de Marco Roberto, Accordini Simone, Antò Josep M, Gislason Thorarinn, Heinrich Joachim, Janson Christer, Jarvis Deborah, Künzli Nino, Leynaert Bénédicte, Marcon Alessandro, Sunyer Jordi, Svanes Cecilie, Wjst Matthias, Burney Peter
Sezione di Epidemiologia & Statistica Medica, Dipartimento di Medicina e Sanità Pubblica, Università degli Studi di Verona c/o Istituti Biologici II, Strada Le Grazie 8, 37134 Verona, Italy.
Am J Respir Crit Care Med. 2009 Nov 15;180(10):956-63. doi: 10.1164/rccm.200904-0543OC. Epub 2009 Aug 20.
Little is known about the long-term outcomes of individuals with mild/moderate chronic obstructive pulmonary disease (COPD) according to spirometric criteria.
To test whether nonsmokers and asymptomatic subjects with a spirometric diagnosis of COPD have a steeper decrease in lung function and higher hospitalization rates than subjects without airway obstruction.
A total of 5,205 subjects without asthma (20-44 years of age) from the general population, with FEV(1) >or= 50% predicted at baseline, were followed for 9 years in the frame of an international cohort study. Percent decrease in FEV(1) (DeltaFEV(1)%) and the annual hospitalization rate for respiratory causes during the follow-up were assessed for each subject.
At baseline, 324 (6.2%) subjects had the prebronchodilator FEV(1)/FVC ratio less than the lower limit of normal (LLN-COPD), and 105 (2.0%) subjects had the same ratio less than 0.70 (modified GOLD-COPD). At follow-up, smokers with LLN-COPD (n = 205) had a greater mean DeltaFEV(1)% (1.7%; 95% confidence interval [CI], 0.8-2.7) and a higher hospitalization rate (rate ratio [RR], 2.52; 95% CI, 1.65-3.86) than normal subjects. Similarly, symptomatic subjects with LLN-COPD (n = 104) had DeltaFEV(1)% (2.0%; 95% CI, 0.8-3.3) and the hospitalization rate (RR, 4.18; 95% CI, 2.43-7.21) higher than the reference group. By contrast, nonsmokers and asymptomatic subjects with LLN-COPD had outcomes that were similar or even better than normal subjects. Among subjects with LLN-COPD, the association of symptoms with DeltaFEV(1)% varied according to smoking habits (P = 0.007); it was particularly strong in symptomatic smokers and disappeared in symptomatic nonsmokers. Similar results were found with the modified GOLD classification.
In relatively young populations, COPD is associated with poor long-term outcomes in smokers and in symptomatic subjects only.
根据肺量计标准，对于轻度/中度慢性阻塞性肺疾病（COPD）患者的长期预后了解甚少。
测试与无气道阻塞的受试者相比，经肺量计诊断为COPD的非吸烟者和无症状受试者的肺功能下降是否更快，住院率是否更高。
在一项国际队列研究中，对来自普通人群的5205名无哮喘（年龄20 - 44岁）、基线时第一秒用力呼气容积（FEV₁）≥预计值50%的受试者进行了9年的随访。评估了每位受试者随访期间FEV₁的下降百分比（ΔFEV₁%）和呼吸道病因的年度住院率。
基线时，324名（6.2%）受试者的支气管扩张剂前FEV₁/FVC比值低于正常下限（LLN - COPD），105名（2.0%）受试者的该比值低于0.70（改良GOLD - COPD）。随访时，LLN - COPD的吸烟者（n = 205）的平均ΔFEV₁%更高（1.7%；95%置信区间[CI]，0.8 - 2.7），住院率也更高（率比[RR]，2.52；95% CI，1.65 - 3.86），高于正常受试者。同样，有症状的LLN - COPD受试者（n = 104）的ΔFEV₁%（2.0%；95% CI，0.8 - 3.3）和住院率（RR，4.18；95% CI，2.43 - 7.21）高于参照组。相比之下，LLN - COPD的非吸烟者和无症状受试者的预后与正常受试者相似甚至更好。在LLN - COPD受试者中，症状与ΔFEV₁%的关联因吸烟习惯而异（P = 0.007）；在有症状的吸烟者中尤为明显，在有症状的非吸烟者中则消失。改良GOLD分类也得到了类似结果。
在相对年轻的人群中，COPD仅与吸烟者和有症状的受试者不良的长期预后相关。
