流行病学
COPD是排名全球第 4 位的致死原因,在美国是排名第 3 位的死亡原因。[1]Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2022 report. 2022 [internet publication]. https://goldcopd.org/2022-gold-reports [3]Hanania NA, Marciniuk DD. A unified front against COPD: clinical practice guidelines from the American College of Physicians, the American College of Chest Physicians, the American Thoracic Society, and the European Respiratory Society. Chest. 2011 Sep;140(3):565-6. http://www.ncbi.nlm.nih.gov/pubmed/21896511?tool=bestpractice.com 在 1970-2002 年期间,由COPD引起的病死率增加超过 100%。[4]Jemal A, Ward E, Hao Y. Trends in the leading causes of death in the United States, 1970-2002. JAMA. 2005 Sep 14;294(10):1255-9. https://jamanetwork.com/journals/jama/fullarticle/201494 http://www.ncbi.nlm.nih.gov/pubmed/16160134?tool=bestpractice.com 在美国,没有其他主要致死原因以如此快的速度增长。在全球范围内,COPD占致死病因的比例在高收入国家为 3.8%,在低收入国家为 4.9%。[5]Mannino DM, Buist AS. Global burden of COPD: risk factors, prevalence, and future trends. Lancet. 2007 Sep 1;370(9589):765-73. http://www.ncbi.nlm.nih.gov/pubmed/17765526?tool=bestpractice.com
不同国家之间COPD的患病率有很大差别。 [6]Mannino DM, Doherty DE, Sonia Buist A. Global Initiative on Obstructive Lung Disease (GOLD) classification of lung disease and mortality: findings from the Atherosclerosis Risk in Communities (ARIC) study. Respir Med. 2006 Jan;100(1):115-22. https://www.resmedjournal.com/article/S0954-6111(05)00141-1/fulltext http://www.ncbi.nlm.nih.gov/pubmed/15893923?tool=bestpractice.com [7]Buist AS, McBurnie MA, Vollmer WM, et al. International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet. 2007 Sep 1;370(9589):741-50. http://www.ncbi.nlm.nih.gov/pubmed/17765523?tool=bestpractice.com [8]Menezes AM, Perez-Padilla R, Jardim JR, et al. Chronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): a prevalence study. Lancet. 2005 Nov 26;366(9500):1875-81. http://www.ncbi.nlm.nih.gov/pubmed/16310554?tool=bestpractice.com 这可能和吸烟、室内和职业污染物的暴露程度不同有关。[5]Mannino DM, Buist AS. Global burden of COPD: risk factors, prevalence, and future trends. Lancet. 2007 Sep 1;370(9589):765-73. http://www.ncbi.nlm.nih.gov/pubmed/17765526?tool=bestpractice.com 在英国,1990-1997年间,经医生诊断的COPD的患病率在男性中为2%,女性中为1%。[9]Soriano JB, Maier WC, Egger P, et al. Recent trends in physician diagnosed COPD in women and men in the UK. Thorax. 2000 Sep;55(9):789-94. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1745847 http://www.ncbi.nlm.nih.gov/pubmed/10950900?tool=bestpractice.com 过去,男性COPD的发病率更高。这种差别认为主要是由于烟草和职业污染物的暴露多所致。调查发现COPD在男性和女性的患病率趋于相等。[7]Buist AS, McBurnie MA, Vollmer WM, et al. International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet. 2007 Sep 1;370(9589):741-50. http://www.ncbi.nlm.nih.gov/pubmed/17765523?tool=bestpractice.com [10]de Torres JP, Casanova C, Hernandez C, et al. Gender and COPD in patients attending a pulmonary clinic. Chest. 2005 Oct;128(4):2012-6. http://www.ncbi.nlm.nih.gov/pubmed/16236849?tool=bestpractice.com COPD对健康资源是一个重要负担。[6]Mannino DM, Doherty DE, Sonia Buist A. Global Initiative on Obstructive Lung Disease (GOLD) classification of lung disease and mortality: findings from the Atherosclerosis Risk in Communities (ARIC) study. Respir Med. 2006 Jan;100(1):115-22. https://www.resmedjournal.com/article/S0954-6111(05)00141-1/fulltext http://www.ncbi.nlm.nih.gov/pubmed/15893923?tool=bestpractice.com 急性加重是慢阻肺患者病死率和致残率高的主要因素,而每年急性加重的次数(中位数)为 1-3 次。