Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China.
BMC Pulm Med. 2022 Apr 28;22(1):167. doi: 10.1186/s12890-022-01929-9.
Although several histological studies have documented airway inflammation and remodelling in the small airways of dust-exposed workers, little is known regarding the prevalence and risk factors of small airway dysfunction (SAD) in pneumoconiosis. The present study investigated the prevalence and characteristics of spirometry-defined SAD in pneumoconiosis and assessed the risk factors for associated with SAD.
A total of 1255 patients with pneumoconiosis were invited to participate, of whom 1115 patients were eligible for final analysis. Spirometry was performed to assess SAD using the following three indicators: maximal mid-expiratory flow and forced expiratory flow 50% and 75%. SAD was defined as at least two of these three indicators being less than 65% of predicted value. Logistic regression analyses were used to analyse the relationships between clinical variables and SAD.
Overall, 66.3% of patients with pneumoconiosis had SAD, among never-smokers the prevalence of SAD was 66.7%. The proportion of SAD did not differ among the subtypes of pneumoconiosis. In addition, SAD was present across the patients with all stages of pneumoconiosis. Even among those with forced expiratory volume in 1 s (FEV) ≥ 80% and FEV/forced vital capacity ratio ≥ 70%, 40.8% of patients had SAD. Patients with SAD were older than patients without SAD, more likely to be women and heavy smokers. Importantly, patients with SAD had more severe airflow obstruction, air trapping, and diffusion dysfunction. All patients with both pneumoconiosis and chronic obstructive pulmonary disease had SAD. Based on multivariate analysis, overall, aged 40 years and older, female sex, heavy smoking, body mass index ≥ 25.0 kg/m and pneumoconiosis stage III were significantly associated with increased risk of SAD. Among the never smokers, risk factors for SAD included female sex, BMI ≥ 25.0 kg/m, pneumoconiosis stage II and stage III CONCLUSION: Spirometry-defined SAD is one of the common functional abnormalities caused by occupational dust exposure and should be taken into account when monitoring respiratory health of workers to guide the early precautions and management in pneumoconiosis.
尽管有几项组织学研究记录了暴露于粉尘的工人小气道中的气道炎症和重塑，但对于尘肺病中小气道功能障碍（SAD）的患病率和危险因素知之甚少。本研究调查了尘肺病中肺量测定定义的 SAD 的患病率和特征，并评估了与 SAD 相关的危险因素。
共邀请了 1255 名尘肺病患者参加，其中 1115 名患者符合最终分析的条件。通过以下三个指标评估 SAD 的肺量测定：最大中期流量和用力呼气流量 50%和 75%。将至少有两个这三个指标低于预测值的 65%定义为 SAD。使用逻辑回归分析来分析临床变量与 SAD 之间的关系。
总体而言，66.3%的尘肺病患者存在 SAD，其中从不吸烟者的 SAD 患病率为 66.7%。SAD 在尘肺病的各亚型中无差异。此外，SAD 存在于尘肺病的所有阶段的患者中。即使在 1 秒用力呼气量（FEV）≥80%和 FEV/用力肺活量比值≥70%的患者中，仍有 40.8%的患者存在 SAD。有 SAD 的患者比没有 SAD 的患者年龄更大，更可能是女性和重度吸烟者。重要的是，有 SAD 的患者有更严重的气流阻塞、空气滞留和弥散功能障碍。所有患有尘肺病和慢性阻塞性肺疾病的患者均有 SAD。基于多变量分析，总体而言，年龄 40 岁及以上、女性、重度吸烟、体重指数≥25.0kg/m2 和尘肺病 III 期与 SAD 风险增加显著相关。在从不吸烟者中，SAD 的危险因素包括女性、BMI≥25.0kg/m2、尘肺病 II 期和 III 期。
肺量测定定义的 SAD 是职业性粉尘暴露引起的常见功能异常之一，在监测工人的呼吸健康时应考虑到这一点，以指导尘肺病的早期预防和管理。
