Cosío Borja G, Pascual-Guardia Sergi, Borras-Santos Alicia, Peces-Barba Germán, Santos Salud, Vigil Laura, Soler-Cataluña Juan José, Martínez-González Cristina, Casanova Ciro, Marcos Pedro J, Alvarez Carlos J, López-Campos José Luis, Gea Joaquim, Garcia-Aymerich Judith, Molina Jesús, Román Miguel, Moises Jorge, Szabo Viktoria, Reagan Elizabeth A, San José Estépar Raúl, Washko George, Agustí Alvar, Faner Rosa
Servicio de Neumología, Hospital Universitario Son Espases-IdISBa, Palma de Mallorca, Spain.
CIBER de Enfermedades Respiratorias, Madrid, Spain.
ERJ Open Res. 2020 Oct 5;6(4). doi: 10.1183/23120541.00047-2020. eCollection 2020 Oct.
The phenotypic characteristics of chronic obstructive pulmonary disease (COPD) in individuals younger than 50 years of age (early COPD) are not well defined. This prospective, multicentre, case-control study sought to describe these characteristics and compare them with those of smokers (≥10 pack-years) of similar age with normal spirometry (controls). We studied 92 cases (post-bronchodilator forced expiratory volume in 1 s (FEV)/forced vital capacity (FVC) <0.7) and 197 controls. Results were contrasted with participants with similar inclusion criteria recruited into the ECLIPSE and COPDGene cohorts. Cases had moderate airflow limitation (FEV 71.3±20.8%) but were often symptomatic, used healthcare resources frequently, had air trapping (residual volume 150.6±55.5% ref.), had reduced diffusing capacity (84.2±20.7% ref.) and had frequent evidence of computed tomography (CT) emphysema (61%). Of note, less than half of cases (46%) had been previously diagnosed with COPD. Interestingly, they also often reported a family history of respiratory diseases and had been hospitalised because of respiratory problems before the age of 5 years more frequently than controls (12% 3%, p=0.009). By and large, these observations were reproduced when available in the ECLIPSE and COPDGene cohorts. These results show that early COPD is associated with substantial health impact and significant structural and functional abnormalities, albeit it is often not diagnosed (hence, treated). The fact that a sizeable proportion of patients with early COPD report a family history of respiratory diseases and/or early-life events (including hospitalisations before the age of 5 years) renders further support to the possibility of early-life origin of COPD.
50岁以下个体慢性阻塞性肺疾病（COPD，早发型COPD）的表型特征尚未明确。这项前瞻性、多中心、病例对照研究旨在描述这些特征，并将其与年龄相仿、肺功能正常的吸烟者（吸烟量≥10包年，对照组）进行比较。我们研究了92例患者（支气管扩张剂后1秒用力呼气容积（FEV）/用力肺活量（FVC）<0.7）和197名对照者。将结果与纳入ECLIPSE和COPDGene队列、具有相似纳入标准的参与者进行对比。病例组存在中度气流受限（FEV为71.3±20.8%），但常伴有症状，频繁使用医疗资源，存在气体潴留（残气量为预计值的150.6±55.5%），弥散功能降低（为预计值的84.2±20.7%），且计算机断层扫描（CT）显示肺气肿的情况较为常见（61%）。值得注意的是，不到一半的病例（46%）此前被诊断为COPD。有趣的是，他们还常报告有呼吸系统疾病家族史，且5岁前因呼吸系统问题住院的频率高于对照组（12%对3%，p = 0.009）。总体而言，这些观察结果在ECLIPSE和COPDGene队列中也得到了重现。这些结果表明，早发型COPD对健康有重大影响，伴有显著的结构和功能异常，尽管其往往未被诊断（因此也未得到治疗）。相当一部分早发型COPD患者报告有呼吸系统疾病家族史和/或早年事件（包括5岁前住院），这进一步支持了COPD起源于早年的可能性。
