Lindberg Anne, Eriksson Berne, Larsson Lars-Gunnar, Rönmark Eva, Sandström Thomas, Lundbäck Bo
Senior Consultant, Division of Respiratory Medicine and Allergy, Department of Medicine, Sunderby Central Hospital of Norrbotten, SE-971 80 Luleå, Sweden.
Chest. 2006 Apr;129(4):879-85. doi: 10.1378/chest.129.4.879.
To estimate the cumulative incidence of COPD and risk factors related to the development of COPD, including evaluation of the relationship between Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 0 (ie, respiratory symptoms and normal lung function) and the development of COPD, in an age-stratified general population sample of middle-aged and elderly individuals.
The third survey of the Obstructive Lung Disease in Northern Sweden studies cohort I (three age strata born in 1919 to 1920, 1934 to 1935, and 1949 to 1950) was performed in 1996, and 5,189 subjects (88%) responded to the postal questionnaire. Of the responders, a random sample (1,500 subjects) was invited to an examination in 1996 and in 2003. A total of 963 subjects performed spirometry on both occasions. COPD was defined according to the spirometric criteria of the GOLD. Two levels of disease severity, grade I and higher (GOLD criteria, FEV(1)/FVC ratio of < 0.70) and also grade II and higher (GOLD II criteria, FEV(1)/FVC ratio of < 0.70 and FEV(1) <80% predicted).
The 7-year cumulative incidence of COPD was 11.0% and 4.9%, respectively, according to GOLD and GOLD II, and was significantly related to smoking (smokers, 18.8% and 10.6%, respectively; ex-smokers, 10.5% and 5.2%, respectively; non-smokers, 7.6% and 1.6%, respectively). Incident COPD according to GOLD, but not according to GOLD II, was significantly associated with increasing age. Most respiratory symptoms at study entry were markers of increased risk for incident COPD when analyzed in a multivariate model adjusting for confounders.
The GOLD criteria yielded a higher cumulative incidence (11.0%) compared to the GOLD II (4.9%). Smoking, but not gender, was associated with incident COPD. Most respiratory symptoms at the beginning of the observation period marked an increased risk for developing COPD, thus the classification GOLD stage 0 seems relevant among middle-aged and elderly persons.
在一个按年龄分层的中老年普通人群样本中，评估慢性阻塞性肺疾病（COPD）的累积发病率以及与COPD发生相关的危险因素，包括评估慢性阻塞性肺疾病全球倡议（GOLD）0期（即呼吸道症状且肺功能正常）与COPD发生之间的关系。
1996年对瑞典北部阻塞性肺疾病研究队列I（三个年龄层，分别出生于1919年至1920年、1934年至1935年和1949年至1950年）进行了第三次调查，5189名受试者（88%）回复了邮寄问卷。在回复者中，随机抽取1500名受试者于1996年和2003年接受检查。共有963名受试者在两个时间点都进行了肺功能测定。COPD根据GOLD的肺功能测定标准进行定义。疾病严重程度分为两级，I级及以上（GOLD标准：FEV(1)/FVC比值<0.70）以及II级及以上（GOLD II标准：FEV(1)/FVC比值<0.70且FEV(1)<预测值的80%）。
根据GOLD和GOLD II标准，COPD的7年累积发病率分别为11.0%和4.9%，且与吸烟显著相关（吸烟者分别为18.8%和10.6%；既往吸烟者分别为10.5%和5.2%；非吸烟者分别为7.6%和1.6%）。根据GOLD标准而非GOLD II标准的新发COPD与年龄增长显著相关。在对混杂因素进行多变量模型分析时，研究开始时的大多数呼吸道症状都是新发COPD风险增加的标志。
与GOLD II标准（4.9%）相比，GOLD标准的累积发病率更高（11.0%）。吸烟而非性别与新发COPD相关。观察期开始时的大多数呼吸道症状表明发生COPD的风险增加，因此GOLD 0期分类在中老年人中似乎是相关的。
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