Bridevaux P-O, Gerbase M W, Probst-Hensch N M, Schindler C, Gaspoz J-M, Rochat T
University Hospitals of Geneva, Division of Pulmonary Medicine, 24 rue Micheli-du-Crest, 1211 Geneva, Switzerland.
Thorax. 2008 Sep;63(9):768-74. doi: 10.1136/thx.2007.093724. Epub 2008 May 27.
Little is known about the long-term outcomes of individuals with mild chronic obstructive pulmonary disease (COPD) as defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD).
A population cohort of 6671 randomly selected adults without asthma was stratified into categories of modified GOLD-defined COPD (prebronchodilator spirometry). Further stratification was based on the presence or absence of respiratory symptoms. After 11 years, associations between baseline categories of COPD and decline in forced expiratory volume in 1 s (FEV(1)), respiratory care utilisation and quality of life as measured by the SF-36 questionnaire were examined after controlling for age, sex, smoking and educational status.
At baseline, modified GOLD criteria were met by 610 (9.1%) participants, 519 (85.1%) of whom had stage 1 COPD. At follow-up, individuals with symptomatic stage 1 COPD (n = 224) had a faster decline in FEV(1) (-9 ml/year (95% CI -13 to -5)), increased respiratory care utilisation (OR 1.6 (95% CI 1.0 to 2.6)) and a lower quality of life than asymptomatic subjects with normal lung function (n = 3627, reference group). In contrast, individuals with asymptomatic stage 1 COPD (n = 295) had no significant differences in FEV(1) decline (-3 ml/year (95% CI -7 to +1)), respiratory care utilisation (OR 1.05 (95% CI 0.63 to 1.73)) or quality of life scores compared with the reference group.
In population-based studies, respiratory symptoms are of major importance for predicting long-term clinical outcomes in subjects with COPD with mild obstruction. Population studies based on spirometry only may misestimate the prevalence of clinically relevant COPD.
对于慢性阻塞性肺疾病全球倡议组织（GOLD）所定义的轻度慢性阻塞性肺疾病（COPD）患者的长期预后，我们了解甚少。
一个由6671名随机选取的无哮喘成年人组成的人群队列，根据改良的GOLD定义的COPD（支气管扩张剂使用前肺量计检查）进行分层。进一步分层依据是否存在呼吸道症状。11年后，在控制年龄、性别、吸烟和教育状况后，研究了COPD基线类别与1秒用力呼气量（FEV₁）下降、呼吸护理利用情况以及通过SF - 36问卷测量的生活质量之间的关联。
在基线时，610名（9.1%）参与者符合改良GOLD标准，其中519名（85.1%）患有1期COPD。在随访时，有症状的I期COPD患者（n = 224）的FEV₁下降更快（-9 ml/年（95%CI -13至-5）），呼吸护理利用率增加（OR 1.6（95%CI 1.0至2.6）），且生活质量低于肺功能正常的无症状受试者（n = 3627，参照组）。相比之下，无症状的I期COPD患者（n = 295）与参照组相比，在FEV₁下降（-3 ml/年（95%CI -7至+1））、呼吸护理利用率（OR 1.05（95%CI 0.63至1.73））或生活质量评分方面无显著差异。
在基于人群的研究中，呼吸道症状对于预测轻度阻塞性COPD患者的长期临床结局至关重要。仅基于肺量计的人群研究可能会高估临床相关COPD的患病率。
