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保留肺功能的吸烟人群中呼吸道症状的临床意义
Clinical Significance of Symptoms in Smokers with Preserved Pulmonary Function


Prescott G. Woodruff ... 呼吸系统疾病 • 2016.05.12
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摘要


背景

目前,诊断慢性阻塞性肺疾病(COPD)时,要求使用支气管扩张剂后进行呼吸量测定,判断标准是第一秒用力呼气量(FEV1)占用力肺活量(FVC)比率(FEV1∶FVC)<0.70。但是,许多吸烟者没有达到这一标准,但仍有呼吸道症状。

 

方法

我们进行了一项观察性研究,纳入了现时吸烟者或既往吸烟者,以从未吸烟者作为对照,共计2,736人。我们使用COPD评估测试(COPD Assessment Test,CAT,评分范围为0~40分,分数较高表示症状较严重)测量了他们的呼吸道症状。我们评价了保留肺功能(使用支气管扩张剂后进行呼吸量测定,FEV1∶FVC≥0.70,同时FVC大于正常范围下限)同时存在呼吸道症状(CAT评分≥10分)的现时吸烟者和既往吸烟者是否比保留肺功能但没有呼吸道症状(CAT评分<10分)的现时吸烟者和既往吸烟者出现呼吸道症状加重的风险更高,以及这两组人群在6分钟步行距离测试、肺功能或胸部高分辨率计算机断层扫描(HRCT)方面是否有不同的结果。

 

结果

在保留肺功能的现时吸烟者和既往吸烟者中,50%的人存在呼吸道症状。在有症状的现时吸烟者或既往吸烟者中,呼吸道症状加重的平均发生率(均值±SD为0.27事件/年±0.67事件/年)显著高于无症状的现时吸烟者或既往吸烟者(0.08事件/年±0.31事件/年)以及从未吸烟者(0.03事件/年±0.21事件/年),有症状者与无症状者的比较以及有症状者与从未吸烟者比较,P值均小于0.001。与无症状的现时吸烟者或既往吸烟者相比,有症状的现时吸烟者或既往吸烟者无论是否有哮喘病史,活动受限情况较严重,FEV1、FVC和吸气量略低,HRCT发现的不伴有肺气肿的气道壁增厚情况较严重。在有症状的现时吸烟者或既往吸烟者中,42%使用支气管扩张剂,23%使用吸入性糖皮质激素。

 

结论

虽然保留肺功能,有症状的现时吸烟者或既往吸烟者还未达到当前COPD的诊断标准,但是他们存在呼吸道症状加重、活动受限并且有气道疾病出现的迹象。他们在没有任何临床证据的情况下使用着一系列的呼吸系统药物(由美国国立心肺血液研究所[National Heart, Lung, and Blood Institute]、国立卫生研究院基金会[Foundation for the National Institutes of Health]资助;SPIROMICS在ClinicalTrials.gov注册号为NCT01969344)。





作者信息

Prescott G. Woodruff, M.D., R. Graham Barr, M.D., Dr.P.H., Eugene Bleecker, M.D., Stephanie A. Christenson, M.D., David Couper, Ph.D., Jeffrey L. Curtis, M.D., Natalia A. Gouskova, Ph.D., Nadia N. Hansel, M.D., Eric A. Hoffman, Ph.D., Richard E. Kanner, M.D., Eric Kleerup, M.D., Stephen C. Lazarus, M.D., Fernando J. Martinez, M.D., Robert Paine, III, M.D., Stephen Rennard, M.D., Donald P. Tashkin, M.D., and MeiLan K. Han, M.D., for the SPIROMICS Research Group*
From the Cardiovascular Research Institute (P.G.W., S.C.L.) and the Department of Medicine, Division of Pulmonary, Critical Care, Sleep, and Allergy (P.G.W., S.A.C., S.C.L.), University of California at San Francisco, San Francisco; the Departments of Medicine and Epidemiology, Columbia University Medical Center (R.G.B.), and the Department of Medicine, Weill–Cornell Medical College (F.J.M.) — both in New York; the Department of Medicine, Center for Genomics and Personalized Medicine Research, Wake Forest University, Winston-Salem (E.B.), and the Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill (D.C., N.A.G.) — both in North Carolina; the Section of Pulmonary and Critical Care Medicine, Medical Service, Veterans Affairs Ann Arbor Healthcare System (J.L.C.), and the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan (J.L.C., M.K.H.) — both in Ann Arbor; the Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore (N.N.H.); the Department of Radiology, University of Iowa Carver College of Medicine, Iowa City (E.A.H.); the Department of Medicine, University of Utah Hospitals and Clinics, Salt Lake City (R.E.K., R.P.); the Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles (E.K., D.P.T.); the Department of Medicine, University of Nebraska Medical Center, Omaha (S.R.); and the Clinical Discovery Unit, AstraZeneca, Cambridge, United Kingdom (S.R.).Address reprint requests to Dr. Woodruff at the University of California at San Francisco, Box 0130, Rm. HSE 1305, 513 Parnassus Ave., San Francisco, CA 94143, or at prescott.woodruff@ucsf.edu. *A complete list of the investigators in the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) is provided in the Supplementary Appendix, available at NEJM.org.

