Chest Research Foundation, Pune, India.
KEM Hospital Research Centre, Pune, India.
Respir Res. 2020 Feb 12;21(1):50. doi: 10.1186/s12931-020-1310-9.
Although COPD among non-smokers (NS-COPD) is common, little is known about this phenotype. We compared NS-COPD subjects with smoking COPD (S-COPD) patients in a rural Indian population using a variety of clinical, physiological, radiological, sputum cellular and blood biomarkers.
Two hundred ninety subjects (118 healthy, 79 S-COPD, 93 NS-COPD) performed pre- and post-bronchodilator spirometry and were followed for 2 years to study the annual rate of decline in lung function. Body plethysmography, impulse oscillometry, inspiratory-expiratory HRCT, induced sputum cellular profile and blood biomarkers were compared between 49 healthy, 45 S-COPD and 55 NS-COPD subjects using standardized methods. Spirometric response to oral corticosteroids was measured in 30 female NS-COPD patients.
Compared to all male S-COPD subjects, 47% of NS-COPD subjects were female, were younger by 3.2 years, had greater body mass index, a slower rate of decline in lung function (80 vs 130 mL/year), more small airways obstruction measured by impulse oscillometry (p < 0.001), significantly less emphysema (29% vs 11%) on CT scans, lower values in lung diffusion parameters, significantly less neutrophils in induced sputum (p < 0.05) and tended to have more sputum eosinophils. Hemoglobin and red cell volume were higher and serum insulin lower in S-COPD compared to NS-COPD. Spirometric indices, symptoms and quality of life were similar between S-COPD and NS-COPD. There was no improvement in spirometry in NS-COPD patients after 2 weeks of an oral corticosteroid.
Compared to S-COPD, NS-COPD is seen in younger subjects with equal male-female predominance, is predominantly a small-airway disease phenotype with less emphysema, preserved lung diffusion and a slower rate of decline in lung function.
虽然非吸烟者（NS-COPD）中的 COPD 很常见，但对这种表型知之甚少。我们使用各种临床、生理、影像学、痰细胞和血液生物标志物，比较了印度农村地区的 NS-COPD 患者与吸烟 COPD（S-COPD）患者。
290 名受试者（118 名健康，79 名 S-COPD，93 名 NS-COPD）进行支气管扩张剂预后肺量测定，并随访 2 年以研究肺功能的年下降率。使用标准化方法比较 49 名健康、45 名 S-COPD 和 55 名 NS-COPD 受试者之间的体描法、脉冲震荡法、吸气-呼气高分辨率 CT、诱导痰细胞谱和血液生物标志物。测量 30 名女性 NS-COPD 患者对口服皮质类固醇的肺量测定反应。
与所有男性 S-COPD 患者相比，47%的 NS-COPD 患者为女性，年轻 3.2 岁，体重指数较高，肺功能下降速度较慢（80 比 130mL/年），脉冲震荡法测量的小气道阻塞程度较高（p<0.001），CT 扫描上的肺气肿程度明显较低（29%比 11%），肺扩散参数值较低，诱导痰中的中性粒细胞明显较少（p<0.05），痰中的嗜酸性粒细胞有增加趋势。与 NS-COPD 相比，S-COPD 患者的血红蛋白和红细胞体积较高，血清胰岛素较低。S-COPD 和 NS-COPD 患者的肺量测定指数、症状和生活质量相似。NS-COPD 患者在口服皮质类固醇 2 周后肺量测定无改善。
与 S-COPD 相比，NS-COPD 见于较年轻的患者，男女比例相等，主要是小气道疾病表型，肺气肿较少，肺扩散功能保留，肺功能下降速度较慢。