[11]Seemungal TA, Donaldson GC, Bhowmik A, et al. Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2000 May;161(5):1608-13. http://www.ncbi.nlm.nih.gov/pubmed/10806163?tool=bestpractice.com [12]Seemungal TA, Donaldson GC, Paul EA, et al. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998 May;157(5 Pt 1):1418-22. http://www.ncbi.nlm.nih.gov/pubmed/9603117?tool=bestpractice.com 有明确证据显示COPD临床表现重的患者整体病死率高。[6]Mannino DM, Doherty DE, Sonia Buist A. Global Initiative on Obstructive Lung Disease (GOLD) classification of lung disease and mortality: findings from the Atherosclerosis Risk in Communities (ARIC) study. Respir Med. 2006 Jan;100(1):115-22. https://www.resmedjournal.com/article/S0954-6111(05)00141-1/fulltext http://www.ncbi.nlm.nih.gov/pubmed/15893923?tool=bestpractice.com 但是,病死率可能被低估,因为这一人群死亡经常归因于其他原因例如其他呼吸疾病、肺癌和心血管疾病。[6]Mannino DM, Doherty DE, Sonia Buist A. Global Initiative on Obstructive Lung Disease (GOLD) classification of lung disease and mortality: findings from the Atherosclerosis Risk in Communities (ARIC) study. Respir Med. 2006 Jan;100(1):115-22. https://www.resmedjournal.com/article/S0954-6111(05)00141-1/fulltext http://www.ncbi.nlm.nih.gov/pubmed/15893923?tool=bestpractice.com
COPD急性加重通常是由细菌或病毒感染、污染物或温度和湿度变化所诱发,表现为急性起病,患者的呼吸道症状、肺功能、健康状态和生活质量持续恶化。[11]Seemungal TA, Donaldson GC, Bhowmik A, et al. Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2000 May;161(5):1608-13. http://www.ncbi.nlm.nih.gov/pubmed/10806163?tool=bestpractice.com [13]Rodriguez-Roisin R. COPD exacerbations. 5: management. Thorax. 2006 Jun;61(6):535-44. http://www.ncbi.nlm.nih.gov/pubmed/16738044?tool=bestpractice.com [14]O'Donnell DE, Parker CM. COPD exacerbations. 3: Pathophysiology. Thorax. 2006 Apr;61(4):354-61. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2104611 http://www.ncbi.nlm.nih.gov/pubmed/16565268?tool=bestpractice.com [15]Barberà JA, Roca J, Ferrer A, et al. Mechanisms of worsening gas exchange during acute exacerbations of chronic obstructive pulmonary disease. Eur Respir J. 1997 Jun;10(6):1285-91. https://erj.ersjournals.com/content/erj/10/6/1285.full.pdf http://www.ncbi.nlm.nih.gov/pubmed/9192930?tool=bestpractice.com [16]Cote CG, Dordelly LJ, Celli BR. Impact of COPD exacerbations on patient-centered outcomes. Chest. 2007 Mar;131(3):696-704. http://www.ncbi.nlm.nih.gov/pubmed/17356082?tool=bestpractice.com [17]Spencer S, Jones PW; GLOBE Study Group. Time course of recovery of health status following an infective exacerbation of chronic bronchitis. Thorax. 2003 Jul;58(7):589-93. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1746751 http://www.ncbi.nlm.nih.gov/pubmed/12832673?tool=bestpractice.com [18]Xu W, Collet JP, Shapiro S, et al. Negative impacts of unreported COPD exacerbations on health-related quality of life at 1 year. Eur Respir J. 2010 May;35(5):1022-30. https://erj.ersjournals.com/content/35/5/1022.long http://www.ncbi.nlm.nih.gov/pubmed/19897555?tool=bestpractice.com 冬季急性加重率和全因死亡率较高。[19]Rabe KF, Fabbri LM, Vogelmeier C, et al. Seasonal distribution of COPD exacerbations in the Prevention of Exacerbations with Tiotropium in COPD trial. Chest. 