Fletcher C, Peto R
Br Med J. 1977 Jun 25;1(6077):1645-8. doi: 10.1136/bmj.1.6077.1645.
A prospective epidemiological study of the early stages of the development of chronic obstructive pulmonary disease was performed on London working men. The findings showed that forced expiratory volume in one second (FEV1) falls gradually over a lifetime, but in most non-smokers and many smokers clinically significant airflow obstruction never develops. In susceptible people, however, smoking causes irreversible obstructive changes. If a susceptible smoker stops smoking he will not recover his lung function, but the average further rates of loss of FEV1 will revert to normal. Therefore, severe or fatal obstructive lung disease could be prevented by screening smokers' lung function in early middle age if those with reduced function could be induced to stop smoking. Infective processes and chronic mucus hypersecretion do not cause chronic airflow obstruction to progress more rapidly. There are thus two largely unrelated disease processes, chronic airflow obstruction and the hypersecretory disorder (including infective processes).
对伦敦在职男性进行了一项关于慢性阻塞性肺疾病早期发展阶段的前瞻性流行病学研究。研究结果表明，一秒用力呼气量（FEV1）在一生中会逐渐下降，但在大多数非吸烟者和许多吸烟者中，临床上显著的气流阻塞从未发生。然而，在易感人群中，吸烟会导致不可逆的阻塞性改变。如果易感吸烟者戒烟，其肺功能不会恢复，但FEV1的平均进一步下降速率将恢复正常。因此，如果能促使肺功能降低的吸烟者戒烟，那么通过在中年早期筛查吸烟者的肺功能，严重或致命的阻塞性肺病是可以预防的。感染过程和慢性黏液高分泌并不会使慢性气流阻塞进展得更快。因此，存在两个基本不相关的疾病过程，即慢性气流阻塞和高分泌性疾病（包括感染过程）。
