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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