prior to diagnosis are associated with a higher risk.
既往加重史用于指导 COPD 的初始维持治疗；然而，这些建议是基于已经诊断和治疗的患者得出的。
我们根据既往加重史、血嗜酸性粒细胞计数（BEC）以及是否开始维持治疗，评估了新诊断为 COPD 的患者在诊断后 1 年内发生中度（接受抗生素和/或全身皮质激素治疗）和重度（住院）加重的发生率。数据从 Optimum Patient Care Research Database 中提取。
共纳入 73189 例患者。61.9%的患者在诊断前无加重史，21.5%的患者有 1 次中度加重，16.5%的患者有≥2 次中度加重，0.3%的患者有≥1 次重度加重。50%的患者开始接受维持治疗。在未开始维持治疗的患者中，既往无、1 次中度、≥2 次中度和≥1 次重度加重的患者在诊断后 1 年内发生中度加重的比例分别为 0.34（95%CI 0.33-0.35）、0.59（95%CI 0.56-0.61）、1.18（95%CI 1.14-1.23）和 1.21（95%CI 0.73-1.69）。在开始维持治疗的患者中也观察到了类似的结果。BEC 并不能显著增加对未来加重风险的预测。
在诊断前的 1 年内有 1 次中度加重会增加随后加重的风险，而在诊断前更频繁或更严重的加重与更高的风险相关。
