Hamad Ghassan, Rigby Alan, Morice Alyn H
Hull York Medical School, Castle Hill Hospital, Hull, UK.
ERJ Open Res. 2020 Nov 23;6(4). doi: 10.1183/23120541.00330-2020. eCollection 2020 Oct.
COPD is a spectrum of disorders primarily caused by smoking and characterised by progressive, not fully reversible airflow obstruction with a forced expiratory volume in 1 s (FEV)/forced vital capacity (FVC) ratio <0.7.
From November 2016 to March 2017 we audited patients with COPD in five general practices in Hull and East Riding, UK. We looked at deviation from the locally agreed guidelines. We extracted data on severity, exacerbations, medication and eosinophil count.
We assessed 1088 records. Median age was 70.9 years; 577 (53%) were male. About two-thirds of patients on the COPD register have an FEV/FVC ratio in the diagnostic range for COPD, however, 388 (36%) out of 1088 had a ratio of ≥0.7. In the patients with a ratio of ≥0.7, 259 (67%) out of 388 had an FEV <80% of predicted. Patients with frequent exacerbations were more likely to be prescribed inhaled corticosteroid (ICS)-containing inhalers (incidence rate ratio of 2). FEV % predicted was a poor indicator of exacerbation frequency; however, the presence of elevated blood eosinophil counts (EOS) on at least two occasions was highly predictive of exacerbations. When ICSs, FEV, EOS were examined in combination, they were highly significant predictors for exacerbations.
FEV maybe a more accurate diagnostic parameter in primary care. Historical evidence of blood eosinophilia is a better predictor than FEV. The combination of biomarkers may prove more accurate indicator of future exacerbation frequency, leading to targeted intervention.
慢性阻塞性肺疾病（COPD）是一组主要由吸烟引起的疾病，其特征为进行性、不完全可逆的气流受限，1秒用力呼气容积（FEV）/用力肺活量（FVC）比值<0.7。
2016年11月至2017年3月，我们对英国赫尔和东里丁的5家普通诊所中慢性阻塞性肺疾病患者进行了审核。我们研究了与当地商定指南的偏差情况。我们提取了有关严重程度、急性加重、药物治疗和嗜酸性粒细胞计数的数据。
我们评估了1088份记录。中位年龄为70.9岁；577例（53%）为男性。在慢性阻塞性肺疾病登记册上的患者中，约三分之二的FEV/FVC比值处于慢性阻塞性肺疾病的诊断范围内，然而，1088例中有388例（36%）的比值≥0.7。在比值≥0.7的患者中，388例中有259例（67%）的FEV<预测值的80%。急性加重频繁的患者更有可能被处方使用含吸入性糖皮质激素（ICS）的吸入器（发病率比值为2）。预测的FEV%是急性加重频率的一个较差指标；然而，至少两次出现血液嗜酸性粒细胞计数（EOS）升高高度预测急性加重。当联合检查ICS、FEV、EOS时，它们是急性加重的高度显著预测因素。
在初级保健中，FEV可能是一个更准确的诊断参数。血液嗜酸性粒细胞增多的既往证据比FEV是更好的预测指标。生物标志物的联合使用可能被证明是未来急性加重频率更准确的指标，从而实现有针对性的干预。
