Respiratory Research Unit, Department of Respiratory Medicine, Hvidovre Hospital, Hvidovre, Denmark.
Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
Int J Chron Obstruct Pulmon Dis. 2019 Jul 22;14:1633-1638. doi: 10.2147/COPD.S204190. eCollection 2019.
To investigate the prevalence and predictors of COPD in a large cohort of symptomatic smokers and ex-smokers in a primary care setting.
General practitioners (n=390) consecutively recruited individuals ≥35 years, with current or previous tobacco exposure, at least one respiratory symptom, and no previous diagnosis of obstructive airways disease; and obtained data on tobacco exposure, body mass index (BMI), and dyspnea (Medical Research Council dyspnea scale). All individuals with airflow obstruction, ie, FEV/FVC <0.70 at initial lung function test, had diagnostic spirometry, including bronchodilator reversibility test. COPD was defined as respiratory symptom(s), tobacco exposure, and nonreversible airflow limitation.
Of the 6,710 at-risk individuals screened with spirometry (52% male sex, mean age 58 years [SD 10.9]), 1,185 were diagnosed with COPD (17.7%). Apart from age and pack-years, multivariate logistics regression analysis, adjusted for FEV, revealed that BMI <25 kg/m (OR 4.2, 95% CI 3.0-5.9, <0.001), BMI 35+ kg/m (OR 1.6, 95% CI 1.2-2.3), self-reported dyspnea (OR 1.2, 95% CI 1.1-14, =0.04), wheeze (OR 1.3, 95% CI 1.1-1.6, =0.001), phlegm (OR 1.4, 95% CI 1.1-1.6, <0.001), and MRC ≥3 (OR 1.6, 95% CI 1.2-2.0, =0.001) were associated with a significantly higher likelihood of being diagnosed with COPD. No association was found between sex, cough, and recurrent respiratory tract infections and a diagnosis of COPD.
The prevalence of COPD is high among smokers and ex-smokers with one or more respiratory symptoms seen in primary care, and the presence of wheeze, phlegm and dyspnea, together with both low BMI and obesity identify a subgroup with an even higher likelihood of COPD.
在初级保健环境中，调查大量有症状的吸烟者和戒烟者中 COPD 的患病率和预测因素。
全科医生（n=390）连续招募≥35 岁、有当前或既往烟草暴露史、至少有一个呼吸道症状且无阻塞性气道疾病既往诊断的个体；并获取有关烟草暴露、体重指数（BMI）和呼吸困难（医学研究委员会呼吸困难量表）的数据。所有气流受限患者，即初始肺功能检查时 FEV/FVC<0.70 的患者，均进行诊断性肺功能检查，包括支气管扩张剂可逆性试验。COPD 定义为呼吸道症状、烟草暴露和不可逆转的气流受限。
在接受肺功能检查的 6710 名高危人群中（52%为男性，平均年龄 58 岁[SD 10.9]），1185 人被诊断为 COPD（17.7%）。除年龄和吸烟包年数外，多变量逻辑回归分析调整 FEV 后发现，BMI<25 kg/m（OR 4.2，95%CI 3.0-5.9，<0.001）、BMI 35+kg/m（OR 1.6，95%CI 1.2-2.3）、自述呼吸困难（OR 1.2，95%CI 1.1-14，=0.04）、喘息（OR 1.3，95%CI 1.1-1.6，=0.001）、咳痰（OR 1.4，95%CI 1.1-1.6，<0.001）和 MRC≥3（OR 1.6，95%CI 1.2-2.0，=0.001）与 COPD 诊断的可能性显著增加相关。性别、咳嗽和反复呼吸道感染与 COPD 诊断之间无关联。
在初级保健中出现一种或多种呼吸道症状的吸烟者和戒烟者中，COPD 的患病率较高，而喘息、咳痰和呼吸困难以及低 BMI 和肥胖的存在则确定了一个 COPD 可能性更高的亚组。
