Marsh S E, Travers J, Weatherall M, Williams M V, Aldington S, Shirtcliffe P M, Hansell A L, Nowitz M R, McNaughton A A, Soriano J B, Beasley R W
Medical Research Institute of New Zealand, P O Box 10055, Wellington 6143, New Zealand.
Thorax. 2008 Sep;63(9):761-7. doi: 10.1136/thx.2007.089193.
Chronic obstructive pulmonary disease (COPD) encompasses a group of disorders characterised by the presence of incompletely reversible airflow obstruction with overlapping subsets of different phenotypes including chronic bronchitis, emphysema or asthma. The aim of this study was to determine the proportion of adult subjects aged >50 years within each phenotypic subgroup of COPD, defined as a post-bronchodilator ratio of forced expiratory volume in 1 s/forced vital capacity (FEV(1)/FVC) <0.7, in accordance with current international guidelines.
Adults aged >50 years derived from a random population-based survey undertook detailed questionnaires, pulmonary function tests and chest CT scans. The proportion of subjects in each of 16 distinct phenotypes was determined based on combinations of chronic bronchitis, emphysema and asthma, with and without incompletely reversible airflow obstruction defined by a post-bronchodilator FEV(1)/FVC ratio of 0.7.
A total of 469 subjects completed the investigative modules, 96 of whom (20.5%) had COPD. Diagrams were constructed to demonstrate the relative proportions of the phenotypic subgroups in subjects with and without COPD. 18/96 subjects with COPD (19%) had the classical phenotypes of chronic bronchitis and/or emphysema but no asthma; asthma was the predominant COPD phenotype, being present in 53/96 (55%). When COPD was defined as a post-bronchodilator FEV(1)/FVC less than the lower limit of normal, there were one-third fewer subjects with COPD and a smaller proportion without a defined emphysema, chronic bronchitis or asthma phenotype.
This study provides proportional classifications of the phenotypic subgroups of COPD which can be used as the basis for further research into the pathogenesis and treatment of this heterogeneous disorder.
慢性阻塞性肺疾病（COPD）包括一组以不完全可逆性气流受限为特征的疾病，有不同表型的重叠亚组，包括慢性支气管炎、肺气肿或哮喘。本研究的目的是根据当前国际指南，确定年龄>50岁的成年受试者在COPD各表型亚组中的比例，COPD定义为支气管扩张剂后1秒用力呼气容积/用力肺活量（FEV(1)/FVC）<0.7。
来自基于人群的随机调查的年龄>50岁的成年人进行了详细问卷调查、肺功能测试和胸部CT扫描。根据慢性支气管炎、肺气肿和哮喘的组合，以及有无由支气管扩张剂后FEV(1)/FVC比值0.7定义的不完全可逆性气流受限，确定16种不同表型中每种表型的受试者比例。
共有469名受试者完成了调查模块，其中96名（20.5%）患有COPD。绘制图表以展示有和没有COPD的受试者中表型亚组的相对比例。96名患有COPD的受试者中有18名（19%）具有慢性支气管炎和/或肺气肿的经典表型但无哮喘；哮喘是COPD的主要表型，在96名中有53名（55%）。当COPD定义为支气管扩张剂后FEV(1)/FVC低于正常下限，患有COPD的受试者减少三分之一，且没有明确的肺气肿、慢性支气管炎或哮喘表型的比例更小。
本研究提供了COPD表型亚组的比例分类，可作为进一步研究这种异质性疾病的发病机制和治疗的基础。
