Howarth Timothy, Gahreman Daniel, Ben Saad Helmi, Ng Lai, Heraganahally Subash S
College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia.
Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia.
Intern Med J. 2023 Nov;53(11):1994-2006. doi: 10.1111/imj.16023. Epub 2023 Feb 11.
The majority of Indigenous Australians reside in non-urban locations, with reduced access to chest radiology such as computed tomography (CT). Spirometry and chest X-ray (CXR) may be used in the absence of CT; however, the correlation of spirometry indices to CT-defined chronic airway diseases (i.e. chronic obstructive pulmonary disease (COPD) and bronchiectasis) compared with CXR among Indigenous people is sparsely reported.
To evaluate spirometry indices against CXR and CT findings among adult Indigenous Australians.
Indigenous patients who had undergone a spirometry test between 2012 and 2020 and had a CXR or chest CT scan assessed for the presence ( )/absence ( ) of airway diseases were included in this study.
Of 643 patients (57% female, 31% remote/very remote), 364 (57%) had CT and CXR available. Patients who were 'CT and CXR ' for airway diseases (48%) recorded a mean FVC, FEV and FEV /FVC of 61%, 59% and 0.76 compared to 57%, 49% and 0.66 in the 'CT and CXR ' group and 53%, 39% and 0.58 in the 'CT and CXR ' group. CXR showed sensitivity (44%) and specificity (88%), while spirometry showed 62% and 77% compared to CT. Spirometry demonstrated predominately restrictive impairment among 'CT and CXR ' and mixed/obstructive impairment among 'CT and CXR ' and 'CT and CXR ' groups.
Indigenous Australians tend to demonstrate restrictive impairment in the absence of radiological evidence of airway disease. However, in the presence of airway disease, combinations of mixed and obstructive impairments were common. Obstructive impairment shows greater sensitivity for identifying COPD than that shown by CXR; however, CXR shows greater specificity. Hence, spirometry in conjunction with chest radiology should be utilised to aid in the assessment of airway diseases in this population.
大多数澳大利亚原住民居住在非城市地区，进行胸部放射检查（如计算机断层扫描（CT））的机会较少。在没有CT的情况下，可使用肺活量测定法和胸部X线（CXR）检查；然而，关于原住民中肺活量测定指标与CT定义的慢性气道疾病（即慢性阻塞性肺疾病（COPD）和支气管扩张症）的相关性与CXR检查结果的比较，相关报道较少。
评估成年澳大利亚原住民的肺活量测定指标与CXR及CT检查结果之间的关系。
本研究纳入了2012年至2020年间接受过肺活量测定检查且进行过CXR或胸部CT扫描以评估气道疾病有无的原住民患者。
在643例患者中（57%为女性，31%来自偏远/非常偏远地区），364例（57%）有CT和CXR检查结果。气道疾病“CT和CXR均阳性”的患者（48%）记录的平均用力肺活量（FVC）、第一秒用力呼气容积（FEV）和FEV /FVC分别为61%、59%和0.76，而“CT阳性但CXR阴性”组分别为57%、49%和0.66，“CT阴性但CXR阳性”组分别为53%、39%和0.58。与CT相比，CXR的敏感性为（44%），特异性为（88%），而肺活量测定法的敏感性和特异性分别为62%和77%。肺活量测定法在“CT和CXR均阳性组”中主要表现为限制性损害，在“CT阳性但CXR阴性组”和“CT阴性但CXR阳性组”中表现为混合性/阻塞性损害。
在没有气道疾病放射学证据的情况下，澳大利亚原住民往往表现出限制性损害。然而，在存在气道疾病的情况下，混合性和阻塞性损害较为常见。阻塞性损害在识别COPD方面比CXR表现出更高的敏感性；然而，CXR表现出更高的特异性。因此，肺活量测定法与胸部放射学检查相结合应有助于评估该人群的气道疾病。
