Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2019 Aug 7;14:1803-1811. doi: 10.2147/COPD.S197552. eCollection 2019.
Sensitively assessing bronchial reversibility by spirometry is difficult in patients with serious airflow limitation and the elderly. Some patients cannot exhale for ≥6 s to achieve FVC testing criteria. The aim of this study was to assess if FEV could be a more sensitive and an acceptable surrogate for evaluating bronchial reversibility in such patients.
Subjects who had undergone pulmonary function examination in Beijing hospital from July 2003 to April 2015 were included in the study. Patients with FEV<50% of the predicted value were classified as the severely lung function-impaired group. Correlation between the severity of lung function impairment and changes in FEV, FEV and FVC in response to a bronchodilator was estimated.
A total of 7745 tests on elderly subjects with a median age of 71 years were reviewed. The severely lung function-impaired group of 1728 accounted for 22.3% of the total number of subjects. There were significantly more patients in the severely lung function-impaired group who exhibited positive response in FEV or FVC and negative response in FEV after bronchodilator test (FEV negative response but FVC positive response, χ2=626.97, <0.001; FEV negative response but FEV positive response, χ2=372.83, <0.001). With the progressive increase in lung function impairment, ΔFEV increased and then declined, while ΔFVC and ΔFEV increased progressively. Changes in FEV or FVC significantly exceeded the change in FEV in the severely lung function-impaired groups (<0.001).
In elderly subjects, especially those with severe lung function impairment, FEV combined with FVC is a more effective and sensitive primary clinical outcome measure to detect bronchial reversibility. In subjects who cannot complete ≥6 s forced expiration and whose FVC is unreliable, FEV combined with FEV might be clinically more valuable in detecting bronchial reversibility.
在严重气流受限和老年人中，通过肺活量测定法敏感评估支气管可逆性较为困难。有些患者无法呼气≥6 s 以达到 FVC 检测标准。本研究旨在评估 FEV 是否可作为评估此类患者支气管可逆性的更敏感和可接受的替代指标。
本研究纳入了 2003 年 7 月至 2015 年 4 月在北京医院接受肺功能检查的患者。将 FEV<50%预计值的患者分为严重肺功能受损组。评估肺功能损害严重程度与 FEV、FEV 和 FVC 对支气管扩张剂反应的变化之间的相关性。
共回顾了 7745 例年龄中位数为 71 岁的老年患者的检测结果。严重肺功能受损组 1728 例，占总例数的 22.3%。在支气管扩张剂试验后，FEV 或 FVC 阳性而 FEV 阴性的患者（FEV 阴性反应但 FVC 阳性反应，χ2=626.97，<0.001；FEV 阴性反应但 FEV 阳性反应，χ2=372.83，<0.001），严重肺功能受损组的患者明显更多。随着肺功能损害程度的逐渐增加，ΔFEV 先增加后下降，而 ΔFVC 和 ΔFEV 则逐渐增加。严重肺功能受损组的 FEV 或 FVC 的变化明显超过 FEV 的变化（<0.001）。
在老年患者中，尤其是严重肺功能受损的患者中，FEV 结合 FVC 是检测支气管可逆性的更有效和敏感的主要临床结局指标。对于无法完成≥6 s 用力呼气且 FVC 不可靠的患者，FEV 结合 FEV 可能在检测支气管可逆性方面具有更大的临床价值。
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