Postma D S, de Vries K, Koëter G H, Sluiter H J
Am Rev Respir Dis. 1986 Aug;134(2):276-80. doi: 10.1164/arrd.1986.134.2.276.
We evaluated factors that might influence the course of lung function after 2 to 21 yr of follow-up in 81 nonallergic patients with chronic air-flow obstruction (CAO) and considerable lung function impairment (initial forced expiratory volume in one second as a percentage of inspiratory slow vital capacity (FEV1 % VC) ranging from 40 to 55% and increasing less than 15% after the administration of the anticholinergic bronchodilator thiazinamium). A more favorable rate of change in FEV1 was associated with less pack-years of smoking, less nonspecific hyperreactivity, and a higher degree of reversibility of air-flow obstruction, when expressed as the increase in FEV1 as a percentage of the predicted minus prebronchodilator FEV1 value. Nonspecific hyperreactivity and reversibility of air-flow obstruction appeared to influence the decline in FEV1 independently of baseline value of FEV1, both in smokers and ex-smokers. The hypothesis is put forward that regular bronchodilating therapy may be able to prevent deterioration of lung function. However, the possibility that interval therapy may ultimately produce the same results cannot be excluded. It seems to be important to stop smoking, both for the sake of its negative influence on the course of FEV1 and for the fact that a beneficial influence of bronchodilating therapy may become even more apparent.
我们对81例非过敏性慢性气流阻塞（CAO）且肺功能有显著损害的患者（初始一秒用力呼气容积占吸气慢肺活量的百分比（FEV1%VC）为40%至55%，给予抗胆碱能支气管扩张剂噻嗪铵后增加不到15%）进行了2至21年的随访，评估了可能影响肺功能进程的因素。当以FEV1增加量占预测值减去支气管扩张剂使用前FEV1值的百分比表示时，FEV1更有利的变化率与吸烟包年数较少、非特异性高反应性较低以及气流阻塞的可逆程度较高相关。无论是吸烟者还是已戒烟者，非特异性高反应性和气流阻塞的可逆性似乎独立于FEV1的基线值影响FEV1的下降。我们提出这样的假设，即规律的支气管扩张治疗可能能够预防肺功能恶化。然而，不能排除间歇治疗最终可能产生相同结果的可能性。戒烟似乎很重要，这既是因为吸烟对FEV1进程有负面影响，也是因为支气管扩张治疗的有益影响可能会更加明显。
