Touilloux Brice, Bongard Cedric, Lechartier Benoit, Truong Minh Khoa, Marques-Vidal Pedro, Vollenweider Peter, Vaucher Julien, Casutt Alessio, von Garnier Christophe
Division of Pulmonology, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.
Division of Pulmonology, Department of Medicine and Specialties, Fribourg Hospital, Fribourg, Switzerland.
ERJ Open Res. 2023 Sep 11;9(5). doi: 10.1183/23120541.00381-2023. eCollection 2023 Sep.
Recent evidence identified exposure to particulate matter of size ≤2.5 µm (PM) as a risk factor for high prevalence of small airway dysfunction (SAD). We assessed the prevalence of SAD in a European region with low air pollution levels.
SAD was defined as a maximum mid-expiratory flow (MMEF) <65% of predicted value (PV) or MMEF <lower limit of normal (LLN) measured by spirometry in the Swiss PneumoLaus cohort. We performed bivariate and multivariable analysis with MMEF criteria, age, sex, body mass index, respiratory symptoms and smoking status. Mean PM values were obtained from a Swiss national database.
Among 3351 participants (97.6% Caucasian, 55.7% female sex, mean age 62.7 years), we observed MMEF <65% PV in 425 (12.7%) and MMEF <LLN in 167 (5.0%) individuals. None of the participants had both MMEF <LLN and ≥65% PV. MMEF <65% PV and MMEF <LLN were significantly associated with age, smoking status, cough, sputum and dyspnoea, whereas a positive association with MMEF <65% PV was observed for individuals aged >65 years only. In an area where ambient PM concentration was <15 µg·m during the observation period (2010 and 2020), ≥72% of participants with SAD were ever-smokers.
The observed low prevalence of SAD of 5.0-12.7% depending on criteria employed may be related to lower PM exposure. Smoking was the main factor associated with SAD in an area with low PM exposure. Employing a MMEF threshold <65% PV carries a risk of SAD overdiagnosis in elderly individuals.
最近有证据表明，暴露于直径≤2.5微米的颗粒物（PM）是小气道功能障碍（SAD）高患病率的一个风险因素。我们评估了空气污染水平较低的欧洲某地区SAD的患病率。
在瑞士肺部洛桑队列研究中，SAD被定义为通过肺活量测定法测得的最大呼气中期流速（MMEF）<预测值（PV）的65%或MMEF<正常下限（LLN）。我们对MMEF标准、年龄、性别、体重指数、呼吸道症状和吸烟状况进行了双变量和多变量分析。平均PM值来自瑞士国家数据库。
在3351名参与者中（97.6%为白种人，55.7%为女性，平均年龄62.7岁），我们观察到425人（12.7%）的MMEF<PV的65%，167人（5.0%）的MMEF<LLN。没有参与者同时出现MMEF<LLN且≥PV的65%。MMEF<PV的65%和MMEF<LLN与年龄、吸烟状况、咳嗽、咳痰和呼吸困难显著相关，而仅在年龄>65岁的个体中观察到与MMEF<PV的65%呈正相关。在观察期（2010年和2020年）期间环境PM浓度<15微克·立方米的地区，≥72%的SAD参与者曾经吸烟。
根据所采用的标准观察到的SAD低患病率（5.0%-12.7%）可能与较低的PM暴露有关。在PM暴露较低的地区，吸烟是与SAD相关的主要因素。采用MMEF阈值<PV的65%会有老年个体SAD过度诊断的风险。
