Fisher Andrew J, Yadegarfar Mohammad E, Collerton Joanna, Small Therese, Kirkwood Thomas B L, Davies Karen, Jagger Carol, Corris Paul A
Department of Respiratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK Institute for Ageing, Newcastle University, Newcastle Upon Tyne, UK.
Institute for Ageing, Newcastle University, Newcastle Upon Tyne, UK Faculty of Medical Sciences, Institute of Health and Society, Newcastle Upon Tyne, UK.
Thorax. 2016 Mar;71(3):255-66. doi: 10.1136/thoraxjnl-2015-207249. Epub 2016 Jan 5.
People aged 85 years and older are the fastest growing age group worldwide. This study assessed respiratory health, prevalence of respiratory disease and use of spirometry in respiratory diagnosis in a population-based cohort of 85 year olds to better understand respiratory health and disease in this sector of society.
A single year birth-cohort of 85 year olds participated in a respiratory assessment at their home or residential institution including self-reporting of symptoms and measurement of spirometry. General practice medical records were reviewed for respiratory diagnoses and treatments.
In the 845 participants, a substantial burden of respiratory disease was seen with a prevalence of COPD in medical records of 16.6% (n=140). A large proportion of the cohort had environmental exposures through past or current smoking (64.2%, n=539) and occupational risk factors (33.6%, n=269). Spirometry meeting reliability criteria was performed in 87% (n=737) of participants. In the subgroup with a diagnosis of COPD (n=123), only 75.6% (n=93) satisfied Global Initiative in Obstructive Lung Disease (GOLD) criteria for airflow obstruction, and in a healthy subgroup without respiratory symptoms or diagnoses (n=151), 44.4% (n=67) reached GOLD criteria for airflow obstruction and 43.3% (n=29) National Institute of Health and Care Excellence criteria for at least moderate COPD.
Spirometry can be successfully performed in the very old, aged 85 years, and may help identify respiratory diseases such as COPD. However interpretation in this age group using current definitions of COPD based on spirometry indices may be difficult and lead to overdiagnosis in a healthy group with transient symptoms.
85岁及以上的人群是全球增长最快的年龄组。本研究评估了一个以85岁人群为基础的队列中的呼吸健康状况、呼吸道疾病患病率以及肺活量测定在呼吸诊断中的应用，以更好地了解该社会群体的呼吸健康和疾病情况。
一个单一年度出生队列的85岁老人在其家中或居住机构参与了呼吸评估，包括症状的自我报告和肺活量测定。查阅全科医疗记录以了解呼吸诊断和治疗情况。
在845名参与者中，呼吸道疾病负担较重，病历中慢性阻塞性肺疾病（COPD）的患病率为16.6%（n = 140）。很大一部分队列人群有过去或当前吸烟导致的环境暴露（64.2%，n = 539）以及职业风险因素（33.6%，n = 269）。87%（n = 737）的参与者进行了符合可靠性标准的肺活量测定。在诊断为COPD的亚组（n = 123）中，只有75.6%（n = 93）符合慢性阻塞性肺疾病全球倡议组织（GOLD）的气流受限标准，而在无呼吸道症状或诊断的健康亚组（n = 151）中，44.4%（n = 67）达到了GOLD气流受限标准，43.3%（n = 29）达到了英国国家卫生与临床优化研究所至少中度COPD的标准。
肺活量测定能够在85岁的高龄人群中成功进行，并且可能有助于识别诸如COPD等呼吸道疾病。然而，使用基于肺活量测定指标的COPD当前定义对此年龄组进行解读可能存在困难，并可能导致对有短暂症状的健康群体进行过度诊断。
