Vazquez Guillamet Rodrigo, Petersen Hans, Meek Paula, Sood Akshay, Tesfaigzi Yohannes
a Department of Internal Medicine , University of New Mexico School of Medicine , Albuquerque , NM , USA.
b COPD Program , Lovelace Respiratory Research Institute , Albuquerque , NM , USA.
COPD. 2018 Apr;15(2):206-213. doi: 10.1080/15412555.2018.1458218. Epub 2018 Apr 26.
The binary approach to the diagnosis of Chronic Bronchitis (CB) is a major barrier to the study of the disease. We investigated whether severity of productive cough can be graded using symptoms and presence of fixed airflow obstruction (FAO), and whether the severity correlates with health status, exposures injurious to the lung, biomarkers of inflammation, and measures of airway wall thickening. Findings from a cross-sectional sample of 1,422 participants from the Lovelace Smokers Cohort (LSC) were validated in 4,488 participants from the COPDGene cohort (COPDGene). Health status was based on the St. George's Respiratory Questionnaire, and Medical Outcomes Study 36-Item Short Form Health Survey. Circulating CC16 levels were quantified by ELISA (LSC), and airway wall thickening was measured using computed tomography (COPDGene). FAO was defined as postbronchodilator FEV/FVC <0.7. The presence and duration of productive cough and presence of FAO or wheeze were graded into Healthy Smokers, Productive Cough (PC), Chronic PC, PC with Signs of Airflow Obstruction, and Chronic PC with Signs of Airflow Obstruction. In both cohorts, higher grade of severity correlated with lower health status, greater frequency of injurious exposures, greater airway wall thickening, and lower circulating CC16 levels. Further, longitudinal follow-up suggested that disease resolution can occur at every grade of severity but is more common in groups of lower severity and least common once airway remodeling develops. Therefore, severity of productive cough can be graded based on symptoms and FAO and early intervention may benefit patients by changing the natural history of disease.
慢性支气管炎（CB）诊断的二元法是该疾病研究的主要障碍。我们调查了是否可以使用症状和固定气流受限（FAO）的存在来对咳痰性咳嗽的严重程度进行分级，以及严重程度是否与健康状况、肺部有害暴露、炎症生物标志物和气道壁增厚测量值相关。来自洛夫莱斯吸烟者队列（LSC）的1422名参与者的横断面样本的研究结果在慢性阻塞性肺疾病基因队列（COPDGene）的4488名参与者中得到验证。健康状况基于圣乔治呼吸问卷和医学结局研究36项简短健康调查。通过酶联免疫吸附测定法（LSC）对循环CC16水平进行定量，并使用计算机断层扫描（COPDGene）测量气道壁增厚。FAO定义为支气管扩张剂后FEV/FVC<0.7。咳痰性咳嗽的存在和持续时间以及FAO或喘息的存在被分为健康吸烟者、咳痰性咳嗽（PC）型、慢性PC型、有气流受限体征的PC型和有气流受限体征的慢性PC型。在两个队列中，严重程度越高与健康状况越差、有害暴露频率越高、气道壁增厚越明显以及循环CC16水平越低相关。此外，纵向随访表明，疾病缓解在每个严重程度等级都可能发生，但在较低严重程度组中更常见，而一旦气道重塑发生则最不常见。因此，咳痰性咳嗽的严重程度可以根据症状和FAO进行分级，早期干预可能通过改变疾病的自然史而使患者受益。
