Bae Juye, Lee Hyo Jin, Choi Kwang Yong, Lee Jung-Kyu, Park Tae Yun, Heo Eun Young, Lee Chang Hoon, Kim Deog Kyeom, Lee Hyun Woo
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of).
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Dongjak-gu, Seoul, Korea (the Republic of).
BMJ Open Respir Res. 2024 Jul 17;11(1):e001740. doi: 10.1136/bmjresp-2023-001740.
We aimed to elucidate the clinical factors associated with acute exacerbation and disease progression in young patients with chronic obstructive pulmonary disease (COPD).
This retrospective longitudinal observational study included patients with COPD aged between 20 and 50 years with post-bronchodilator forced expiratory volume in one second (FEV)/forced vital capacity (FVC)<0.7. Eligible patients were followed up with ≥2 spirometry examinations at 1 year interval after COPD diagnosis. The primary outcome was moderate-to-severe acute exacerbation in young patients with COPD. Secondary outcomes were early initiation of regular inhalation therapy and accelerated annual post-bronchodilator FEV decline.
A total of 342 patients were followed up during a median of 64 months. In multivariable analyses, risk factors for moderate-to-severe exacerbation were history of asthma (adjusted HR (aHR)=2.999, 95% CI=[2.074-4.335]), emphysema (aHR=1.951, 95% CI=[1.331-2.960]), blood eosinophil count >300/µL (aHR=1.469, 95% CI=[1.038-2.081]) and low FEV (%) (aHR=0.979, 95% CI=[0.970-0.987]). A history of asthma, sputum, blood eosinophil count >300/µL, low FEV (%) and low diffusing capacity of the lung for carbon monoxide (DL) (%) were identified as clinical factors associated with the early initiation of regular inhalation therapy. The risk factors associated with worsened FEV decline were increasing age, female sex, history of pulmonary tuberculosis, sputum, low FEV (%) and low DL (%).
In young COPD patients, specific high-risk features of acute exacerbation and disease progression need to be identified, including a history of previous respiratory diseases, current respiratory symptoms, blood eosinophil counts, and structural or functional pulmonary impairment.
我们旨在阐明慢性阻塞性肺疾病（COPD）年轻患者急性加重和疾病进展的相关临床因素。
这项回顾性纵向观察性研究纳入了年龄在20至50岁之间、支气管扩张剂后一秒用力呼气容积（FEV）/用力肺活量（FVC）<0.7的COPD患者。符合条件的患者在COPD诊断后每隔1年进行≥2次肺功能检查随访。主要结局是COPD年轻患者的中重度急性加重。次要结局是早期开始规律吸入治疗和支气管扩张剂后FEV年下降加速。
共对342例患者进行了中位时间为64个月的随访。在多变量分析中，中重度加重的危险因素包括哮喘病史（调整后风险比（aHR）=2.999，95%置信区间=[2.074 - 4.335]）、肺气肿（aHR=1.951，95%置信区间=[1.331 - 2.960]）、血嗜酸性粒细胞计数>300/µL（aHR=1.469，95%置信区间=[1.038 - 2.081]）和低FEV（%）（aHR=0.979，95%置信区间=[0.970 - 0.987]）。哮喘病史、咳痰、血嗜酸性粒细胞计数>300/µL、低FEV（%）和低肺一氧化碳弥散量（DL）（%）被确定为与早期开始规律吸入治疗相关的临床因素。与FEV下降恶化相关的危险因素包括年龄增加、女性、肺结核病史、咳痰、低FEV（%）和低DL（%）。
在年轻的COPD患者中，需要识别急性加重和疾病进展的特定高危特征，包括既往呼吸系统疾病史、当前呼吸道症状、血嗜酸性粒细胞计数以及肺部结构或功能损害。
