An Official American Thoracic Society Public Policy Statement: Novel Risk Factors and the Global Burden of Chronic Obstructive Pulmonary Disease
An Official American Thoracic Society Public Policy Statement: Novel Risk Factors and the Global Burden of Chronic Obstructive Pulmonary Disease
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DOI：
10.1164/rccm.200811-1757st
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发表时间：
2010-09-01
影响因子：
24.7
通讯作者：
Balmes, John R.
中科院分区：
文献类型：
--
作者：
Eisner, Mark D.;Anthonisen, Nicholas;Balmes, John R.
理论基础：虽然吸烟是慢性阻塞性肺疾病(COPD)最重要的原因，但很大一部分COPD病例不能仅用吸烟来解释。目的：评估除个人吸烟外，COPD的危险因素。方法：我们成立了美国胸科学会环境与职业健康大会的一个特设小组委员会。邀请了一个由国际成员组成的小组，基于他们在COPD特定风险因素方面的科学专长。对于每个危险因素领域，委员会回顾了文献，总结了证据，并得出了关于其导致COPD的可能性的结论。所有结论都是基于一致的共识。测量和主要结果：吸烟是COPD的一个原因的人口归因率在9.7%到97.9%之间，但在大多数研究中不到80%，这表明不吸烟的危险因素造成了很大的疾病负担。在我们综述的基础上，我们得出结论，特定的遗传综合征和职业暴露与COPD的发展存在因果关系。交通和其他户外污染、二手烟、生物质烟雾和饮食因素与COPD有关，但没有达到充分的病因标准。慢性哮喘和肺结核与不可逆转的肺功能丧失有关，但与COPD相比是否存在重要的表型差异仍不确定，因为它通常在临床环境中遇到。结论：从公共卫生角度来看，COPD的实质性负担可归因于吸烟以外的危险因素。为了预防与COPD相关的残疾和死亡，必须将工作重点放在预防和停止接触吸烟和这些其他较不为人所知的危险因素上。
Rationale: Although cigarette smoking is the most important cause of chronic obstructive pulmonary disease (COPD), a substantial proportion of COPD cases cannot be explained by smoking alone.Objectives: To evaluate the risk factors for COPD besides personal cigarette smoking.Methods: We constituted an ad hoc subcommittee of the American Thoracic Society Environmental and Occupational Health Assembly. An international group of members was invited, based on their scientific expertise in a specific risk factor for COPD. For each risk factor area, the committee reviewed the literature, summarized the evidence, and developed conclusions about the likelihood of it causing COPD. All conclusions were based on unanimous consensus.Measurements and Main Results: The population-attributable fraction for smoking as a cause of COPD ranged from 9.7 to 97.9%, but was less than 80% in most studies, indicating a substantial burden of disease attributable to nonsmoking risk factors. On the basis of our review, we concluded that specific genetic syndromes and occupational exposures were causally related to the development of COPD. Traffic and other outdoor pollution, secondhand smoke, biomass smoke, and dietary factors are associated with COPD, but sufficient criteria for causation were not met. Chronic asthma and tuberculosis are associated with irreversible loss of lung function, but there remains uncertainty about whether there are important phenotypic differences compared with COPD as it is typically encountered in clinical settings.Conclusions: In public health terms, a substantive burden of COPD is attributable to risk factors other than smoking. To prevent COPD-related disability and mortality, efforts must focus on prevention and cessation of exposure to smoking and these other, less well-recognized risk factors.