Kronik Obstrüktif Akciğer Hastalığı Alevlenmelerinde Mevsimsel Varyasyonlar

Her alevlenme ile hastanın sağlık durumu ve prognozu kötüleştiğinden kronik obstrüktif akciğer hastalığı (KOAH) tedavisinde ana amaç alevlenmelerin sıklığını ve ağırlığını azaltmaktır. Kış mevsiminde KOAH alevlenmelerinde ve hastane başvurularında artış olduğu uzun zamandan beri biliniyor olsa da meteorolojik faktörlere maruz kalmanın hangi mekanizmalarla morbidite riskini arttırdığı belli değildir. Sıcak veya soğuk algı eşiğinin coğrafik lokalizasyona göre değişmesi nedeniyle bazı araştırmalar birbirleriyle çelişen ilişkiler bulmuşlardır. Soğuğun KOAH üzerine etkisi sıcaktan daha fazla olup bu etki özellikle yaşlılarda belirgindir. Sıcaklığa bağlı mortalitede latent bir süreç bulunmaktadır. Solunum yolu enfeksiyonları ve hava kirliliği sıcaklığın etkisini arttırıp azaltabilir. Alevlenme için risk faktörlerinin erkenden saptanması yüksek riskli KOAH hastalarının alevlenmeden korunmasına ve yaşam kalitelerinin iyileşmesine yardımcı olabilir.

Seasonal Variations in Exacerbations of Chronic Obstructive Pulmonary Disease

Because the prognosis and health status deteriorates with each exacerbation, the main objective of chronic obstructive pulmonary disease (COPD) treatment is to reduce the frequency and severity of exacerbations. Although the increase in COPD exacerbations and the higher number of hospital admissions during the winter season have been well known for years, the exact mechanism by which exposure to meteorological factors can increase the risk of morbidity remains unclear. Some studies have found inconsistent associations because temperature thresholds for cold or hot change by geographic location. Cold effect is higher than heat effect on COPD, especially elderly. Temperature-related mortality has a latent period. Respiratory infections and air pollution may modify the effect of temperature. Early identification of risk factors for exacerbation may help to prevent high-risk COPD patients from suffering an exacerbation and improve their quality of life.

