Zou Weifeng, Ou Jie, Wu Fan, Xiao Shan, Deng Zhishan, Li Haiqing, Wang Zihui, Tang Gaoying, Liu Shuling, Ye Dong, Zhu Dongshuang, Hu Jinxing, Ran Pixin
State Key Laboratory of Respiratory Disease, Guangzhou Chest Hospital, Guangzhou, People's Republic of China.
Department of Pulmonary and Critical Care Medicine, Shufu County People's Hospital, Kashgar region, Xinjiang, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2025 Jan 30;20:217-229. doi: 10.2147/COPD.S497634. eCollection 2025.
It is unclear whether patients with Global Initiative for Chronic Obstructive Lung Disease stage 1 (mild) chronic obstructive pulmonary disease (COPD) have a higher risk of all-cause mortality than participants with normal spirometry results.
We used the data from the National Health and Nutrition Examination Survey (NHANES) III and 2007-2012, which included participants aged 20-79 years, to investigate whether patients with mild COPD (whole population and subgroups) have a higher risk of all-cause mortality than participants with normal spirometry. Mild COPD was defined as prebronchodilator forced expiratory volume in 1 second /forced vital capacity <0.70 and FEV ≥80% of the predicted value. All-cause mortality risk is the total risk of death from all causes over a given period of time. We performed subgroup analyses by sex, age, smoking status, race, body mass index, and level of education. We also performed sensitivity analyses using the lower limit of normal to define COPD.
1,760 patients (64.5% male; median aged 59 years) with mild COPD and 19,969 participants with normal spirometry (46.9% male; median aged 43 years) were followed up (median 308 months). Patients with mild COPD had a higher all-cause mortality risk than participants with normal spirometry (adjusted: Hazard Ratios 1.13, 95% Confidence Intervals 1.04-1.23; P = 0.005). The results remained robust in the sensitivity analyses. The subgroup analyses results for male sex, age ≥50 years, and current smokers were consistent with the main analysis.
Patients with mild COPD had a higher all-cause mortality risk than those with normal spirometry, especially males, those aged ≥50 years, and current smokers. These results suggest the need for appropriate management of different subgroups with mild COPD.
慢性阻塞性肺疾病全球倡议（GOLD）1期（轻度）慢性阻塞性肺疾病（COPD）患者的全因死亡率是否高于肺功能正常的参与者尚不清楚。
我们使用了来自美国国家健康与营养检查调查（NHANES）III以及2007 - 2012年的数据，这些数据涵盖了20 - 79岁的参与者，以调查轻度COPD患者（总体人群和亚组）的全因死亡率是否高于肺功能正常的参与者。轻度COPD定义为支气管扩张剂使用前1秒用力呼气容积/用力肺活量<0.70且第1秒用力呼气容积（FEV）≥预测值的80%。全因死亡风险是指在给定时间段内所有原因导致的死亡总风险。我们按性别、年龄、吸烟状况、种族、体重指数和教育程度进行了亚组分析。我们还使用正常下限来定义COPD进行了敏感性分析。
对1760例轻度COPD患者（64.5%为男性；中位年龄59岁）和19969例肺功能正常的参与者（46.9%为男性；中位年龄43岁）进行了随访（中位随访308个月）。轻度COPD患者的全因死亡风险高于肺功能正常的参与者（校正后：风险比1.13，95%置信区间1.04 - 1.23；P = 0.005）。敏感性分析结果依然稳健。男性、年龄≥50岁和当前吸烟者的亚组分析结果与主要分析一致。
轻度COPD患者的全因死亡风险高于肺功能正常者，尤其是男性、年龄≥50岁者和当前吸烟者。这些结果表明需要对不同亚组的轻度COPD患者进行适当管理。
