Domiciliary pulse-oximetry at exacerbation of chronic obstructive pulmonary disease: prospective pilot study
详细信息 查看全文
- 作者：John R Hurst (1) <br> Gavin C Donaldson (1) <br> Jennifer K Quint (1) <br> James JP Goldring (1) <br> Anant RC Patel (1) <br> Jadwiga A Wedzicha (1) <br>
- 刊名：BMC Pulmonary Medicine
- 出版年：2010
- 出版时间：December 2010
- 年：2010
- 卷：10
- 期：1
- 全文大小：2271KB
- 参考文献：1. Global Initiative for Chronic Obstructive Lung Disease: Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Lung Disease Updated. [http://www.goldcopd.org/Guidelineitem.asp?l1=2&l2=1&intId=2180] <br> 2. Wilkinson TMA, Donaldson GC, Hurst JR, Seemungal TAR, Wedzicha JA: Early Therapy Improves Outcomes of Exacerbations of Chronic Obstructive Pulmonary Disease. / Am J Respir Crit Care Med 2004, 169:1298-303. CrossRef <br> 3. Jones P, Higenbottam T: Quantifying of severity of exacerbations in chronic obstructive pulmonary disease: adaptations to the definition to allow quantification. / Proc Am Thorac Soc 2007, 4:597-01. CrossRef <br> 4. Hurst JR, Perera WR, Wilkinson TMA, Donaldson GC, Wedzicha JA: Systemic and Upper and Lower Airway Inflammation at Exacerbation of Chronic Obstructive Pulmonary Disease. / Am J Respir Crit Care Med 2006, 173:71-8. CrossRef <br> 5. Hurst JR, Donaldson GC, Perera WR, Wilkinson TMA, Bilello JA, Hagan GW, Vessey RS, Wedzicha JA: Use of Plasma Biomarkers at Exacerbation of Chronic Obstructive Pulmonary Disease. / Am J Respir Crit Care Med 2006, 174:867-74. CrossRef <br> 6. Seemungal TA, Donaldson GC, Bhowmik A, Jeffries DJ, Wedzicha JA: Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. / Am J Respir Crit Care Med 2000, 161:1608-613. <br> 7. Calverley P, Pauwels R, L?fdahl CG, Svensson K, Higenbottam T, Carlsson LG, St?hl E: Relationship between respiratory symptoms and medical treatment in exacerbations of COPD. / Eur Respir J 2005, 26:406-13. CrossRef <br> 8. McKinstry B, Pinnock H, Sheikh A: Telemedicine for management of patients with COPD? / Lancet 2009, 374:672-73. CrossRef <br> 9. Seemungal TA, Donaldson GC, Paul EA, Bestall JC, Jeffries DJ, Wedzicha JA: Effect of exacerbation of quality of life in patients with chronic obstructive pulmonary disease. / Am J Respir Crit Care Med 1998, 157:1418-422. <br> 10. Bhowmik A, Seemungal TA, Sapsford RJ, Wedzicha JA: Relation of sputum inflammatory markers to symptoms and lung function changes in COPD exacerbations. / Thorax 2000, 55:114-20. CrossRef <br> 11. Donaldson GC, Seemungal TAR, Bhowmik A, Wedzicha JA: Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. / Thorax <br> 12. Donaldson GC, Wilkinson TMA, Hurst JR, Perera WR, Wedzicha JA: Exacerbations and Time Spent Outdoors in Chronic Obstructive Pulmonary Disease. / Am J Respir Crit Care Med 2005, 171:446-52. CrossRef <br> 13. Jones PW, Quirk FH, Baveystock CM, Littlejohns P: A self-complete measure of health status for chronic airflow limitation. The St. George's Respiratory Questionnaire. / Am Rev Respir Dis 1992, 145:1321-327. <br> 14. Kanner RE, Anthonisen NR, Connett JE: Lower respiratory illnesses promote FEV
- 作者单位：John R Hurst (1) <br> Gavin C Donaldson (1) <br> Jennifer K Quint (1) <br> James JP Goldring (1) <br> Anant RC Patel (1) <br> Jadwiga A Wedzicha (1) <br><br>1. Academic Unit of Respiratory Medicine, Royal Free Campus, UCL Medical School, NW3 2PF, London, UK <br>
文摘
Background The ability to objectively differentiate exacerbations of chronic obstructive pulmonary disease (COPD) from day-to-day symptom variations would be an important development in clinical practice and research. We assessed the ability of domiciliary pulse oximetry to achieve this. Methods 40 patients with moderate-severe COPD collected daily data on changes in symptoms, heart-rate (HR), oxygen saturation (SpO2b>) and peak-expiratory flow (PEF) over a total of 2705 days. 31 patients had data suitable for baseline analysis, and 13 patients experienced an exacerbation. Data were expressed as multiples of the standard deviation (SD) observed from each patient when stable. Results In stable COPD, the SD for HR, SpO2b> and PEF were approximately 5 min-1, 1% and 10l min-1. There were detectable changes in all three variables just prior to exacerbation onset, greatest 2-3 days following symptom onset. A composite Oximetry Score (mean magnitude of SpO2b> fall and HR rise) distinguished exacerbation onset from symptom variation (area under receiver-operating characteristic curve, AUC = 0.832, 95%CI 0.735-0.929, p = 0.003). In the presence of symptoms, a change in Score of ? (average of ?SD change in both HR and SpO2b>) was 71% sensitive and 74% specific for exacerbation onset. Conclusion We have defined normal variation of pulse oximetry variables in a small sample of patients with COPD. A composite HR and SpO2b> score distinguished exacerbation onset from symptom variation, potentially facilitating prompt therapy and providing validation of such events in clinical trials.