Shirtcliffe P, Weatherall M, Marsh S, Travers J, Hansell A, McNaughton A, Aldington S, Muellerova H, Beasley R
Medical Research Institute of New Zealand, P.O. Box 10055, Wellington, New Zealand.
Eur Respir J. 2007 Aug;30(2):232-9. doi: 10.1183/09031936.00157906.
A recent American Thoracic Society and European Respiratory Society joint Task Force report recommends using a lower limit of normal (LLN) of forced expiratory volume in one second/forced vital capacity as opposed to a fixed ratio of <0.7 to diagnose airflow obstruction, in order to reduce false positive diagnoses of chronic obstructive pulmonary disease (COPD) as defined by the Global Initiative for Obstructive Lung Disease (GOLD). To date, there is no reliable spirometry-based prevalence data for COPD in New Zealand and the effect of different definitions of airflow obstruction based on post-bronchodilator spirometry is not known. Detailed written questionnaires, full pulmonary function tests (including pre- and post-bronchodilator flow-volume loops) and atopy testing were completed in 749 subjects recruited from a random population sample. The GOLD-defined, age-adjusted prevalence (95% confidence interval) for adults aged >or=40 yrs was 14.2 (11.0-17.0)% compared with an LLN-defined, age-adjusted, post-bronchodilator prevalence in the same group of 9.0 (6.7-11.3)%. The prevalence of chronic obstructive pulmonary disease varied markedly depending on the definition used. Further research using longitudinal rather than cross-sectional data will help decide the preferred approach in chronic obstructive pulmonary disease prevalence surveys.
美国胸科学会和欧洲呼吸学会联合特别工作组最近的一份报告建议,使用一秒用力呼气容积/用力肺活量的正常下限(LLN),而非固定比值<0.7来诊断气流受限,以减少慢性阻塞性肺疾病(COPD)(根据慢性阻塞性肺疾病全球倡议组织(GOLD)的定义)的假阳性诊断。迄今为止,新西兰尚无基于可靠肺量计的COPD患病率数据,基于支气管扩张剂后肺量计的气流受限不同定义的影响也尚不清楚。对从随机人群样本中招募的749名受试者完成了详细的书面问卷、全面的肺功能测试(包括支气管扩张剂前后的流量-容积环)和特应性检测。对于年龄≥40岁的成年人,GOLD定义的年龄校正患病率(95%置信区间)为14.2(11.0 - 17.0)%,而同一组中基于LLN定义的支气管扩张剂后年龄校正患病率为9.0(6.7 - 11.3)%。慢性阻塞性肺疾病的患病率因所使用的定义不同而有显著差异。使用纵向而非横断面数据进行进一步研究,将有助于确定慢性阻塞性肺疾病患病率调查的首选方法。