Soumagne Thibaud, Guillien Alicia, Roche Nicolas, Annesi-Maesano Isabella, Andujar Pascal, Laurent Lucie, Jouneau Stéphane, Botebol Martial, Laplante Jean-Jacques, Dalphin Jean-Charles, Degano Bruno
Service de Pneumologie, Oncologie Thoracique et Allergologie Respiratoire, CHU de Besançon, Besançon, France.
Equipe d'Epidémiologie Environnementale, Institute for Advanced Biosciences, Centre de Recherche UGA, INSERM U1209, CNRS UMR 5309, Grenoble, France.
Int J Chron Obstruct Pulmon Dis. 2020 Jul 1;15:1545-1555. doi: 10.2147/COPD.S253417. eCollection 2020.
Comorbidities including cardiovascular diseases are very common in chronic obstructive pulmonary disease (COPD) secondary to tobacco smoking and contribute to the overall severity of the disease. In non-smoking COPD, which accounts for about 25% of COPD cases worldwide, current knowledge on the frequency and determinants of comorbidities remains scarce. The aims of the current study were to assess the frequency of major comorbidities and to evaluate their determinants in a group of non-selected patients with mild-to-moderate COPD who were exposed to organic dust (dairy farmers), to tobacco smoking, or to both, and in controls without COPD who were exposed to organic dust (dairy farmers), or to tobacco smoking, or to both, or who were without exposure.
A total of 4665 subjects (2323 dairy farmers and 2342 non-farmers) including 355 patients with COPD and 4310 controls with normal spirometry were recruited through a large COPD screening program. Self-reported physician-diagnosed diseases with plausible links to COPD were recorded in this cross-sectional study.
Whatever the exposure, cardiovascular comorbidities were not more frequent in patients with COPD than their counterparts without airflow limitation. A higher risk of major cardiovascular comorbidities was associated with tobacco smoking and a lower risk was associated with exposure to organic dusts.
Tobacco smoking (but not COPD) is associated with higher frequency of cardiovascular comorbidities. By contrast, being a dairy farmer exposed to organic dusts is associated with a lower frequency of the same comorbidities. This reinforces the crucial need for controlling established cardiovascular risk factors even in patients with mild-to-moderate COPD.
包括心血管疾病在内的合并症在吸烟所致的慢性阻塞性肺疾病（COPD）中非常常见，并且会加重该疾病的整体严重程度。在占全球COPD病例约25%的非吸烟COPD患者中，目前关于合并症的发生率及其决定因素的了解仍然很少。本研究的目的是评估一组未经过挑选的轻至中度COPD患者（他们接触有机粉尘——奶农，或吸烟，或两者皆接触）以及未患COPD的对照组（他们接触有机粉尘——奶农，或吸烟，或两者皆接触，或未接触任何因素）中主要合并症的发生率，并评估其决定因素。
通过一项大型COPD筛查项目招募了总共4665名受试者（2323名奶农和2342名非奶农），其中包括355例COPD患者和4310例肺功能正常的对照者。在这项横断面研究中记录了自我报告的、经医生诊断的、与COPD可能相关的疾病。
无论暴露情况如何，COPD患者中心血管合并症的发生率并不高于无气流受限的对照组。吸烟与主要心血管合并症的较高风险相关，而接触有机粉尘则与较低风险相关。
吸烟（而非COPD）与心血管合并症的较高发生率相关。相比之下，作为接触有机粉尘的奶农则与相同合并症的较低发生率相关。这进一步强调了即使在轻至中度COPD患者中控制已确定的心血管危险因素的迫切需求。
