. Departamento de Pneumologia, Hospital da Luz Lisboa, Lisboa, Portugal.
. Departamento de Matemática, Universidade de Aveiro, Aveiro, Portugal.
J Bras Pneumol. 2022 Jan 7;47(6):e20210124. doi: 10.36416/1806-3756/e20210124. eCollection 2022.
The identification of persistent airway obstruction is key to making a diagnosis of COPD. The GOLD guidelines suggest a fixed criterion-a post-bronchodilator FEV1/FVC ratio < 70%-to define obstruction, although other guidelines suggest that a post-bronchodilator FEV1/FVC ratio < the lower limit of normal (LLN) is the most accurate criterion.
This was an observational study of individuals ≥ 40 years of age with risk factors for COPD who were referred to our pulmonary function laboratory for spirometry. Respiratory symptoms were also recorded. We calculated the prevalence of airway obstruction and of no airway obstruction, according to the GOLD criterion (GOLD+ and GOLD-, respectively) and according to the LLN criterion (LLN+ and LLN-, respectively). We also evaluated the level of agreement between the two criteria.
A total of 241 individuals were included. Airway obstruction was identified according to the GOLD criterion in 42 individuals (17.4%) and according to the LLN criterion in 23 (9.5%). The overall level of agreement between the two criteria was good (k = 0.67; 95% CI: 0.52-0.81), although it was lower among the individuals ≥ 70 years of age (k = 0.42; 95% CI: 0.12-0.72). The proportion of obese individuals was lower in the GOLD+/LLN+ category than in the GOLD+/LLN- category (p = 0.03), as was the median DLCO (p = 0.04).
The use of the GOLD criterion appears to be associated with a higher prevalence of COPD. The agreement between the GOLD and LLN criteria also appears to be good, albeit weaker in older individuals. The use of different criteria to define airway obstruction seems to identify individuals with different characteristics. It is essential to understand the clinical meaning of discordance between such criteria. Until more data are available, we recommend a holistic, individualized approach to, as well as close follow-up of, patients with discordant results for airway obstruction.
持续性气道阻塞的识别是 COPD 诊断的关键。GOLD 指南建议使用固定标准（支气管扩张剂后 FEV1/FVC 比值<70%）来定义阻塞，尽管其他指南认为支气管扩张剂后 FEV1/FVC 比值<正常下限（LLN）是最准确的标准。
这是一项针对≥40 岁且有 COPD 风险因素的个体的观察性研究，这些个体被转诊到我们的肺功能实验室进行肺活量测定。还记录了呼吸症状。我们根据 GOLD 标准（分别为 GOLD+和 GOLD-）和 LLN 标准（分别为 LLN+和 LLN-）计算气道阻塞和无气道阻塞的患病率。我们还评估了这两个标准之间的一致性水平。
共纳入 241 名个体。根据 GOLD 标准，42 名（17.4%）个体存在气道阻塞，根据 LLN 标准，23 名（9.5%）个体存在气道阻塞。两个标准之间的总体一致性水平较好（k=0.67；95%CI：0.52-0.81），但在≥70 岁的个体中较低（k=0.42；95%CI：0.12-0.72）。GOLD+/LLN+组肥胖个体的比例低于 GOLD+/LLN-组（p=0.03），DLCO 中位数也较低（p=0.04）。
使用 GOLD 标准似乎与 COPD 的更高患病率相关。GOLD 和 LLN 标准之间的一致性似乎也很好，尽管在老年个体中较弱。使用不同的标准来定义气道阻塞似乎可以识别具有不同特征的个体。了解这些标准之间的差异具有重要意义。在有更多数据之前，我们建议对气道阻塞结果不一致的患者采取整体、个体化的方法，并进行密切随访。