2013 Mar;143(3):711-9. http://www.ncbi.nlm.nih.gov/pubmed/23188489?tool=bestpractice.com COPD急性加重,特别是中到重度的患者,对公共健康产生重大影响,增加医疗资源的使用、医疗花费,增加病死率。[20]Sutherland ER, Cherniack RM. Management of chronic obstructive pulmonary disease. N Engl J Med. 2004 Jun 24;350(26):2689-97. http://www.ncbi.nlm.nih.gov/pubmed/15215485?tool=bestpractice.com [21]Ai-Ping C, Lee KH, Lim TK. In-hospital and 5-year mortality of patients treated in the ICU for acute exacerbation of COPD: a retrospective study. Chest. 2005 Aug;128(2):518-24. http://www.ncbi.nlm.nih.gov/pubmed/16100133?tool=bestpractice.com [22]Donaldson GC, Seemungal TA, Bhowmik A, et al. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax. 2002 Oct;57(10):847-52. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1746193 http://www.ncbi.nlm.nih.gov/pubmed/12324669?tool=bestpractice.com [23]Seneff MG, Wagner DP, Wagner RP, et al. Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic obstructive pulmonary disease. JAMA. 1995 Dec 20;274(23):1852-7. http://www.ncbi.nlm.nih.gov/pubmed/7500534?tool=bestpractice.com [24]Soler-Cataluña JJ, Martínez-García MA, Román Sánchez P, et al. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax. 2005 Nov;60(11):925-31. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1747235 http://www.ncbi.nlm.nih.gov/pubmed/16055622?tool=bestpractice.com 重度 COPD 加重住院患者的早期死亡原因多为合并疾病,例如肺栓塞、肺炎或充血性心力衰竭。 [25]Zvezdin B, Milutinov S, Kojicic M, et al. A postmortem analysis of major causes of early death in patients hospitalized with COPD exacerbation. Chest. 2009 Aug;136(2):376-80. http://www.ncbi.nlm.nih.gov/pubmed/19318666?tool=bestpractice.com 在急性加重后的阶段,患者心肌梗死和卒中的风险仍高。[26]Donaldson GC, Hurst JR, Smith CJ, et al. Increased risk of myocardial infarction and stroke following exacerbation of COPD. Chest. 2010 May;137(5):1091-7. http://www.ncbi.nlm.nih.gov/pubmed/20022970?tool=bestpractice.com
危险因素
细菌是COPD急性加重的主要原因。有证据显示脓性痰多和下呼吸道细菌感染相关。[58]Soler N, Agusti C, Angrill J, et al. Bronchoscopic validation of the significance of sputum purulence in severe exacerbations of chronic obstructive pulmonary disease. Thorax. 2007 Jan;62(1):29-35. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2111274 http://www.ncbi.nlm.nih.gov/pubmed/16928715?tool=bestpractice.com 由于COPD患者的下呼吸道不是无菌的,上、下呼吸道标本培养结果的解读必须慎重。COPD急性加重患者细菌菌落数是否超出基线水平目前证据不确定。[59]Wilkinson TM, Hurst JR, Perera WR, et al. Effect of interactions between lower airway bacterial and rhinoviral infection in exacerbations of COPD. Chest. 2006 Feb;129(2):317-24. http://www.ncbi.nlm.nih.gov/pubmed/16478847?tool=bestpractice.com [60]Sethi S, Sethi R, Eschberger K, et al. Airway bacterial concentrations and exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2007 Aug 15;176(4):356-61. http://www.ncbi.nlm.nih.gov/pubmed/17478618?tool=bestpractice.com