 

参考文献

1.Vestbo J, Hurd SS, Agustí AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2013;187:347-365

2.Martinez CH, Kim V, Chen Y, et al. The clinical impact of non-obstructive chronic bronchitis in current and former smokers. Respir Med 2014;108:491-499

3.van der Molen T, Willemse BW, Schokker S, ten Hacken NH, Postma DS, Juniper EF. Development, validity and responsiveness of the Clinical COPD Questionnaire. Health Qual Life Outcomes 2003;1:13-13

4.Johns DP, Walters JA, Walters EH. Diagnosis and early detection of COPD using spirometry. J Thorac Dis 2014;6:1557-1569

5.Celli BR, Decramer M, Wedzicha JA, et al. An official American Thoracic Society/European Respiratory Society statement: research questions in COPD. Eur Respir Rev 2015;24:159-172

6.Couper D, LaVange LM, Han M, et al. Design of the Subpopulations and Intermediate Outcomes in COPD Study (SPIROMICS). Thorax 2014;69:491-494

7.Hankinson JL, Odencrantz JR, Fedan KB. Spirometric reference values from a sample of the general U.S. population. Am J Respir Crit Care Med 1999;159:179-187

8.Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (updated 2015) (http://www.goldcopd.org).

9.Jones PW, Harding G, Berry P, Wiklund I, Chen WH, Kline Leidy N. Development and first validation of the COPD Assessment Test. Eur Respir J 2009;34:648-654

10.ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002;166:111-117

11.Patel BD, Coxson HO, Pillai SG, et al. Airway wall thickening and emphysema show independent familial aggregation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2008;178:500-505

12.Lin DY, Wei LJ, Yang I, Ying Z. Semiparametric regression for the mean and rate functions of recurrent events. J R Stat Soc B 2000;62:711-730

13.Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax 1999;54:581-586

14.Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests. Eur Respir J 2005;26:948-968

15.Pinto LM, Gupta N, Tan W, et al. Derivation of normative data for the COPD assessment test (CAT). Respir Res 2014;15:68-68

16.Agusti A, Edwards LD, Celli B, et al. Characteristics, stability and outcomes of the 2011 GOLD COPD groups in the ECLIPSE cohort. Eur Respir J 2013;42:636-646

17.Agusti A, Hurd S, Jones P, et al. FAQs about the GOLD 2011 assessment proposal of COPD: a comparative analysis of four different cohorts. Eur Respir J 2013;42:1391-1401

18.Salome CM, King GG, Berend N. Physiology of obesity and effects on lung function. J Appl Physiol (1985) 2010;108:206-211

19.Sin DD, Jones RL, Man SF. Obesity is a risk factor for dyspnea but not for airflow obstruction. Arch Intern Med 2002;162:1477-1481

20.Definition and classification of chronic bronchitis for clinical and epidemiological purposes: a report to the Medical Research Council by their Committee on the Aetiology of Chronic Bronchitis. Lancet 1965;1:775-779

21.Lopez-Campos JL, Agustí A. Heterogeneity of chronic obstructive pulmonary disease exacerbations: a two-axes classification proposal. Lancet Respir Med 2015;3:729-734

22.Beghé B, Verduri A, Roca M, Fabbri LM. Exacerbation of respiratory symptoms in COPD patients may not be exacerbations of COPD. Eur Respir J 2013;41:993-995

23.Tan WC, Bourbeau J, Hernandez P, et al. Exacerbation-like respiratory symptoms in individuals without chronic obstructive pulmonary disease: results from a population-based study. Thorax 2014;69:709-717

24.Bowler RP, Kim V, Regan E, et al. Prediction of acute respiratory disease in current and former smokers with and without COPD. Chest 2014;146:941-950

25.Oelsner EC, Hoffman EA, Folsom AR, et al. Association between emphysema-like lung on cardiac computed tomography and mortality in persons without airflow obstruction: a cohort study. Ann Intern Med 2014;161:863-873

26.Regan EA, Lynch DA, Curran-Everett D, et al. Clinical and radiologic disease in smokers with normal spirometry. JAMA Intern Med 2015;175:1539-1549

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