Fan Jing, Cong Shu, Zhang Yang, Jiang Xiao, Wang Ning, Fang Liwen, Chen Yahong
Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, China.
National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
Pulmonology. 2025 Dec 31;31(1):2486881. doi: 10.1080/25310429.2025.2486881. Epub 2025 May 12.
Pre-chronic obstructive pulmonary disease (COPD) indicators are associated with COPD development, but their associations with lung function decline in persons without COPD and their longitudinal transitions remain uncertain.
In this prospective cohort study, 3526 subjects without COPD from the 2014-2015 national COPD surveillance in China were investigated for a second time during 2018-2020. Four potential pre-COPD indicators at baseline were chronic bronchitis, preserved ratio impaired spirometry (PRISm), low peak expiratory flow (PEF), and spirometric small airway dysfunction (sSAD). To include the incident COPD subjects in the lung function decline analysis for consistent indicators, forced expiratory volume in 1 s (FEV) <80% predicted was used instead of PRISm. Lung function outcomes were the declines in post-bronchodilator FEV, forced vital capacity (FVC), and FEV/FVC.
Subjects with initial chronic bronchitis had faster declines in FEV and FVC compared with those without initial chronic bronchitis among smokers. Consistent chronic bronchitis was associated with faster declines in FEV and FVC among non-smokers. Consistent sSAD was associated with faster declines in FEV/FVC among smokers and non-smokers. Consistent FEV <80% predicted and consistent low PEF were associated with a faster decline in FEV/FVC among smokers. Incident COPD developed from sSAD in almost half of the cases.
Initial chronic bronchitis and consistent FEV <80% predicted, sSAD, and low PEF are associated with excessive lung function decline among smokers, while consistent chronic bronchitis and sSAD are associated with excessive lung function decline among non-smokers. Initial sSAD accounts for a larger proportion of incident COPD than initial chronic bronchitis, PRISm, and low PEF.
慢性阻塞性肺疾病（COPD）前期指标与COPD的发生相关，但其与无COPD者肺功能下降的关联及其纵向转变仍不明确。
在这项前瞻性队列研究中，对来自2014 - 2015年中国全国COPD监测的3526名无COPD受试者在2018 - 2020年期间进行了二次调查。基线时的四个潜在COPD前期指标为慢性支气管炎、肺量计保存比率受损（PRISm）、低呼气峰值流速（PEF）和肺量计小气道功能障碍（sSAD）。为了在肺功能下降分析中纳入新发COPD受试者以保持指标一致，采用1秒用力呼气容积（FEV）<预测值的80%替代PRISm。肺功能结局指标为支气管扩张剂后FEV、用力肺活量（FVC）和FEV/FVC的下降情况。
在吸烟者中，初始患有慢性支气管炎的受试者FEV和FVC下降速度比无初始慢性支气管炎的受试者更快。在非吸烟者中，持续性慢性支气管炎与FEV和FVC下降速度更快相关。持续性sSAD与吸烟者和非吸烟者的FEV/FVC下降速度更快相关。持续性FEV<预测值的80%和持续性低PEF与吸烟者的FEV/FVC下降速度更快相关。近一半的病例中，新发COPD由sSAD发展而来。
初始慢性支气管炎以及持续性FEV<预测值的80%、sSAD和低PEF与吸烟者肺功能过度下降相关，而持续性慢性支气管炎和sSAD与非吸烟者肺功能过度下降相关。初始sSAD在新发COPD中所占比例比初始慢性支气管炎、PRISm和低PEF更大。
