Reversible and irreversible airflow obstruction as predictor of overall mortality in asthma and chronic obstructive pulmonary disease
Reversible and irreversible airflow obstruction as predictor of overall mortality in asthma and chronic obstructive pulmonary disease
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DOI：
10.1164/ajrccm.159.4.9807121
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发表时间：
1999-04-01
影响因子：
24.7
通讯作者：
Dirksen, A
中科院分区：
文献类型：
--
作者：
Hansen, EF;Phanareth, K;Dirksen, A
可逆性气流阻塞对哮喘和慢性阻塞性肺疾病(COPD)预后的重要性尚不清楚。我们测试了这样一种假设，即对皮质类固醇和支气管扩张剂的可逆性不是预后的独立预测因素，而只是反映最大可达到肺功能的一个组成部分，这是最好的肺活量预测因素。在为期6年的时间里(1983-1988)，1586名哮喘或COPD患者在哥本哈根的一家胸科诊所接受了标准化的支气管扩张剂和皮质类固醇可逆性试验。1997年9月获得生命垂危状态。死亡率与年龄、性别、吸烟、FEV1和可逆性之间的关系通过COX比例风险分析进行检验。在1586名受试者中，850人在1997年9月之前死亡。年龄、吸烟和FEV1是死亡率的显著预测因素。在控制了基线FEV1后，支气管扩张剂和皮质类固醇可逆性与较好的存活率显著相关。然而，在控制最佳FEV1之后，所有可逆性都变得不显著和不可预测。在生存分析中联合使用皮质类固醇和支气管扩张剂的可逆性是一种新的方法，我们已经证明，这两种药物在一定程度上都有助于预测生存，因为它们改变了FEV1。然而，可逆性本身并不影响中到重度哮喘或COPD患者的存活率。
The importance of reversible airflow obstruction to the prognosis of asthma and chronic obstructive pulmonary disease (COPD) is not clear. We tested the hypothesis that reversibility to corticosteroid and bronchodilator is not an independent predictor of prognosis, but merely reflects a component of the maximal attainable lung function, which is the best spirometric predictor of survival. During a 6-yr period (1983-1988), 1,586 subjects with asthma or COPD underwent standardized bronchodilator and corticosteroid reversibility tests at a chest clinic in Copenhagen. The vital status was obtained by September 1997. The relationship between mortality and age, gender, smoking, FEV1, and reversibilities was examined by Cox proportional hazards analyses. Of 1,586 subjects, 850 had died before September 1997. Age, smoking, and FEV1 were significant predictors of mortality. After controlling for baseline FEV1, bronchodilator and corticosteroid reversibility were significantly associated with better survival. However, after controlling for best FEV1 all reversibilities became nonsignificant and nonpredictive. The combined use of corticosteroid and bronchodilator reversibility in survival analyses is a novel approach, and we have shown that both contribute to survival prediction to the extent that they modify FEV1. However, reversibility per se does not influence survival in subjects with moderate to severe asthma or COPD.