Schermer Tjard, Heijdra Yvonne, Zadel Sabina, van den Bemt Lisette, Boonman-de Winter Leandra, Dekhuijzen Richard, Smeele Ivo
Department of General Practice, Radboud University Nijmegen Medical Centre, 6500 HB Nijmegen, The Netherlands.
Respir Med. 2007 Jun;101(6):1355-62. doi: 10.1016/j.rmed.2006.09.024. Epub 2006 Nov 13.
Flow response after administration of a bronchodilator is widely used as an indicator of reversibility of airflow limitation in chronic obstructive pulmonary disease (COPD). We hypothesized that the association between flow and volume responses would reverse along with the progression of the disease.
We used the database of a large primary care diagnostic centre containing pre- and postbronchodilator tests of patients referred for spirometry by their GP. Patients 40 years with a smoking history were categorized into Global initiative for chronic obstructive lung disease (GOLD) stages I-IV. Flow and volume responses (DeltaFVC and DeltaFEV(1), respectively) were calculated and compared between the GOLD stages using linear regression analysis.
About 2210 patients (63% males, 49% current smokers) were analysed. Four hundred and forty-two patients were classified into GOLD stage I, 1297 in GOLD II, 426 in GOLD III, and 45 in GOLD IV. The overall mean values for DeltaFEV(1) and DeltaFVC were 0.180 (sd 0.150) and 0.226l (sd 0.227). DeltaFEV(1) decreased as the GOLD stage was more severe, whereas DeltaFVC increased (P<0.001). There was a clear positive correlation between DeltaFEV(1) and DeltaFVC within each GOLD stage (P<0.01), but when FVC response was plotted against FEV(1) response the slope of the regression line became gradually steeper with each more severe GOLD stage (P<0.001).
Our hypothesis that COPD patients on the mild side of the severity spectrum differ from patients on the severe side regarding the association between their bronchodilator flow and volume responses was confirmed. The difference is probably explained by the higher degree of loss of lung elastic recoil and/or compression of the smaller airways due to enlarged air spaces that accompanies the progression of COPD to the more severe stages.
支气管扩张剂给药后的气流反应被广泛用作慢性阻塞性肺疾病（COPD）气流受限可逆性的指标。我们假设气流和容积反应之间的关联会随着疾病进展而发生逆转。
我们使用了一家大型初级保健诊断中心的数据库，其中包含由其全科医生转诊进行肺活量测定的患者的支气管扩张剂给药前和给药后测试。年龄≥40岁且有吸烟史的患者被分为慢性阻塞性肺疾病全球倡议组织（GOLD）I-IV期。计算气流和容积反应（分别为ΔFVC和ΔFEV₁），并使用线性回归分析在GOLD各期之间进行比较。
共分析了约2210例患者（63%为男性，49%为当前吸烟者）。442例患者被分类为GOLD I期，1297例为GOLD II期，426例为GOLD III期，45例为GOLD IV期。ΔFEV₁和ΔFVC的总体平均值分别为0.180（标准差0.150）和0.226升（标准差0.227）。随着GOLD分期越严重，ΔFEV₁降低，而ΔFVC增加（P<0.001）。在每个GOLD期内，ΔFEV₁和ΔFVC之间存在明显的正相关（P<0.01），但当将FVC反应与FEV₁反应绘制在一起时，随着GOLD分期越严重，回归线的斜率逐渐变陡（P<0.001）。
我们的假设得到证实，即COPD严重程度较轻的患者与严重患者在支气管扩张剂气流和容积反应之间的关联方面存在差异。这种差异可能是由于随着COPD进展到更严重阶段，肺弹性回缩丧失程度更高和/或由于气腔扩大导致较小气道受压所致。
