Long-term decline in lung function, utilisation of care and quality of life in modified GOLD stage 1 COPD
Long-term decline in lung function, utilisation of care and quality of life in modified GOLD stage 1 COPD
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DOI：
10.1136/thx.2007.093724
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发表时间：
2008-09-01
期刊：
影响因子：
10
通讯作者：
Rochat, T.
中科院分区：
文献类型：
--
作者：
Bridevaux, P-O;Gerbase, M. W.;Rochat, T.
背景：全球慢性阻塞性肺疾病倡议（GOLD）定义的轻度慢性阻塞性肺疾病（COPD）患者的长期预后知之甚少。方法：随机选择6671名无哮喘的成年人，将其按gold定义的COPD（支气管扩张剂前肺活量测定法）进行分层。进一步分层是基于有无呼吸道症状。11年后，在控制年龄、性别、吸烟和教育程度后，通过SF-36问卷测量COPD基线类别与15秒用力呼气量（FEV1）下降、呼吸保健利用和生活质量之间的关系。结果：基线时，610名（9.1%）参与者符合修改后的GOLD标准，其中519名（85.1%）为1期COPD。在随访中，有症状的1期COPD患者（n=224）的FEV1下降更快（-9 ml/年（95% CI -13至-5）），呼吸护理利用率增加（OR 1.6 (95% CI 1.0至2.6)），生活质量低于肺功能正常的无症状受试者（n=3627，参照组）。相比之下，与对照组相比，无症状1期COPD患者（n=295）在FEV1下降（-3 ml/年（95% CI -7至+1））、呼吸保健利用（OR 1.05 (95% CI 0.63至1.73)）或生活质量评分方面无显著差异。结论：在基于人群的研究中，呼吸道症状对于预测轻度阻塞性肺疾病患者的长期临床结果具有重要意义。仅基于肺活量测定的人群研究可能会错误估计临床相关COPD的患病率。
Background: Little is known about the long-term outcomes of individuals with mild chronic obstructive pulmonary disease ( COPD) as defined by the Global Initiative for Chronic Obstructive Lung Disease ( GOLD).Methods: A population cohort of 6671 randomly selected adults without asthma was stratified into categories of modified GOLD-defined COPD (prebronchodilator spirometry). Further stratification was based on the presence or absence of respiratory symptoms. After 11 years, associations between baseline categories of COPD and decline in forced expiratory volume in 1 s (FEV1), respiratory care utilisation and quality of life as measured by the SF-36 questionnaire were examined after controlling for age, sex, smoking and educational status.Results: At baseline, modified GOLD criteria were met by 610 (9.1%) participants, 519 (85.1%) of whom had stage 1 COPD. At follow-up, individuals with symptomatic stage 1 COPD (n=224) had a faster decline in FEV1 (-9 ml/year (95% CI -13 to -5)), increased respiratory care utilisation (OR 1.6 (95% CI 1.0 to 2.6)) and a lower quality of life than asymptomatic subjects with normal lung function (n=3627, reference group). In contrast, individuals with asymptomatic stage 1 COPD (n=295) had no significant differences in FEV1 decline (-3 ml/year (95% CI -7 to +1)), respiratory care utilisation (OR 1.05 (95% CI 0.63 to 1.73)) or quality of life scores compared with the reference group.Conclusions: In population-based studies, respiratory symptoms are of major importance for predicting long-term clinical outcomes in subjects with COPD with mild obstruction. Population studies based on spirometry only may misestimate the prevalence of clinically relevant COPD.