ERSCOPD综合原文.docx
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ERSCOPD综合原文.docx
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ERSCOPD综合原文
Inflammatorybiomarkersandcomorbiditiesinchronicobstructivepulmonarydisease[P455]
M.Dahl,M.Thomsen,P.Lange,J.Vestbo,B.Nordestgaard(Hvidovre,Herlev,Copenhagen,Denmark;Manchester,UnitedKingdom)
Session:
AsthmaandCOPD:
qualityoflifeandcomorbidities
OrganisedbytheScientificGrouponEpidemiology
Abstract:
BackgroundPatientswithchronicobstructivepulmonarydisease(COPD)haveevidenceofsystemicinflammationthatmaybeimplicatedinthedevelopmentofcomorbidities.WetestedthehypothesisthatelevatedlevelsofthreeinflammatorybiomarkersareassociatedwithincreasedriskofcomorbiditiesinCOPD.MethodsWemeasuredbaselineC-reactiveprotein(CRP),fibrinogen,andleukocytecountin10,052COPDpatientsfromtwolargepopulationstudies.Duringamedian5-yearsfollow-upwerecordedhospitaladmissionsduetoischemicheartdisease,myocardialinfarction,heartfailure,typeIIdiabetes,lungcancer,pneumonia,pulmonaryembolism,hipfracture,anddepressionasendpoints.ResultsMultifactoriallyadjustedriskofischemicheartdiseasewasincreasedbyafactorof2.19(95%confidenceinterval1.48to3.23)inindividualswiththreebiomarkerselevated(CRPabove3mgperliter,fibrinogenabove14μmolperliter,andleukocytecountabove9x109perliter)versusindividualswithallthreebiomarkersatorbelowtheselimits.Correspondinghazardratioswere2.32(1.34to4.04)formyocardialinfarction,2.63(1.71to4.04)forheartfailure,3.54(2.03to6.19)fordiabetes,4.00(2.12to7.54)forlungcancer,and2.71(2.03to3.63)forpneumonia.Therewerenoconsistentdifferencesinriskofpulmonaryembolism,hipfracture,ordepressionasafunctionofthesethreebiomarkers.ConclusionsSimultaneouslyelevatedlevelsofCRP,fibrinogen,andleukocytecountareassociatedwitha2to4-foldincreasedriskofmajorcomorbiditiesinCOPD.ThesefindingsmayenableclinicianstoconductstratifiedmanagementofcomorbiditiesinCOPDpatients.
MortalityrisksofCOPDfornonsmokersandsmokersfromaprospectivecohortstudyof390,269subjectsinTaiwan-Assessinginvolvementbeyondthelungs[P993]
W.E.Cheng,C.P.Wen,M.K.Tsai,Y.C.Yang,X.Wu(Taichung,Zhunan,Taiwan;Houston,UnitedStatesOfAmerica)
Time:
Sunday2012/09/02,12:
50-14:
40
Place:
HalleA-25
Session:
COPDepidemiology
OrganisedbytheScientificGrouponEpidemiology
Abstract:
BackgroundCOPDisknowntoincreasemortalityinrespiratorydiseases,butislessknownforitsextra-pulmonaryandlungcancereffect,particularlyamongnonsmokersObjectivesToassesstherisksofCOPDsubjectsamongsmokersandnonsmokersandtoquantifyitsmortalityeffectbeyondthelungs.MethodThecohortconsistedof390,269adults,between1994and2008,wentthroughafee-for-service,standardpanelofhealthscreeningprogram.COPDwasdefinedbyGoldcriteria.Mortalityandcancerincidencewereidentifiedinanaverageof8.5yearsoffollow-up.Coxproportionatemodelwasusedtocalculatethehazardratios(HR)ResultsMoremen(4.6%)thanwomen(3.8%)andmoresmokers(5.3%)thannonsmokers(3.7%)hadCOPD,withameanageof50.Theexcessall-causemortalityforsmokers(HR:
2.51)wasthreetimeslargerthannonsmokers(HR:
1.53),whencomparedtothosewithoutCOPD.Notonlysmokers(4.5-fold)butalsononsmokers(1.4-fold)hadlungcancermortalitysignificantlyincreased,implyingtheindependenteffectfromCOPD.Otherthanlungcancerandrespiratorydiseases,COPDhadincreasedrisksforCVD(HR:
1.76),includingischemicheartdisease(HR:
1.63)andstroke(HR:
1.80),andkidneydiseases(HR:
2.32).Theextra-pulmonarycausesconstituted77%fornon-smokersand58%forsmokers.ConclusionThreequartersoftheexcessdeathsamongnonsmokingCOPDsubjectsdiedfromcausesbeyondthelungs.Theyhadincreasesinstroke,heart,renalandinfectiousdiseases,inadditiontolungcancer.Theseextra-pulmonaryrisks,under-appreciatedbycliniciansandunawareofbythepatients,aremajorchallengestoovercome.
