慢性阻塞性肺病急性加重

COPD 患者出现并发症和死亡最常发生在急性加重的情况下。一项研究发现，COPD 急性加重住院治疗后的 5 年死亡率约为 50%。[153]Hoogendoorn M, Hoogenveen RT, Rutten-van Mölken MP, et al. Case fatality of COPD exacerbations: a meta-analysis and statistical modelling approach. Eur Respir J. 2011;37:508-515. http://erj.ersjournals.com/content/37/3/508.long http://www.ncbi.nlm.nih.gov/pubmed/20595157?tool=bestpractice.com 再入院率和/或死亡率与 FEV₁ 更低、PaCO₂ 更高、PaO₂ 更低、体重指数更低、高龄、合并症和体力活动水平低相关。[154]Breen D, Churches T, Hawker F, et al. Acute respiratory failure secondary to chronic obstructive pulmonary disease treated in the intensive care unit: a long term follow up study. Thorax. 2002 Jan;57(1):29-33. https://thorax.bmj.com/content/57/1/29.long http://www.ncbi.nlm.nih.gov/pubmed/11809986?tool=bestpractice.com [155]Dewan NA, Rafique S, Kanwar B, et al. Acute exacerbation of COPD: factors associated with poor treatment outcome. Chest. 2000 Mar;117(3):662-71. http://www.ncbi.nlm.nih.gov/pubmed/10712989?tool=bestpractice.com [156]Gunen H, Hacievliyagil SS, Kosar F, et al. Factors affecting survival of hospitalised patients with COPD. Eur Respir J. 2005 Aug;26(2):234-41. http://erj.ersjournals.com/content/26/2/234.full http://www.ncbi.nlm.nih.gov/pubmed/16055870?tool=bestpractice.com [157]Garcia-Aymerich J, Farrero E, Felez MA, et al. Risk factors of readmission to hospital for a COPD exacerbation: a prospective study. Thorax. 2003 Feb;58(2):100-5. https://thorax.bmj.com/content/58/2/100.long http://www.ncbi.nlm.nih.gov/pubmed/12554887?tool=bestpractice.com [158]Garcia-Aymerich J, Lange P, Benet M, et al. Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study. Thorax. 2006 Sep;61(9):772-8. https://thorax.bmj.com/content/61/9/772.long http://www.ncbi.nlm.nih.gov/pubmed/16738033?tool=bestpractice.com [159]Piquet J, Chavaillon JM, David P, et al. High-risk patients following hospitalisation for an acute exacerbation of COPD. Eur Respir J. 2013 Oct;42(4):946-55. https://erj.ersjournals.com/content/42/4/946.long http://www.ncbi.nlm.nih.gov/pubmed/23349446?tool=bestpractice.com [160]Singanayagam A, Schembri S, Chalmers JD. Predictors of mortality in hospitalized adults with acute exacerbation of chronic obstructive pulmonary disease. Ann Am Thorac Soc. 2013 Apr;10(2):81-9. https://www.atsjournals.org/doi/full/10.1513/AnnalsATS.201208-043OC http://www.ncbi.nlm.nih.gov/pubmed/23607835?tool=bestpractice.com 多维 CODEX（合并症、气道阻塞、呼吸困难和既往重度急性加重）指数可预测 COPD 加重住院后 3 个月和 1 年的再入院率和存活率。[161]Almagro P, Soriano JB, Cabrera FJ, et al. Short- and medium-term prognosis in patients hospitalized for COPD exacerbation: the CODEX index. Chest. 2014 May;145(5):972-80. http://www.ncbi.nlm.nih.gov/pubmed/24077342?tool=bestpractice.com

急性加重的程度从极轻度到重度不等，甚至可危及生命。

COPD 严重加重的患者不一定总是能恢复到病前的功能状态。出院后可能需要参与肺康复项目，以提高运动耐量、体能和生活质量。