1 Department of Pulmonary Medicine, Hvidovre Hospital, Hvidovre, Denmark.
2 Department of Pulmonary Medicine and Allergy, Århus Hospital, Århus, Denmark.
Chron Respir Dis. 2018 Nov;15(4):393-399. doi: 10.1177/1479972318761655. Epub 2018 Feb 27.
Even in subjects at high risk of chronic obstructive pulmonary disease (COPD), the diagnosis is often missed due to lack of awareness of symptoms and risk factors. The objective of this study was to identify predictors of a diagnosis of COPD in symptomatic current and ex-smokers seen in a primary care setting. General practitioners ( n = 241) consecutively recruited subjects ≥ 35 years, with tobacco exposure, at least one respiratory symptom (i.e. cough, sputum, wheeze, dyspnoea and/or recurrent lower respiratory tract infections), and no previous diagnosis of obstructive airways disease. Information on age, smoking status, body mass index (BMI) and dyspnoea (Medical Research Council (MRC) dyspnoea scale) was obtained. Individuals with airway obstruction (i.e. forced expiratory volume in 1 second (FEV/forced vital capacity ratio (FVC) < 0.70) at initial spirometry had a diagnostic spirometry after administration of a bronchodilator. COPD was defined as the presence of symptoms, tobacco exposure and persistent airflow limitation. The most prevalent symptoms were cough (72%) and dyspnoea (48%). Of 3875 (50% females, mean age 57 years) subjects screened, 700 (18.1%) were diagnosed with COPD. Multivariate logistic regression analysis revealed that increasing age 50-59 years (OR 2.4, 95% CI 1.8-3.3), 60-69 years (OR 4.1, 95% CI 3.1-5.5), ≥70 years (OR 5.7, 95% CI 4.2-7.8), BMI < 25 (OR 2.3, 95% CI 1.9-2.7), being current smoker (OR 1.2, 95% CI 1.01-1.5), self-reported dyspnoea (OR 1.7, 95% CI 1.4-2.0), wheeze (OR 1.9, 95% CI 1.5-2.3) and sputum (OR 1.4, 95% CI 1.1-1.7) were associated with a significantly higher risk of being diagnosed with COPD. No association was found between gender, cough and recurrent respiratory tract infections and a diagnosis of COPD. Among symptomatic smokers and ex-smokers seen in primary care, self-reported sputum production, wheeze, dyspnoea and low BMI identify a subgroup with a higher likelihood of COPD.
即使在患有慢性阻塞性肺疾病（COPD）高风险的人群中，由于对症状和危险因素缺乏认识，诊断也常常被漏诊。本研究的目的是确定在初级保健环境中出现症状的当前和曾经吸烟的人群中 COPD 诊断的预测因素。全科医生（n=241）连续招募≥35 岁、有烟草暴露史、至少有一个呼吸道症状（即咳嗽、咳痰、喘息、呼吸困难和/或复发性下呼吸道感染）且无阻塞性气道疾病既往诊断的患者。获取了年龄、吸烟状况、体重指数（BMI）和呼吸困难（呼吸困难量表[MRC 呼吸困难量表]）的信息。在初始肺活量测定时，气道阻塞（即 1 秒用力呼气量（FEV）/用力肺活量（FVC）比值<0.70）的个体在给予支气管扩张剂后进行诊断性肺活量测定。COPD 的定义是存在症状、烟草暴露和持续气流受限。最常见的症状是咳嗽（72%）和呼吸困难（48%）。在筛查的 3875 名（50%为女性，平均年龄 57 岁）患者中，有 700 名（18.1%）被诊断为 COPD。多变量逻辑回归分析显示，年龄在 50-59 岁（比值比[OR]2.4，95%置信区间[CI]1.8-3.3）、60-69 岁（OR 4.1，95%CI 3.1-5.5）、≥70 岁（OR 5.7，95%CI 4.2-7.8）、BMI<25（OR 2.3，95%CI 1.9-2.7）、当前吸烟者（OR 1.2，95%CI 1.01-1.5）、自述呼吸困难（OR 1.7，95%CI 1.4-2.0）、喘息（OR 1.9，95%CI 1.5-2.3）和咳痰（OR 1.4，95%CI 1.1-1.7）与 COPD 诊断的风险显著增加相关。性别、咳嗽和复发性呼吸道感染与 COPD 诊断之间无关联。在初级保健中出现症状的吸烟者和曾经吸烟者中，自述咳痰、喘息、呼吸困难和低 BMI 可识别出 COPD 可能性更高的亚组。
