Fixed Ratio Versus Lower Limit of Normal: Health Status and Risk Factors for COPD Overdiagnosis
Fixed Ratio Versus Lower Limit of Normal: Health Status and Risk Factors for COPD Overdiagnosis
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固定比率与正常下限：健康状况和慢性阻塞性肺病过度诊断的危险因素
DOI：
10.4187/respcare.07069
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发表时间：
2020-05-01
期刊：
影响因子：
2.5
通讯作者：
Mo, Biwen
中科院分区：
文献类型：
--
作者：
Ma, Libing;Jiang, Ming;Mo, Biwen
背景技术背景：对于COPD的诊断，肺功能正常范围下限的阈值已被建议为比0.7固定比率（FEV 1/FVC < 0.7）更准确。本研究旨在探讨以正常范围下限作为诊断参考时，过度诊断COPD患者的健康状况及危险因素。方法：从2016年10月至2018年4月招募了由肺病专家根据慢性阻塞性肺疾病全球倡议指南诊断的COPD受试者。过度诊断COPD定义为FEV 1/FVC符合0.7固定比值标准，但不符合正常范围标准的下限。由合格受试者进行肺量测定和问卷调查。研究结果：在最终分析纳入的513例受试者中，当使用正常范围下限作为诊断参考时，20例（3.9%）被过度诊断。过度诊断的受试者年龄较大，体重较重，肺功能较好，改良英国医学研究理事会评分较低，圣乔治呼吸问卷和36项简表调查评分高于正确诊断的受试者。年龄较大、体重较重、暴露于烹饪油烟、或新建或新装修的房屋与COPD过度诊断的风险增加有关（年龄校正比值比（OR）1.17，95% CI 1.09-1.26;体重校正OR 1.08，95% CI 1.03-1.13;暴露于烹饪油烟调整OR 3.00，95%CI，1.04-8.68;暴露于新建或新装修的家庭调整OR 10.88，95%CI 1.46-80.87。结论：过度诊断COPD患者的健康状况和肺功能优于正确诊断的COPD患者。年龄较大，体重较重，暴露于烹饪油烟或新建或新装修的房屋是与COPD过度诊断相关的因素。这些发现可能有助于减少COPD的过度诊断。
BACKGROUND: The threshold of the lower limit of the normal range of lung function has been suggested to be more accurate than the 0.7 fixed ratio (FEV1/FVC < 0.7) for a diagnosis of COPD. We aimed to explore the health status and risk factors of patients overdiagnosed with COPD when using the lower limit of the normal range as a diagnostic reference. METHODS: Subjects with COPD diagnosed by a pulmonologist according to guidelines of the Global Initiative for Chronic Obstructive Lung Disease were recruited from October 2016 to April 2018. Overdiagnosed COPD was defined as FEV1/FVC that meets the criterion of the 0.7 fixed ratio but not the the lower limit of the normal range criterion. Spirometry and questionnaires were performed by eligible subjects. RESULTS: Of the 513 subjects included in the final analysis, 20 (3.9%) were overdiagnosed when using the lower limit of the normal range as the diagnostic reference. The subjects who were overdiagnosed were older, weighed more, had better lung function, lower modified Medical British Research Council scores, and higher St. George's Respiratory Questionnaire and 36-item Short Form Survey scores than the subjects who were correctly diagnosed. Older age, heavier weight, exposure to cooking oil fumes, or a new-built or newly renovated home were associated with an increased risk of overdiagnosis of COPD (age adjusted odds ratio (OR) 1.17, 95% CI 1.09-1.26; weight adjusted OR 1.08, 95% CI 1.03-1.13; exposure to cooking oil fumes adjusted OR 3.00, 95% CI, 1.04-8.68; exposure to new-built or newly renovated home adjusted OR 10.88, 95% CI 1.46-80.87. CONCLUSIONS: The subjects with overdiagnosed COPD had a better health status and lung function than the subjects who were correctly diagnosed. Older age, heavier weight, and exposure to cooking oil fumes or a new-built or newly renovated home were factors associated with the overdiagnosis of COPD. These findings may help reduce overdiagnosis of COPD.