中低收入国家慢性阻塞性肺病患者的严重恶化率、医疗资源利用率和临床疗效:EXACOS 国际研究的结果

IF 3.6 3区 医学 Q1 RESPIRATORY SYSTEM BMJ Open Respiratory Research Pub Date : 2024-04-01 DOI:10.1136/bmjresp-2023-002101
Rodrigo Abensur Athanazio, Laura Bernal Villada, Sergey N Avdeev, Hao-Chien Wang, Alejandra Ramírez-Venegas, Martín Sivori, Jorge Dreyse, Manuel Pacheco, Sin Kit Man, Lorena Noriega-Aguirre, Hisham Farouk
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The study population comprised patients ≥40 years of age with COPD. Outcomes/variables included the prevalence of severe exacerbations, the annual rate of severe exacerbations and time between severe exacerbations; change in lung function over time (measured by the forced expiratory volume in 1 s (FEV1)); peripheral blood eosinophil counts (BECs) and the prevalence of comorbidities; treatment patterns; and HCRU. Results In total, 1702 patients were included in the study. The study population had a mean age of 69.7 years, with 69.4% males, and a mean body mass index of 26.4 kg/m2. The mean annual prevalence of severe exacerbations was 20.1%, and 48.4% of patients experienced ≥1 severe exacerbation during the 5-year study period. As the number of severe exacerbations increased, the interval between successive exacerbations decreased. 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引用次数: 0

摘要

导言:慢性阻塞性肺病(COPD)严重恶化及其结果(EXACOS)国际研究旨在量化中低收入国家慢性阻塞性肺病患者的严重恶化率,并检查医疗资源利用率(HCRU)和临床结果。方法 EXACOS 国际研究是一项观察性横断面研究,从医疗记录中收集长达 5 年的回顾性数据。数据来自 12 个国家:阿根廷、巴西、智利、哥伦比亚、哥斯达黎加、多米尼加共和国、危地马拉、香港、墨西哥、巴拿马、俄罗斯和台湾。研究对象包括年龄≥40 岁的慢性阻塞性肺病患者。结果/变量包括严重恶化的发生率、严重恶化的年发生率和严重恶化的间隔时间;肺功能随时间的变化(以 1 秒内用力呼气容积(FEV1)测量);外周血嗜酸性粒细胞计数(BEC)和合并症的发生率;治疗模式;以及 HCRU。结果 共有 1702 名患者参与了研究。研究对象的平均年龄为 69.7 岁,男性占 69.4%,平均体重指数为 26.4 kg/m2。严重病情恶化的年平均发生率为 20.1%,48.4% 的患者在 5 年研究期间经历了≥1 次严重病情恶化。随着严重恶化次数的增加,连续恶化之间的间隔时间缩短。从基线到基线后,≥1 次严重恶化患者的平均(标度)FEV1 出现了统计学意义上的显著下降(1.23 (0.51) 升至 1.13 (0.52) 升;P=0.0000)。平均 BEC 为 0.198 x109 cells/L,64.7% 的患者 BEC ≥0.1 x109 cells/L,21.3% 的患者 BEC ≥0.3 x109 cells/L。最常见的合并症是高血压(58.3%)。每年严重恶化次数的增加与 HCRU 的增加有关。讨论 本文的研究结果表明,在低收入和中等收入国家,预防慢性阻塞性肺疾病患者病情严重恶化的有效治疗策略仍是一项尚未满足的重大需求。如有合理要求,可提供相关数据。根据阿斯利康的数据共享政策,本手稿中描述的研究结果所依据的数据可在:.Vivli 上直接列出的研究数据可通过 www.vivli.org 申请。未在 Vivli 上列出的研究数据可通过 Vivli 申请,网址为 。阿斯利康的 Vivli 成员页面也可提供更多详细信息:.
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Rate of severe exacerbations, healthcare resource utilisation and clinical outcomes in patients with COPD in low-income and middle-income countries: results from the EXACOS International Study
Introduction The EXAcerbations of Chronic obstructive lung disease (COPD) and their OutcomeS (EXACOS) International Study aimed to quantify the rate of severe exacerbations and examine healthcare resource utilisation (HCRU) and clinical outcomes in patients with COPD from low-income and middle-income countries. Methods EXACOS International was an observational, cross-sectional study with retrospective data collection from medical records for a period of up to 5 years. Data were collected from 12 countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Guatemala, Hong Kong, Mexico, Panama, Russia and Taiwan. The study population comprised patients ≥40 years of age with COPD. Outcomes/variables included the prevalence of severe exacerbations, the annual rate of severe exacerbations and time between severe exacerbations; change in lung function over time (measured by the forced expiratory volume in 1 s (FEV1)); peripheral blood eosinophil counts (BECs) and the prevalence of comorbidities; treatment patterns; and HCRU. Results In total, 1702 patients were included in the study. The study population had a mean age of 69.7 years, with 69.4% males, and a mean body mass index of 26.4 kg/m2. The mean annual prevalence of severe exacerbations was 20.1%, and 48.4% of patients experienced ≥1 severe exacerbation during the 5-year study period. As the number of severe exacerbations increased, the interval between successive exacerbations decreased. A statistically significant decrease in mean (SD) FEV1 from baseline to post-baseline was observed in patients with ≥1 severe exacerbation (1.23 (0.51) to 1.13 (0.52) L; p=0.0000). Mean BEC was 0.198 x109 cells/L, with 64.7% of patients having a BEC ≥0.1 x109 cells/L and 21.3% having a BEC ≥0.3 x109 cells/L. The most common comorbidity was hypertension (58.3%). An increasing number of severe exacerbations per year was associated with greater HCRU. Discussion The findings presented here indicate that effective treatment strategies to prevent severe exacerbations in patients with COPD remain a significant unmet need in low-income and middle-income countries. Data are available upon reasonable request. Data underlying the findings described in this manuscript may be obtained in accordance with AstraZeneca’s data-sharing policy described at: . Data for studies directly listed on Vivli can be requested through Vivli at www.vivli.org. Data for studies not listed on Vivli could be requested through Vivli at . The AstraZeneca Vivli member page is also available, outlining further details: .
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来源期刊
BMJ Open Respiratory Research
BMJ Open Respiratory Research RESPIRATORY SYSTEM-
CiteScore
6.60
自引率
2.40%
发文量
95
审稿时长
12 weeks
期刊介绍: BMJ Open Respiratory Research is a peer-reviewed, open access journal publishing respiratory and critical care medicine. It is the sister journal to Thorax and co-owned by the British Thoracic Society and BMJ. The journal focuses on robustness of methodology and scientific rigour with less emphasis on novelty or perceived impact. BMJ Open Respiratory Research operates a rapid review process, with continuous publication online, ensuring timely, up-to-date research is available worldwide. The journal publishes review articles and all research study types: Basic science including laboratory based experiments and animal models, Pilot studies or proof of concept, Observational studies, Study protocols, Registries, Clinical trials from phase I to multicentre randomised clinical trials, Systematic reviews and meta-analyses.
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