Isolated small airways obstruction predicts future chronic airflow obstruction: a multinational longitudinal study.
Isolated small airways obstruction predicts future chronic airflow obstruction: a multinational longitudinal study.
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DOI：
10.1136/bmjresp-2023-002056
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发表时间：
2023-11
影响因子：
4.1
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慢性气流阻塞是慢性阻塞性肺疾病的一个重要特征。我们调查了孤立性小气道阻塞是否与生命后期的慢性气流阻塞有关。我们使用了来自多国阻塞性肺病负担研究的3957名参与者的纵向数据。我们使用支气管前扩张器定义孤立性小气道阻塞，如果在1秒与肺活量之比（FEV1/FVC）正常的情况下，结果低于正常下限（<LLN），则平均用力呼气流量在用力肺活量（FVC）的25%至75% （FEF25-75）之间。我们还使用3秒用力呼气量与FVC的比值（FEV3/FVC）来确定小气道阻塞。我们将慢性气流阻塞定义为支气管扩张剂后FEV1/FVC<LLN。我们进行了混合效应回归分析来模拟基线孤立性小气道阻塞和随访时慢性气流阻塞之间的关系。我们通过计算受试者工作曲线下面积（AUC）和Brier评分来评估鉴别和预测能力。我们在英国生物银行研究的26512名参与者中重复了我们的分析。中位随访时间为8.3年。基线时孤立性小气道阻塞的参与者更容易发生慢性气流阻塞（FEF25-75小于LLN， OR: 2.95, 95% CI 1.02至8.54；FEV3/FVC小于LLN， OR: 1.94, 95% CI 1.05至3.62）。FEF25-75优于FEV3/FVC比值（AUC: 0.764 vs 0.692）。在英国生物银行研究的参与者中，结果相似。小气道阻塞的测量可作为未来阻塞性肺疾病的早期标志。
Chronic airflow obstruction is a key characteristic of chronic obstructive pulmonary disease. We investigated whether isolated small airways obstruction is associated with chronic airflow obstruction later in life. We used longitudinal data from 3957 participants of the multinational Burden of Obstructive Lung Disease study. We defined isolated small airways obstruction using the prebronchodilator mean forced expiratory flow rate between 25% and 75% of the forced vital capacity (FVC) (FEF25–75) if a result was less than the lower limit of normal (<LLN) in the presence of a normal forced expiratory volume in 1 s to FVC ratio (FEV1/FVC). We also used the forced expiratory volume in 3 s to FVC ratio (FEV3/FVC) to define small airways obstruction. We defined chronic airflow obstruction as post-bronchodilator FEV1/FVC<LLN. We performed mixed effects regression analyses to model the association between baseline isolated small airways obstruction and chronic airflow obstruction at follow-up. We assessed discriminative and predictive ability by calculating the area under the receiver operating curve (AUC) and Brier score. We replicated our analyses in 26 512 participants of the UK Biobank study. Median follow-up time was 8.3 years. Chronic airflow obstruction was more likely to develop in participants with isolated small airways obstruction at baseline (FEF25-75 less than the LLN, OR: 2.95, 95% CI 1.02 to 8.54; FEV3/FVC less than the LLN, OR: 1.94, 95% CI 1.05 to 3.62). FEF25-75 was better than the FEV3/FVC ratio to discriminate future chronic airflow obstruction (AUC: 0.764 vs 0.692). Results were similar among participants of the UK Biobank study. Measurements of small airways obstruction can be used as early markers of future obstructive lung disease.