最常被识别出的细菌病原体包括流感嗜血杆菌、肺炎链球菌和卡他莫拉菌。[31]Woodhead M, Blasi F, Ewig S, et al. Guidelines for the management of adult lower respiratory tract infections - full version. Clin Microbiol Infect. 2011 Nov;17 Suppl 6:E1-59. https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)61404-X/fulltext http://www.ncbi.nlm.nih.gov/pubmed/21951385?tool=bestpractice.com [51]Wedzicha JA, Seemungal TA. COPD exacerbations: defining their cause and prevention. Lancet. 2007 Sep 1;370(9589):786-96. http://www.ncbi.nlm.nih.gov/pubmed/17765528?tool=bestpractice.com 其他革兰氏阳性菌(例如金黄色葡萄球菌)和革兰氏阴性菌(例如铜绿假单胞菌)在 COPD 急性加重发病机制中的作用还不明确,但 COPD 更严重且加重更频繁和/或更严重的患者,或近期住院或近期(2 周内)每日全身性应用皮质类固醇(即泼尼松龙>10 mg/天)的患者更容易出现这些致病菌定植。[31]Woodhead M, Blasi F, Ewig S, et al. Guidelines for the management of adult lower respiratory tract infections - full version. Clin Microbiol Infect. 2011 Nov;17 Suppl 6:E1-59. https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)61404-X/fulltext http://www.ncbi.nlm.nih.gov/pubmed/21951385?tool=bestpractice.com [61]Caramori G, Adcock IM, Papi A. Clinical definition of COPD exacerbations and classification of their severity. South Med J. 2009 Mar;102(3):277-82. http://www.ncbi.nlm.nih.gov/pubmed/19204646?tool=bestpractice.com
值得注意的是,有证据显示COPD患者感染新的细菌菌株是急性加重的危险因素。[62]Sethi S, Evans N, Grant BJ, et al. New strains of bacteria and exacerbations of chronic obstructive pulmonary disease. N Engl J Med. 2002 Aug 15;347(7):465-71. http://www.ncbi.nlm.nih.gov/pubmed/12181400?tool=bestpractice.com 先天和/或适应性免疫反应的改变可能导致炎症和感染循环性持续存在。[42]Sethi S, Murphy TF. Infection in the pathogenesis and course of chronic obstructive pulmonary disease. N Engl J Med. 2008 Nov 27;359(22):2355-65. http://www.ncbi.nlm.nih.gov/pubmed/19038881?tool=bestpractice.com
细菌和病毒性呼吸道致病菌的混合感染和更加严重的急性发作相关。[50]Papi A, Bellettato CM, Braccioni F, et al. Infections and airway inflammation in chronic obstructive pulmonary disease severe exacerbations. Am J Respir Crit Care Med. 2006 May 15;173(10):1114-21. http://www.ncbi.nlm.nih.gov/pubmed/16484677?tool=bestpractice.com 对中到重度急性加重的患者应用抗菌药物治疗和预后改善相关。[63]Anthonisen NR, Manfreda J, Warren CP, et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med. 1987 Feb;106(2):196-204. http://www.ncbi.nlm.nih.gov/pubmed/3492164?tool=bestpractice.com [64]Puhan MA, Vollenweider D, Latshang T, et al. Exacerbations of chronic obstructive pulmonary disease: when are antibiotics indicated? A systematic review. Respir Res. 2007 Apr 4;8:30. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1853091 http://www.ncbi.nlm.nih.gov/pubmed/17407610?tool=bestpractice.com 流感疫苗接种可能在降低铜绿假单胞菌感染风险方面具有保护作用。[31]Woodhead M, Blasi F, Ewig S, et al. Guidelines for the management of adult lower respiratory tract infections - full version. Clin Microbiol Infect. 2011 Nov;17 Suppl 6:E1-59. https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)61404-X/fulltext http://www.ncbi.nlm.nih.gov/pubmed/21951385?tool=bestpractice.com
胃食管反流和吞咽功能障碍导致的误吸是COPD急性加重的常见诱因。[65]Terada K, Muro S, Sato S, et al. Impact of gastro-oesophageal reflux disease symptoms on COPD exacerbation. Thorax. 2008 Nov;63(11):951-5. http://www.ncbi.nlm.nih.gov/pubmed/18535116?tool=bestpractice.com [66]Terada K, Muro S, Ohara T, et al. Abnormal swallowing reflex and COPD exacerbations. Chest. 2010 Feb;137(2):326-32. http://www.ncbi.nlm.nih.gov/pubmed/19783670?tool=bestpractice.com 目前很少有研究表明治疗反流能否改善 COPD 加重。在一项涉及 600 多名稳定期 COPD 患者的观察性研究中,质子泵抑制剂治疗并未降低重度加重的风险。[67]Baumeler L, Papakonstantinou E, Milenkovic B, et al. Therapy with proton-pump inhibitors for gastroesophageal reflux disease does not reduce the risk for severe exacerbations in COPD. Respirology. 2016 Jul;21(5):883-90. https://orbi.uliege.be/handle/2268/206956 http://www.ncbi.nlm.nih.gov/pubmed/26970108?tool=bestpractice.com
