Perez-Padilla Rogelio, Wehrmeister Fernando C, de Oca Maria Montes, Lopez Maria Victorina, Jardim Jose R, Muiño Adriana, Valdivia Gonzalo, Menezes Ana Maria B
National Institute of Respiratory Diseases, Mexico City, Mexico,
Federal University of Pelotas, Pelotas, Brazil.
Int J Chron Obstruct Pulmon Dis. 2018 Oct 26;13:3549-3561. doi: 10.2147/COPD.S175527. eCollection 2018.
We aimed to study the adverse outcomes of symptomatic and asymptomatic non-obstructed individuals and those with mild COPD longitudinally in participants from three Latin-American cities.
Two population-based surveys of adults with spirometry were conducted for these same individuals with a 5- to 9-year interval. We evaluated the impact of respiratory symptoms (cough, phlegm, wheezing or dyspnea) in non-obstructed individuals, and among those classified as Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 1, COPD on exacerbation frequency, mortality and FEV decline, compared with asymptomatic individuals without airflow obstruction or restriction.
Non-obstructed symptomatic individuals had a marginal increased risk of mortality (HR 1.3; 95% CI 0.9-1.94), increased FEV decline (-4.5 mL/year; 95% CI -8.6, -0.4) and increased risk of 2+ exacerbations in the previous year (OR 2.6; 95% CI 1.2-6.5). Individuals with GOLD stage 1 had a marginal increase in mortality (HR 1.5; 95% CI 0.93-2.3) but a non-significant impact on FEV decline or exacerbations compared with non-obstructed individuals.
The presence of respiratory symptoms in non-obstructed individuals was a predictor of mortality, lung-function decline and exacerbations, whereas the impact of GOLD stage 1 was mild and inconsistent. Respiratory symptoms were associated with asthma, current smoking, and the report of heart disease. Spirometric case-finding and treatment should target individuals with moderate-to-severe airflow obstruction and those with restriction, the groups with consistent increased mortality.
我们旨在对来自三个拉丁美洲城市的参与者进行纵向研究，以了解有症状和无症状的非阻塞性个体以及轻度慢性阻塞性肺疾病（COPD）患者的不良结局。
对这些相同个体进行了两次基于人群的成人肺功能检查调查，间隔时间为5至9年。我们评估了非阻塞性个体以及那些被分类为慢性阻塞性肺疾病全球倡议（GOLD）1期的COPD患者中呼吸道症状（咳嗽、咳痰、喘息或呼吸困难）对急性加重频率、死亡率和第一秒用力呼气容积（FEV）下降的影响，并与无气流阻塞或限制的无症状个体进行比较。
有症状的非阻塞性个体的死亡风险略有增加（风险比[HR] 1.3；95%置信区间[CI] 0.9 - 1.94），FEV下降增加（-4.5毫升/年；95% CI -8.6，-0.4），且前一年发生2次及以上急性加重的风险增加（比值比[OR] 2.6；95% CI 1.2 - 6.5）。与非阻塞性个体相比，GOLD 1期患者的死亡率略有增加（HR 1.5；95% CI 0.93 - 2.3），但对FEV下降或急性加重无显著影响。
非阻塞性个体中呼吸道症状的存在是死亡率、肺功能下降和急性加重的预测因素，而GOLD 1期的影响轻微且不一致。呼吸道症状与哮喘、当前吸烟和心脏病报告相关。肺功能检查病例发现和治疗应针对中重度气流阻塞和有气流受限的个体，即死亡率持续增加的人群。
