抽象的
COPD exacerbation self-management does not reduce COPD exacerbation days or hospitalisation, rather to more oral corticosteroid use and is rarely effective as it is not targetedhttp://bit.ly/33d89jf
To the Editor:
我们感兴趣地阅读了COPE-III试验结果的报告Enferinket al.[1]。这项大型随机试验继续从作者的早期COPE-II研究[2],具有基于相关合并症的个性化加剧行动计划。动作计划详细介绍,旨在确定症状的改变和随后加重的迹象。这项研究对其主要终点(COPD加剧的日子)为阴性,使用自我管理干预措施未发现生活质量。作者在两个臂中的口服泼尼松龙课程的数量没有差异,尽管每个事件都很明显,自我管理决定了每个事件的泼尼松龙处方的显着增加(95%(208/216)versus71%(163/230)),因此也将是心力衰竭,焦虑,抑郁和缺血性心脏病事件的初始治疗方法。有趣的是,作者发现,在12个月的研究期间受益于自我管理部门的患者是患有一种或多种COPD加重的患者。我们现在知道,嗜酸性炎症与加重风险增加有关[3]并且对全身性皮质类固醇具有最佳反应的患者具有嗜酸性加重[4]。我们兴趣询问作者是否在随机化之前表现出COPD患者的炎症?
Undoubtedly pharmacotherapy should reflect the underlying cause, and although the authors move towards achieving this, it is difficult to be confident that self-management during symptom deterioration of COPD leads to accurate treatment to match the underlying cause. This might explain these and other findings of increased harm in interventions associated with self-management [5,6]。虽然lEnferinket al.[1] make a significant step in trying to manage comorbidities in their programme, systemic corticosteroids are the predominant treatment in the self-management intervention: a highly toxic and potentially ineffective intervention [7]。In parallel to personalising treatment towards comorbidities, we believe that we should also be aiming at getting the right and best treatment to the patient first. Achieving this and improving outcomes in COPD is unlikely to occur, however, with current strategies directed towards self-management, where we have an unknown explanation for symptom worsening and toxic treatment.
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脚注
利益冲突:S。Ramakrishnan报告了在提交工作之外的阿斯利康的非金融(旅行)支持。
Conflict of interest: M. Bafadhel reports grants from AZ, personal fees for consulting and advisory boards, and support for travel to conferences from AZ, Chiesi and GSK, outside the submitted work.
- 已收到October 28, 2019.
- AcceptedOctober 31, 2019.
- 复制right ©ERS 2020