估计呼吸道病毒导致 22%~50% 的急性加重。[33]Greenberg SB, Allen M, Wilson J, et al. Respiratory viral infections in adults with and without chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2000 Jul;162(1):167-73. http://www.ncbi.nlm.nih.gov/pubmed/10903237?tool=bestpractice.com
COPD急性加重患者分离到的鼻病毒明显多于其他病毒。[68]Seemungal TA, Harper-Owen R, Bhowmik A, et al. Detection of rhinovirus in induced sputum at exacerbation of chronic obstructive pulmonary disease. Eur Respir J. 2000 Oct;16(4):677-83. https://erj.ersjournals.com/content/erj/16/4/677.full.pdf http://www.ncbi.nlm.nih.gov/pubmed/11106212?tool=bestpractice.com
流感病毒、呼吸道合胞病毒、副流感病毒、冠状病毒、腺病毒和人偏肺病毒也和急性加重相关。[31]Woodhead M, Blasi F, Ewig S, et al. Guidelines for the management of adult lower respiratory tract infections - full version. Clin Microbiol Infect. 2011 Nov;17 Suppl 6:E1-59. https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)61404-X/fulltext http://www.ncbi.nlm.nih.gov/pubmed/21951385?tool=bestpractice.com [34]Beckham JD, Cadena A, Lin J, et al. Respiratory viral infections in patients with chronic obstructive pulmonary disease. J Infect. 2005 May;50(4):322-30. http://www.ncbi.nlm.nih.gov/pubmed/15845430?tool=bestpractice.com [35]Martinello RA, Esper F, Weibel C, et al. Human metapneumovirus and exacerbations of chronic obstructive pulmonary disease. J Infect. 2006 Oct;53(4):248-54. http://www.ncbi.nlm.nih.gov/pubmed/16412516?tool=bestpractice.com [69]Falsey AR, Formica MA, Hennessey PA, et al. Detection of respiratory syncytial virus in adults with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2006 Mar 15;173(6):639-43. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2662947 http://www.ncbi.nlm.nih.gov/pubmed/16387798?tool=bestpractice.com
呼吸道病毒比其他诱因导致的急性加重更重,缓解需要的时间更长。[68]Seemungal TA, Harper-Owen R, Bhowmik A, et al. Detection of rhinovirus in induced sputum at exacerbation of chronic obstructive pulmonary disease. Eur Respir J. 2000 Oct;16(4):677-83. https://erj.ersjournals.com/content/erj/16/4/677.full.pdf http://www.ncbi.nlm.nih.gov/pubmed/11106212?tool=bestpractice.com [70]Hurst JR, Donaldson GC, Wilkinson TM, et al. Epidemiological relationships between the common cold and exacerbation frequency in COPD. Eur Respir J. 2005 Nov;26(5):846-52. https://erj.ersjournals.com/content/26/5/846.long http://www.ncbi.nlm.nih.gov/pubmed/16264045?tool=bestpractice.com 病毒和细菌混合感染并不少见。
据推测,下呼吸道长期存在呼吸道病毒在COPD发生机制中发挥作用。[71]Hogg JC. Role of latent viral infections in chronic obstructive pulmonary disease and asthma. Am J Respir Crit Care Med. 2001 Nov 15;164(10 Pt 2):S71-5. http://www.ncbi.nlm.nih.gov/pubmed/11734471?tool=bestpractice.com
