a Department of Medicine , Queen's University and Kingston General Hospital , Kingston , ON , Canada.
b Department of Chest Diseases, Faculty of Medicine , Alexandria University , Alexandria , Egypt.
Expert Rev Respir Med. 2017 Jul;11(7):549-563. doi: 10.1080/17476348.2017.1334553. Epub 2017 Jun 5.
Chronic obstructive pulmonary disease (COPD) - an inflammatory disease of the airways, alveoli and lung microvasculature - is a leading cause of death worldwide. Smokers with milder airway obstruction constitute the majority of patients with this disease. Many studies have shown increased morbidity, activity-related dyspnea, exercise intolerance and mortality in such patients, compared with age-matched healthy populations. Clinical evaluation of symptomatic smokers with ostensibly mild airway obstruction poses a challenge in clinical practice as spirometry can obscure extensive heterogeneous pathophysiological impairment. Areas covered: A detailed review of the evidence for complex biological, physiological and radiological abnormalities in smokers who barely fit arbitrary spirometric criteria for COPD diagnosis. A brief discussion of the debate about current diagnostic spirometric criteria for COPD that can lead to diagnostic confusion and, in-some-instances, to inappropriate management. Finally, we provide a review of the clinical implications of these structural and functional abnormalities and try to build a solid rationale for earlier detection and effective, timely management. Expert commentary: The prevalence of mild COPD among smokers is high, yet under-diagnosis remains a major problem and there is lack of evidence-based management recommendations for this sub-population. Further tests beyond spirometry are useful in uncovering patho-physiological derangements that are clinically relevant.
慢性阻塞性肺疾病（COPD）-一种气道、肺泡和肺微血管的炎症性疾病-是全球主要的死亡原因。具有较轻气道阻塞的吸烟者构成了此类疾病的大多数患者。许多研究表明，与年龄匹配的健康人群相比，此类患者的发病率、与活动相关的呼吸困难、运动不耐受和死亡率更高。对于有症状的轻度气道阻塞的吸烟者进行临床评估在临床实践中具有挑战性，因为肺量计检查可能会掩盖广泛的异质性病理生理损害。涵盖的领域：详细回顾了勉强符合 COPD 诊断的肺量计标准的吸烟者中存在的复杂的生物学、生理学和影像学异常的证据。简要讨论了目前关于 COPD 的诊断肺量计标准的争议，这些标准可能导致诊断混淆，并且在某些情况下导致不适当的管理。最后，我们回顾了这些结构和功能异常的临床意义，并试图为早期检测和有效、及时的管理建立一个合理的基础。专家评论：吸烟者中轻度 COPD 的患病率很高，但诊断不足仍然是一个主要问题，并且针对该亚人群缺乏基于证据的管理建议。除肺量计检查外，进一步的检查对于揭示临床上相关的病理生理紊乱很有用。