PDF

___

1. Hoffmann C, Hanisch M, Heinsohn JB, et al. Increased vulnerability of COPD patient groups to urban climate in view of global warming. Int J Chron Obstruct Pulmon Dis 2018;13:3493-501.
2. Analitis A, Katsouyanni K, Biggeri A, et al. Effects of cold weather on mortality: results from 15 European cities within the PHEWE project. Am J Epidemiol 2008;168:1397-408.
3. Mann M, Patel K, Reardon JZ, et al. The influence of spring and summer New England meteorologic conditions on the respiratory status of patients with chronic lung disease. Chest 1993;103:1369-74.
4. López-Campos JL, Abad Arranz M, CaleroAcuña C, et al. Seasonal variability in clinical care of COPD outpatients: results from the Andalusian COPD audit. Int J Chron Obstruct Pulmon Dis 2017;12:785-92.
5. Donaldson GC, Seemungal T, Jeffries DJ, Wedzicha JA. Effect of temperature on lung function and symptoms in chronic obstructive pulmonary disease. Eur Respir J 1999;13:844-9.
6. Almagro P, Hernandez C, Martinez-Cambor P, Tresserras R, Escarrabill J. Seasonality, ambient temperatures and hospitalizations for acute exacerbation of COPD: a population-based study in a metropolitan area. Int J Chron Obstruct Pulmon Dis 2015;10:899-908.
7. Hurst JR, Donaldson GC, Quint JK, Goldring JJ, Baghai-Ravary R, Wedzicha JA. Temporal clustering of exacerbations in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2009;179:369-74.
8. Lin S, Luo M, Walker RJ, Liu X, Hwang SA, Chinery R. Extreme high temperatures and hospital admissions for respiratory and cardiovascular diseases. Epidemiology 2009;20:738–46.
9. Tseng CM, Chen YT, Ou SM, et al. The effect of cold temperature on increased exacerbation of chronic obstructive pulmonary disease: a nationwide study. PLoS One 2013;8:e57066.
10. Donaldson GC, Goldring JJ, Wedzicha JA. Influence of season on exacerbation characteristics in patients with COPD. Chest 2012;141:94-100.
11. Ferrari U, Exner T, Wanka ER, et al. Influence of air pressure, humidity, solar radiation, temperature, and wind speed on ambulatory visits due to chronic obstructive pulmonary disease in Bavaria, Germany. Int J Biometeorol 2012;56:137- 43.
12. McAllister DA, Morling JR, Fischbacher CM, MacNee W, Wild SH. Socioeconomic deprivation increases the effect of winter on admissions to hospital with COPD: retrospective analysis of 10 years of national hospitalisation data. Prim Care Respir J 2013;22:296-9.
13. Mourtzoukou EG, Falagas ME. Exposure to cold and respiratory tract infections. Int J Tuberc Lung Dis 2007;11:938-43.
14. Wise RA, Calverley PM, Carter K, Clerisme-Beaty E, Metzdorf N, Anzueto A. Seasonal variations in exacerbations and deaths in patients with COPD during the TIOSPIR® trial. Int J Chron Obstruct Pulmon Dis 2018;13:605-16.
15. Rabe KF, Fabbri LM, Vogelmeier C, et al. Seasonal distribution of COPD exacerbations in the Prevention of Exacerbations with Tiotropium in COPD trial. Chest 2013;143:711-9.
16. Jenkins CR, Celli B, Anderson JA, et al. Seasonality and determinants of moderate and severe COPD exacerbations in the TORCH study. Eur Respir J 2012;39:38-45.
17. So JY, Zhao H, Voelker H, et al. Seasonal and regional variations in chronic obstructive pulmonary disease exacerbation rates in adults without cardiovascular risk factors. Ann Am Thorac Soc 2018;15:1296-303.
18. Bryden C, Bird W, Titley HA, Halpin DM, Levy ML. Stratification of COPD patients by previous admission for targeting of preventative care. Respir Med 2009;103:558-65.
19. Liang WM, Liu WP, Kuo HW. Diurnal temperature range and emergency room admissions for chronic obstructive pulmonary disease in Taiwan. Int J Biometeorol. 2009;53:17-23.
20. Conlon KC, Rajkovich NB, WhiteNewsome JL, Larsen L, O'Neill MS. Preventing cold-related morbidity and mortality in a changing climate. Maturitas 2011;69:197-202.
21. Brims FJ, Asiimwe A, Andrews NP, et al. Weekend admission and mortality from acute exacerbations of chronic obstructive pulmonary disease in winter. Clin Med (Lond) 2011;11:334-9.
22. Suissa S, Dell'Aniello S, Ernst P. Long-term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality. Thorax 2012;67:957-63.
23. Keatinge WR. Winter mortality and its causes. Int J Circumpolar Health 2002;61:292-9.
24. Donaldson GC, Keatinge WR. Early increases in ischaemic heart disease mortality dissociated from and later changes associated with respiratory mortality after cold weather in south east England. J Epidemiol Community Health 1997;51:643-8.
25. Donaldson GC, Wedzicha JA. The causes and consequences of seasonal variation in COPD exacerbations. Int J Chron Obstruct Pulmon Dis 2014;9:1101-10.
26. Upshur RE, Moineddin R, Crighton E, Kiefer L, Mamdani M. Simplicity within complexity: seasonality and predictability of hospital admissions in the province of Ontario 1988-2001, a population-based analysis. BMC Health Serv Res 2005;5:13.
27. Williams NP, Coombs NA, Johnson MJ, et al. Seasonality, risk factors and burden of community-acquired pneumonia in COPD patients: a population database study using linked health care records. Int J Chron Obstruct Pulmon Dis 2017;12:313-22.
28. Bekkat-Berkani R, Wilkinson T, Buchy P, et al. Seasonal influenza vaccination in patients with COPD: a systematic literature review. BMC Pulm Med 2017;17:79.
29. Wilkinson TMA, Aris E, Bourne S, et al. A prospective, observational cohort study of the seasonal dynamics of airway pathogens in the aetiology of exacerbations in COPD. Thorax 2017;72:919-27.
30. Kinnunen T, Säynäjäkangs O, Tuuponen T, Keistinen T. Regional and seasonal variation in the length of hospital stay for chronic obstructive pulmonary disease in Finland. Int J Circumpolar Health 2002;61:131-5.
31. Ko FW, Tam W, Wong TW, et al. Temporal relationship between air pollutants and hospital admissions for chronic obstructive pulmonary disease in Hong Kong. Thorax 2007;62:780-5.