Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
Fundación Caubet-CIMERA Illes Balears, Bunyola, Illes Balears, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain.
Chest. 2011 May;139(5):1072-1080. doi: 10.1378/chest.10-1721. Epub 2010 Dec 23.
The current debate about the lower limit of normal (LLN) vs the 0.7 fixed ratio to diagnose COPD is not completely resolved, and little information about the clinical impact of these different criteria is available. We compared differences in health-related quality of life, exacerbations, exercise tolerance, physical activity, comorbidity, and systemic biomarkers of subjects with FEV(1)/FVC < 0.7 but > LLN (ratio-only group) vs subjects without COPD and those with mild or moderate to severe COPD.
A population-based sample of 3,802 subjects aged 40 to 80 years from the Epidemiologic Study of COPD in Spain was selected. Subjects were evaluated with postbronchodilator spirometry, quality-of-life and physical activity questionnaires, and 6-min walk tests. Exacerbations within the previous year and comorbidities were recorded. Systemic biomarkers were measured after excluding subjects with conditions associated with systemic inflammatory processes.
Fixed-ratio COPD overdiagnosis affects up to 4.6% of subjects aged 40 to 80 years, is more frequent in men, and increases with age. After adjusting for confounding factors, the ratio-only group had a worse health-related quality of life than the non-COPD group, with poorer scores in all questionnaire domains (P < .05). However, no differences between the two groups for respiratory exacerbations, 6-min walk distance, physical activity, or systemic biomarkers were observed. Ratio-only subjects did not present greater risk for cardiovascular disease (adjusted relative OR, 1.47; 95% CI, 0.81-2.64), whereas subjects with mild COPD did (adjusted relative OR, 2.32; 95% CI, 1.11-4.84).
Subjects receiving a diagnosis of COPD by the fixed ratio present worse self-reported quality of life than subjects without COPD but had similar exercise, frequency of exacerbations, and indices of systemic effects.
目前关于正常下限（LLN）与 0.7 固定比值诊断 COPD 的争论尚未完全解决，关于这些不同标准的临床影响的信息也很少。我们比较了 FEV1/FVC<0.7 但>LLN（仅比值组）的患者、无 COPD 患者以及轻度、中度至重度 COPD 患者的健康相关生活质量、加重、运动耐量、体力活动、合并症和全身生物标志物的差异。
从西班牙 COPD 流行病学研究中选择了一个年龄在 40 至 80 岁的基于人群的 3802 名受试者样本。对受试者进行支气管扩张剂后肺量测定、生活质量和体力活动问卷以及 6 分钟步行测试。记录了前一年的加重情况和合并症。排除了与全身炎症过程相关的疾病后，测量了全身生物标志物。
固定比值 COPD 的过度诊断影响了多达 40 至 80 岁年龄组的 4.6%的受试者，在男性中更为常见，并随着年龄的增长而增加。在调整了混杂因素后，仅比值组的健康相关生活质量比非 COPD 组差，所有问卷领域的评分均较差（P<.05）。然而，两组之间的呼吸加重、6 分钟步行距离、体力活动或全身生物标志物均无差异。仅比值组的心血管疾病风险并未增加（调整后的相对 OR，1.47；95%CI，0.81-2.64），而轻度 COPD 患者的风险增加（调整后的相对 OR，2.32；95%CI，1.11-4.84）。
通过固定比值诊断为 COPD 的患者的自我报告生活质量比无 COPD 的患者差，但运动、加重频率和全身影响指标相似。