DistributionofCOPDpatientsintheGOLDassessmentframeworkbyexacerbations[P980]
G.Nadeau,L.Adamek,M.Small(Uxbridge,Macclesfield,UnitedKingdom)
Time:
Sunday2012/09/02,12:
50-14:
40
Place:
HalleA-25
Session:
COPDepidemiology
OrganisedbytheScientificGrouponEpidemiology
Abstract:
GOLD2011proposesanewCOPDassessmentframeworkfocussedonsymptomsmeasuredbytheCOPDAssessmentTest(CAT™)orthemMRCandonriskbasedonpoorlungfunction(FEV1<50%)andahistoryof≥2exacerbationsinthepreviousyear.Thisanalysisfocussesonexacerbations.The2011AdelphiDiseaseSpecificProgrammedatasetwasusedtounderstandthedistributionofpatientsintheGOLDframework.Exacerbationeventsdefinedasthosenotbroughtundercontrolbyrescuemedicationwererecordedbyphysicians.Weincluded1041EUCOPDpatientswithdocumentedCAT,mMRC,FEV1andexacerbationhistoryinthelastyear:
401(38.5%)werefromprimarycareand640(61.5%)fromspecialtyclinics.Almostall(97.7%)wereonmaintenancetreatment.104subjects(10%)reportedgoodhealthstatus(CAT<10);only7ofthesewererepeatexacerbatorsorhadpoorlungfunction.½ofallpatients(48.6%)hadnoexacerbationsand18.5%had1exacerbationinthepreviousyear.
%DistributionbasedonExacerbationHistory-(n)
GOLDQuadrant
ExacerbationHistory
0
1
≥2
A
8.0%(83)
1.3%(14)
0%(0)
B
35.4%(368)
13.2%(137)
0%(0)
C
0.3%(3)
0.1%
(1)
0.3%(3)
D
5.0%(52)
3.9%(41)
32.5%(339)
Total
48.6%(506)
18.5%(193)
32.9%(342)
Inobservationaldatabases,1exacerbationincreasestheriskoffutureexacerbations1andnegativelyimpactshealthstatusandoutcomes2.Therapeuticinterventionsreducethenumberandseverityofexacerbationsinpatientswith1ormoreexacerbations.Nearly1/5ofpatientsintheAdelphidatasethad1exacerbationinthepreviousyearandwouldfailtobeincludedinGOLDhighriskcategory.Theseobservationsmayhaveimportantclinicalimplications.1.HurstJR,NEJM20102.CoteC,CHEST2007.
