Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK.
Epidemiology (Value Evidence and Outcomes), GlaxoSmithKline, R&D, Uxbridge, UK.
Int J Chron Obstruct Pulmon Dis. 2020 Nov 25;15:3079-3091. doi: 10.2147/COPD.S278981. eCollection 2020.
Estimates for lung function decline in chronic obstructive pulmonary disease (COPD) have differed by study setting and have not been described in a UK primary care population.
To describe rates of FEV and FVC decline in COPD and investigate characteristics associated with accelerated decline.
Current/ex-smoking COPD patients (35 years+) who had at least 2 FEV or FVC measurements ≥6 months apart were included using Clinical Practice Research Datalink. Patients were followed up for a maximum of 13 years. Accelerated rate of lung function decline was defined as the fastest quartile of decline using mixed linear regression, and association with baseline characteristics was investigated using logistic regression.
A total of 72,683 and 50,649 COPD patients had at least 2 FEV or FVC measurements, respectively. Median rates of FEV and FVC changes or decline were -18.1mL/year (IQR: -31.6 to -6.0) and -22.7mL/year (IQR: -39.9 to -6.7), respectively. Older age, high socioeconomic status, being underweight, high mMRC dyspnoea and frequent AECOPD or severe AECOPD were associated with an accelerated rate of FEV and FVC decline. Current smoking, mild airflow obstruction and inhaled corticosteroid treatment were additionally associated with accelerated FEV decline whilst women, sputum production and severe airflow obstruction were associated with accelerated FVC decline.
Rate of FEV and FVC decline was similar and showed similar heterogeneity. Whilst FEV and FVC shared associations with baseline characteristics, a few differences highlighted the importance of both lung function measures in COPD progression. We identified important characteristics that should be monitored for disease progression.
慢性阻塞性肺疾病（COPD）的肺功能下降估计因研究环境而异，在英国初级保健人群中尚未描述。
描述 COPD 患者的 FEV 和 FVC 下降率，并研究与加速下降相关的特征。
使用临床实践研究数据链接（Clinical Practice Research Datalink）纳入至少有 2 次 FEV 或 FVC 测量值间隔≥6 个月的当前/曾经吸烟的 COPD 患者（年龄≥35 岁）。患者最多随访 13 年。使用混合线性回归定义肺功能下降的最快四分位数作为加速下降率，使用逻辑回归研究与基线特征的相关性。
共有 72683 名和 50649 名 COPD 患者分别至少有 2 次 FEV 或 FVC 测量值。FEV 和 FVC 变化或下降的中位率分别为-18.1mL/年（IQR：-31.6 至-6.0）和-22.7mL/年（IQR：-39.9 至-6.7）。年龄较大、高社会经济地位、体重不足、mMRC 呼吸困难评分较高、频繁急性加重或严重急性加重与 FEV 和 FVC 下降加速有关。当前吸烟、轻度气流受限和吸入皮质激素治疗与 FEV 加速下降有关，而女性、痰液产生和严重气流受限与 FVC 加速下降有关。
FEV 和 FVC 的下降率相似，表现出相似的异质性。虽然 FEV 和 FVC 与基线特征有共同的关联，但一些差异强调了这两种肺功能测量在 COPD 进展中的重要性。我们确定了重要的特征，应监测这些特征以评估疾病进展。