污染物水平增加(特别是二氧化氮 [NO2]、二氧化硫 [SO2]、臭氧 [O3] 和黑烟微粒 [包括木材燃烧的烟雾])与 COPD 患者急性加重率和入院率增加相关。[72]Anderson HR, Spix C, Medina S, et al. Air pollution and daily admissions for chronic obstructive pulmonary disease in 6 European cities: results from the APHEA project. Eur Respir J. 1997 May;10(5):1064-71. https://erj.ersjournals.com/content/erj/10/5/1064.full.pdf http://www.ncbi.nlm.nih.gov/pubmed/9163648?tool=bestpractice.com [73]Yang CY, Chen CC, Chen CY, et al. Air pollution and hospital admissions for asthma in a subtropical city: Taipei, Taiwan. J Toxicol Environ Health A. 2007 Jan 15;70(2):111-7. http://www.ncbi.nlm.nih.gov/pubmed/17365571?tool=bestpractice.com [74]Pope CA 3rd, Kanner RE. Acute effects of PM10 pollution on pulmonary function of smokers with mild to moderate chronic obstructive pulmonary disease. Am Rev Respir Dis. 1993 Jun;147(6 Pt 1):1336-40. http://www.ncbi.nlm.nih.gov/pubmed/8503541?tool=bestpractice.com 空气污染高峰也可能增加住院率和死亡率。[75]Faustini A, Stafoggia M, Colais P, et al. Air pollution and multiple acute respiratory outcomes. Eur Respir J. 2013 Aug;42(2):304-13. https://erj.ersjournals.com/content/42/2/304.long http://www.ncbi.nlm.nih.gov/pubmed/23314899?tool=bestpractice.com 大剂量杀虫剂吸入性暴露者存在较高的呼吸道症状、气道阻塞和 COPD 发生率。[1]Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2022 report. 2022 [internet publication]. https://goldcopd.org/2022-gold-reports
已经发现,暴露于许多这样的污染物中导致呼吸道的炎症反应。[28]Sapey E, Stockley RA. COPD exacerbations. 2: aetiology. Thorax. 2006 Mar;61(3):250-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2080749 http://www.ncbi.nlm.nih.gov/pubmed/16517585?tool=bestpractice.com
短期暴露于细颗粒物与急性加重致住院率增加以及死亡率增加有关。[1]Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2022 report. 2022 [internet publication]. https://goldcopd.org/2022-gold-reports
非典型病原体(肺炎支原体、肺炎衣原体和军团菌)被证实与急性加重相关,但研究结果并不一致。[76]Diederen BM, van der Valk PD, Kluytmans JA, et al. The role of atypical respiratory pathogens in exacerbations of chronic obstructive pulmonary disease. Eur Respir J. 2007 Aug;30(2):240-4. https://erj.ersjournals.com/content/30/2/240.long http://www.ncbi.nlm.nih.gov/pubmed/17459899?tool=bestpractice.com [77]Blasi F, Damato S, Cosentini R, et al. Chlamydia pneumoniae and chronic bronchitis: association with severity and bacterial clearance following treatment. Thorax. 2002 Aug;57(8):672-6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1746406 http://www.ncbi.nlm.nih.gov/pubmed/12149525?tool=bestpractice.com [78]Seemungal TA, Wedzicha JA, MacCallum PK, et al. Chlamydia pneumoniae and COPD exacerbation. Thorax. 2002 Dec;57(12):1087-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1758790 http://www.ncbi.nlm.nih.gov/pubmed/12454307?tool=bestpractice.com 没有足够的证据证明覆盖非典型细菌的抗菌药物治疗可以改善预后。
温度和湿度的变化和COPD急性加重风险增高相关。[28]Sapey E, Stockley RA. COPD exacerbations. 2: aetiology. Thorax. 2006 Mar;61(3):250-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2080749 http://www.ncbi.nlm.nih.gov/pubmed/16517585?tool=bestpractice.com [79]Donaldson GC, Seemungal T, Jeffries DJ, et al. Effect of temperature on lung function and symptoms in chronic obstructive pulmonary disease. Eur Respir J. 1999 Apr;13(4):844-9. https://erj.ersjournals.com/content/erj/13/4/844.full.pdf http://www.ncbi.nlm.nih.gov/pubmed/10362051?tool=bestpractice.com 但是,目前还不清楚环境温度和/或湿度的变化,或由于呼吸道病毒导致的感染风险变化是否和这种相关性有关。
冬季急性加重率和全因死亡率较高。[19]Rabe KF, Fabbri LM, Vogelmeier C, et al. Seasonal distribution of COPD exacerbations in the Prevention of Exacerbations with Tiotropium in COPD trial. Chest. 2013 Mar;143(3):711-9. http://www.ncbi.nlm.nih.gov/pubmed/23188489?tool=bestpractice.com
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