Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
Monash Lung, Sleep, Allergy & Immunology, Monash Health, Melbourne, Victoria, Australia.
Am J Respir Crit Care Med. 2024 Jun 15;209(12):1431-1440. doi: 10.1164/rccm.202212-2330OC.
The term "pre-chronic obstructive pulmonary disease" ("pre-COPD") refers to individuals at high risk of developing COPD who do not meet conventional spirometric criteria for airflow obstruction. New approaches to identifying these individuals are needed, particularly in younger populations. To determine whether lung function thresholds and respiratory symptoms can be used to identify individuals at risk of developing COPD. The Tasmanian Longitudinal Health Study comprises a population-based cohort first studied in 1968 (at age 7 yr). Respiratory symptoms, pre- and post-bronchodilator (BD) spirometry, diffusing capacity, and static lung volumes were measured in a subgroup at age 45, and the incidence of COPD was assessed at age 53. For each lung function measure, -scores were calculated using Global Lung Function Initiative references. The optimal threshold for best discrimination of COPD incidence was determined by the unweighted Youden index. Among 801 participants who did not have COPD at age 45, the optimal threshold for COPD incidence by age 53 was pre-BD FEV/FVC -score less than -1.264, corresponding to the lowest 10 percentile. Those below this threshold had a 36-fold increased risk of developing COPD over an 8-year follow-up period (risk ratio, 35.8; 95% confidence interval, 8.88 to 144), corresponding to a risk difference of 16.4% (95% confidence interval, 3.7 to 67.4). The sensitivity was 88%, and the specificity was 87%. Positive and negative likelihood ratios were 6.79 and 0.14, respectively. Respiratory symptoms, post-BD spirometry, diffusing capacity, and static lung volumes did not improve on the classification achieved by pre-BD FEV/FVC alone. This is the first study, to our knowledge, to evaluate the discriminatory accuracy of spirometry, diffusing capacity, and static lung volume thresholds for COPD incidence in middle-aged adults. Our findings support the inclusion of pre-BD spirometry in the physiological definition of pre-COPD and indicate that pre-BD FEV/FVC at the 10th percentile accurately identifies individuals at high risk of developing COPD in community-based settings.
“慢性阻塞性肺疾病前期（pre-COPD）”一词是指那些有发展为 COPD 风险但不符合常规气流阻塞性肺功能障碍标准的高危人群。需要寻找新的方法来识别这些人群，尤其是在年轻人群中。本研究旨在探讨肺功能指标和呼吸症状是否可以用来识别有发展为 COPD 风险的人群。塔斯马尼亚纵向健康研究（Tasmanian Longitudinal Health Study）是一项基于人群的队列研究，首次于 1968 年（7 岁时）开始研究。在一个亚组中，于 45 岁时测量呼吸症状、支气管扩张剂后（BD）肺功能、弥散量和静态肺容积，在 53 岁时评估 COPD 的发病率。使用全球肺功能倡议（Global Lung Function Initiative）的参考值计算每个肺功能指标的 Z 评分。通过未加权 Youden 指数确定最佳 COPD 发病率区分的截断值。在 801 名 45 岁时无 COPD 的参与者中，BD 前 FEV/FVC 的最佳截断值为-1.264，对应最低的 10%百分位数。低于此阈值的人在 8 年的随访期间发展为 COPD 的风险增加了 36 倍（风险比，35.8；95%置信区间，8.88 至 144），对应的风险差异为 16.4%（95%置信区间，3.7 至 67.4）。敏感性为 88%，特异性为 87%。阳性和阴性似然比分别为 6.79 和 0.14。呼吸症状、BD 后肺功能、弥散量和静态肺容积并不能改善仅通过 BD 前 FEV/FVC 进行的分类。据我们所知，这是第一项评估中年人群中 COPD 发病率的肺功能、弥散量和静态肺容积截断值的鉴别准确性的研究。我们的研究结果支持在慢性阻塞性肺疾病前期的生理定义中纳入 BD 前肺功能，并表明 BD 前 FEV/FVC 的第 10 百分位数可准确识别社区环境中发展为 COPD 的高危人群。
