Deng Zhishan, Li Xiaochen, Li Chenglong, Zheng Youlan, Wu Fan, Wang Zihui, Liu Sha, Tian Heshen, Zheng Jinzhen, Peng Jieqi, Huang Peiyu, Yang Huajing, Xiao Shan, Wen Xiang, Yang Changli, Luo Xiangwen, Peng Gongyong, Li Bing, Zhou Yumin, Ran Pixin
State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & Guangzhou Institute of Respiratory Health & National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China.
Guangzhou Laboratory, Bioland, Guangzhou, China.
J Thorac Dis. 2023 Feb 28;15(2):472-483. doi: 10.21037/jtd-22-1328. Epub 2023 Feb 15.
Whether individuals with non-obstructive spirometry-defined small airway dysfunction (SAD) have impaired exercise capacity is unclear, particularly in never-smokers. This study clarifies the degree of impaired exercise capacity and its potential cause in individuals with non-obstructive SAD.
This community-based, multiyear cross-sectional study analyzed data collected in Guangdong, China from 2012-2019 by the National Science and Technology Support Plan Program. Measurements of exercise capacity [peak work rate and peak oxygen uptake ( )] in participants with non-obstructive spirometry-defined SAD (n=157) were compared with those in controls (n=85) and Global Initiative for Chronic Obstructive Lung Disease (GOLD) I patients (n=239). Subgroup analyses were performed by smoking status.
The risk of impaired exercise capacity was significantly higher in participants with non-obstructive SAD [ <84%predicted, adjusted odds ratio (aOR) =2.53; 95% confidence interval (CI): 1.42-4.52] than in controls but was not significantly different from that in GOLD I patients. Results were consistent within subgroups of smoking status (ever-smokers: non-obstructive SAD controls, aOR =2.44; 95% CI: 1.08-5.51; never-smokers: non-obstructive SAD controls, aOR =2.38, 95% CI: 1.02-5.58). Participants with non-obstructive SAD had a significantly lower peak work rate (β=-10.5; 95% CI: -16.3 to -4.7) and (%predicted, β=-4.0; 95% CI: -7.7 to -0.2) and tended to have higher ventilatory equivalents for carbon dioxide at the ventilatory threshold ( , β=1.1; 95% CI: -0.1 to 2.3) when compared with controls. Both peak work rate and were negatively correlated with .
Although not meeting the current criteria for chronic obstructive pulmonary disease, individuals with non-obstructive SAD have impaired exercise capacity that may be associated with ventilatory inefficiency regardless of smoking status.
通过肺量计测定的非阻塞性小气道功能障碍（SAD）个体的运动能力是否受损尚不清楚，尤其是在从不吸烟者中。本研究阐明了非阻塞性SAD个体运动能力受损的程度及其潜在原因。
这项基于社区的多年横断面研究分析了中国广东在2012 - 2019年由国家科技支撑计划项目收集的数据。将通过肺量计测定的非阻塞性SAD参与者（n = 157）的运动能力[峰值工作率和峰值摄氧量（ ）]测量值与对照组（n = 85）和慢性阻塞性肺疾病全球倡议（GOLD）I级患者（n = 239）进行比较。按吸烟状况进行亚组分析。
非阻塞性SAD参与者[ <84%预测值，调整优势比（aOR）= 2.53；95%置信区间（CI）：1.42 - 4.52]运动能力受损的风险显著高于对照组，但与GOLD I级患者无显著差异。吸烟状况亚组内的结果一致（曾经吸烟者：非阻塞性SAD 对照组，aOR = 2.44；95% CI：1.08 - 5.51；从不吸烟者：非阻塞性SAD 对照组，aOR = 2.38，95% CI：1.02 - 5.58）。与对照组相比，非阻塞性SAD参与者的峰值工作率显著更低（β = -10.5；95% CI：-16.3至-4.7）和 （%预测值，β = -4.0；95% CI：-7.7至-0.2），并且在通气阈值时二氧化碳通气当量往往更高（ ，β = 1.1；95% CI：-0.1至2.3）。峰值工作率和 均与 呈负相关。
尽管不符合慢性阻塞性肺疾病的当前标准，但非阻塞性SAD个体存在运动能力受损，无论吸烟状况如何，这可能与通气效率低下有关。
