Thorax Institute, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Spain.
Respir Res. 2010 Sep 10;11(1):122. doi: 10.1186/1465-9921-11-122.
Chronic obstructive pulmonary disease (COPD) is a complex condition with pulmonary and extra-pulmonary manifestations. This study describes the heterogeneity of COPD in a large and well characterised and controlled COPD cohort (ECLIPSE).
We studied 2164 clinically stable COPD patients, 337 smokers with normal lung function and 245 never smokers. In these individuals, we measured clinical parameters, nutritional status, spirometry, exercise tolerance, and amount of emphysema by computed tomography.
COPD patients were slightly older than controls and had more pack years of smoking than smokers with normal lung function. Co-morbidities were more prevalent in COPD patients than in controls, and occurred to the same extent irrespective of the GOLD stage. The severity of airflow limitation in COPD patients was poorly related to the degree of breathlessness, health status, presence of co-morbidity, exercise capacity and number of exacerbations reported in the year before the study. The distribution of these variables within each GOLD stage was wide. Even in subjects with severe airflow obstruction, a substantial proportion did not report symptoms, exacerbations or exercise limitation. The amount of emphysema increased with GOLD severity. The prevalence of bronchiectasis was low (4%) but also increased with GOLD stage. Some gender differences were also identified.
The clinical manifestations of COPD are highly variable and the degree of airflow limitation does not capture the heterogeneity of the disease.
慢性阻塞性肺疾病（COPD）是一种具有肺部和肺外表现的复杂疾病。本研究描述了在一个大型、特征明确且得到良好控制的 COPD 队列（ECLIPSE）中 COPD 的异质性。
我们研究了 2164 例临床稳定的 COPD 患者、337 例肺功能正常的吸烟者和 245 例从不吸烟者。在这些个体中，我们测量了临床参数、营养状况、肺功能、运动耐量和通过计算机断层扫描测量的肺气肿程度。
COPD 患者比对照组稍年长，且吸烟的包年数多于肺功能正常的吸烟者。与对照组相比，COPD 患者的合并症更为常见，且不论 GOLD 分期如何，其发生率相同。COPD 患者气流受限的严重程度与呼吸困难的程度、健康状况、合并症的存在、运动能力和研究前一年报告的恶化次数相关性较差。这些变量在每个 GOLD 分期内的分布范围很广。即使在严重气流阻塞的患者中，仍有相当一部分患者没有报告症状、恶化或运动受限。肺气肿的程度随着 GOLD 严重程度的增加而增加。支气管扩张症的患病率较低（4%），但也随着 GOLD 分期的增加而增加。还发现了一些性别差异。
COPD 的临床表现高度可变，气流受限程度并不能捕捉到疾病的异质性。