InfluenceofstatintreatmentoncancermortalityinCOPDpatients:
Retrospectiveobservationalcohortstudy[P997]
P.Crequit,I.Annesi-Maesano,C.Chouaid,G.Hejblum(Paris,France)
Session:
HealthcareutilisationandtreatmentofasthmaandCOPD
OrganisedbytheScientificGrouponEpidemiology
Abstract:
Background:
Theanti-inflammatoryandimmunomodulatorystatinpropertieshavebeensuggestedforpreventingcancerdevelopmentinpatientswithChronicObstructivePulmonaryDisease(COPD).However,theeffectofstatinoncancermortalityinCOPDpatientsispoorlydocumented.ThestudyendpointistoevaluatetheimpactofstatinoncancermortalityofCOPDpatients.Methods:
BasedonalargepharmaceuticalFrenchdatabaseoftheNortharea,aretrospectivecohortstudywasconductedinordertoevaluatetheeffectofstatinoncancermortalityinCOPDpatients.Analysis,basedonaCoxproportionalhazardsmodelwithstatinexposurehandledasatime-dependentvariable,includedthe66429individuals40yearsoldormorewhohadatleastonepharmaceuticaldispensationbetween01/01/2000and05/11/2007.Inthiscohort,9531COPDpatientswereidentified;18.1%ofCOPDpatientswereconsideredexposedtostatin.Findings:
TheoveralldeathrateofCOPDpatientsis40.8%.ThevariouscausesaccountableforCOPDpatients'deathwere:
cardiovasculardiseasesfor33.7%,respiratorydiseasesfor33.7%andcancerfor24.8%.StatintreatmentwassignificantlyassociatedwithadecreaseofcancermortalityinCOPDpatientswithestimates(hazardratio[95%CI],pvalue)at0.586[0.465-0.739],p=<0.0001.Interpretation:
ItseemsthatstatindeliverytoCOPDpatientreducesthecancerdeathrate.Howevertheresulthastobecheckedoutbyprospectiverandomizedstudies.
ComparisonofdifferentdosagenebulisedbudesonideinCOPDexacerbation[P4824]
E.YilmazelUcar,O.Araz,D.Ozturk,M.Akgun,L.Saglam,M.Gorguner(Erzurum,Turkey)
Time:
Wednesday2012/09/05,10:
45-12:
45
Place:
RoomC7
Session:
COPDexacerbation
OrganisedbytheScientificGrouponClinicalproblems
Abstract:
Objective:
Tocomparetheefficacyandsafetyofdifferentdosagenebulisedbudesonide(NB)inthetreatmentofacuteexacerbationsofchronicobstructivepulmonarydisease(COPD).Design:
Randomised,double-blind,parallel-grouptrial.Patientsandinterventions:
Atotalof64patientswhohadmoderatetosevereacuteexacerbationsofCOPDandrequiredhospitalisationwereenrolledinthestudy.Thepatientswererandomizedintothreegroups.Group1receivedsystemic(intravenous)prednisolone40mgdaily(n=28),group2received4mgNBdaily(n=20),group3received8mgNBdaily(n=18).Airwayobstruction[forcedvitalecapacity(FVC),forcedexpiratuarvolüme1second(FEV1)]wasevaulatedatadmissionanddischarged.Arterialpartialpressureofoxygen(PaO2),carbondioxide(PaCO2),pH,andoxygensaturation(SaO2)wereevaulatedat24and48hours,andatday10.Results:
Therewerenosignificantdifferencesbetweengroupsatbaseline.Ingroups,differencesweresignificantforFVC,FEV1,PaO2,andSaO2(p=0,000),butnotforPaCO2andpH,incomparisonwiththeirbaselinevalues.Therewerenosignificantdifferencesbetweengroupsforallparametersatalltimeperiods.Whilebloodglucoseexhibitedanupwardtrendonlygroup1(8patients),oralmonoliazisandhoarsenesswereobservedingroup2and3(5patient).Butthedifferenceswerenotstatisticallysignificant(p=0,69).Conclusions:
NebulisedbudesonideiseffectiveandsafetyinthetreatmentofCOPDexacerbation.Thereisnosignificantdifferenceintermsofefficacyandsafetybetween4mgand8mgnebulisedbudesonide.
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