Chronic obstructive pulmonary disease in older persons: A comparison of two spirometric definitions.
Chronic obstructive pulmonary disease in older persons: A comparison of two spirometric definitions.
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DOI：
10.1016/j.rmed.2009.10.030
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发表时间：
2010-08
影响因子：
4.3
通讯作者：
Gill, Thomas M.
中科院分区：
文献类型：
--
作者：
Fragoso, Carlos A. Vaz;Concato, John;McAvay, Gail;Van Ness, Peter H.;Rochester, Carolyn L.;Yaggi, H. Klar;Gill, Thomas M.
在老年人中，我们先前批准了慢性阻塞性肺疾病(COPD)的两步肺活量定义，要求1秒内用力呼气量与用力肺活量(FEV1/FVC)的比率低于0.70，FEV1低于标准化残留百分位数第5或第10个百分位数(“SR-TILE策略”)。评估SR-TILE策略的临床有效性，并与全球阻塞性肺病倡议(GOLD-COPD)发表的COPD当前定义在老年人中进行比较。我们评估了2480名年龄在65岁到80岁之间的人的国家数据。在单独的分析中，我们评估了与GOLD-COPD相关的SR-TRAIL策略与死亡率和呼吸道症状的相关性。按照惯例，GOLD-COPD仅由FEV1/FVC和.70定义，严重程度根据FEV1临界点80%和50%预测(%PRED)进行分期。在831名患有GOLD-COPD的参与者中，只有179人(21.5%)的死亡风险在同时患有FEV1和5thSR基因的人中增加；在同时患有FEV1和10thSR基因的人中，只有310人(37.4%)出现呼吸道症状的几率增加。相比之下，在FEV1为50-79%的PRED时，GOLD-COPD分别导致209名(66.4%)和77名(24.6%)参与者的错误分类(高估)，没有增加死亡风险或出现呼吸道症状的可能性。相对于SR-TILE策略，大多数患有GOLD-COPD的老年人既没有增加死亡风险，也没有增加出现呼吸道症状的可能性。这些结果引发了人们对GOLD指南在老年人中的临床有效性的担忧。
Among older persons, we previously endorsed a two-step spirometric definition of chronic obstructive pulmonary disease (COPD) that requires a ratio of forced expiratory volume in 1-second to forced vital capacity (FEV1/FVC) below .70, and an FEV1 below the 5th or 10th standardized-residual percentile (“SR-tile strategy”). To evaluate the clinical validity of an SR-tile strategy, compared to a current definition of COPD, as published by the Global Initiative for Obstructive Lung Disease (GOLD-COPD), in older persons. We assessed national data from 2,480 persons aged 65-to-80 years. In separate analyses, we evaluated the association of an SR-tile strategy with mortality and respiratory symptoms, relative to GOLD-COPD. As per convention, GOLD-COPD was defined solely by an FEV1/FVC<.70, with severity staged according to FEV1 cut-points at 80 and 50 percent-predicted (%Pred). Among 831 participants with GOLD-COPD, the risk of death was elevated only in 179 (21.5%) of those who also had an FEV1 <5thSR-tile; and the odds of having respiratory symptoms was elevated only in 310 (37.4%) of those who also had an FEV1 <10thSR-tile. In contrast, GOLD-COPD staged at an FEV1 50-79%Pred led to misclassification (overestimation) in terms of 209 (66.4%) and 77 (24.6%) participants, respectively, not having an increased risk of death or likelihood of respiratory symptoms. Relative to an SR-tile strategy, the majority of older persons with GOLD-COPD had neither an increased risk of death nor an increased likelihood of respiratory symptoms. These results raise concerns about the clinical validity of GOLD guidelines in older persons.
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