Department of Respiratory Medicine of Peking University Third Hospital, Beijing Chaoyang Hospital, Capital University of Medical Science, Beijing, China.
Respirology. 2010 Oct;15(7):1072-8. doi: 10.1111/j.1440-1843.2010.01817.x. Epub 2010 Aug 16.
COPD has a variable natural history and not all individuals follow the same course. The aim of this study was to assess the prevalence of COPD in the absence of chronic bronchitis (CB) based on a population survey in China, and to identify the determinants of CB in patients with COPD.
A multi-stage cluster sampling strategy was used to survey a population from seven different provinces/cities of China. All residents over 40 years of age were interviewed using a standardized questionnaire and spirometry was measured. A post-bronchodilator FEV(1)/FVC < 70% was defined as the diagnostic criterion for COPD. All COPD patients who were screened were divided into two groups according to the presence or absence of CB.
Of the population of 20,245 that was surveyed, 70% of the 1668 patients who were diagnosed with COPD reported no history of CB. The ages, BMI and comorbidities of COPD patients with or without CB were similar. Male gender, residence in a rural area, having a lower level of education, exposure to tobacco smoke or biomass fuels, poor ventilation in the kitchen and a family history of respiratory disease were all associated with a higher risk of COPD with CB. Patients without CB had less difficulty in walking and higher FEV(1)/FVC values than patients with CB, but were more likely to be underdiagnosed. The strongest predictors of CB were male gender, current smoking and severity of dyspnoea.
This survey confirmed that there is a high prevalence of COPD in the absence of CB in China. It appears that CB is not essential to the diagnosis of COPD.
COPD 的自然病程存在个体差异，并非所有患者均遵循相同的病程。本研究旨在评估中国人群中无慢性支气管炎（CB）的 COPD 患病率，并确定 COPD 患者 CB 的决定因素。
采用多阶段聚类抽样策略对中国 7 个不同省市的人群进行调查。对所有 40 岁以上的居民进行标准化问卷访谈和肺量测定。使用支气管扩张剂后 FEV1/FVC＜70%定义为 COPD 的诊断标准。所有筛选出的 COPD 患者均根据是否存在 CB 分为两组。
在接受调查的 20245 人中，1668 例诊断为 COPD 的患者中，70%的患者无 CB 病史。有或无 CB 的 COPD 患者的年龄、BMI 和合并症相似。男性、农村居住、受教育程度较低、接触烟草烟雾或生物质燃料、厨房通风不良和有呼吸道疾病家族史与 COPD 伴 CB 的风险增加相关。无 CB 的患者步行困难程度较低，FEV1/FVC 值较高，但更可能被漏诊。CB 的最强预测因素是男性、当前吸烟和呼吸困难严重程度。
本调查证实中国存在较高比例的无 CB 的 COPD。似乎 CB 对 COPD 的诊断并非必需。
