Cohort Profile: The Birmingham Chronic Obstructive Pulmonary Disease (COPD) Cohort Study
Cohort Profile: The Birmingham Chronic Obstructive Pulmonary Disease (COPD) Cohort Study
复制标题
队列概况：伯明翰慢性阻塞性肺疾病 (COPD) 队列研究
DOI：
10.1093/ije/dyv350
复制
发表时间：
2017-02-01
影响因子：
7.7
通讯作者：
Jordan, R. E.
中科院分区：
文献类型：
--
作者：
Adab, P.;Fitzmaurice, D. A.;Jordan, R. E.
慢性阻塞性肺疾病（COPD）影响全球5-10%的人，1患病率正在上升2，是第三大常见死因。3在美国（2010年价格4）和E48，COPD在医疗保健（主要是导致急诊入院的加重）和社会（主要是生产力损失）成本方面的年度负担估计约为499亿美元。40亿欧元（2011年价格5）。相当一部分COPD患者处于工作年龄，但有证据表明，与普通人群相比，他们的就业史较差，病假率较高6，工作表现较差（出勤率）8。关于COPD的自然史，以及哪些干预措施能有效改变早期疾病的病程，仍存在很大的不确定性。此外，在11-13号病例中，高达85%的病例未得到诊断，这意味着许多人的需求可能未得到满足。报告14-16强调了COPD的负担、诊断不足的程度和早期疾病预后的不确定性，专家审查强调需要进一步的纵向数据。然而，已建立的队列通常代表了更晚期疾病的二级护理患者，随访时间短，通常样本量小。17-19虽然大规模人群队列有时会解决与COPD相关的问题，但20-28结果测量和肺功能测试质量的局限性提供的数据不足以为COPD竞技场提供信息。重要的是，没有初级保健COPD队列的病例发现患者，很少有患者代表疾病的全部严重程度，特别是那些轻度至中度疾病和不同的社会经济组合。近年来，几项研究也关注了报告呼吸道症状但肺功能正常的患者[前慢性阻塞性肺疾病全球倡议（GOLD）严重程度029期]。进展为COPD的证据有限且相互矛盾23，30，31，评估症状的方法也不一致。23，32因此，关于该患者组的临床相关性和自然病史的证据也很少。需要更好地了解自然病史和预后因素，以促进协商，并为管理决策和卫生服务规划提供信息。现有的COPD预后指标（PI）主要集中在
Chronic obstructive pulmonary disease (COPD) affects 5–10% of people worldwide, 1 is rising in prevalence 2 and is the third most common cause of death. 3 The annual burden of COPD regarding healthcare (mainly exacerbations resulting in emergency admissions) and societal (predominantly lost productivity) costs was estimated to be around $49.9 billion in the USA (2010 prices 4) and E48. 4 billion in the EU (2011 prices 5). A substantial proportion of those with COPD are of working age, but there is some evidence that they have poorer employment history, 6 higher rate of sickness absence 7 and poorer work performance (presenteeism) 8 compared with the general population. There remains much uncertainty about the natural history of COPD 9, 10 and which interventions are effective in altering the course of early disease. Furthermore, up to 85% of cases 11–13 are undiagnosed, representing many with potentially unmet need. Partly in response to reports 14–16 highlighting the burden of COPD, extent of underdiagnosis and uncertainty about prognosis of early disease, expert reviews have highlighted a need for further longitudinal data. 9, 10 However, established cohorts usually represent secondary care patients with more advanced disease, with short duration of follow-up and, generally, small samples. 17–19 Although large population cohorts have sometimes addressed questions relevant to COPD, 20–28 limitations in outcome measures and quality of lung function testing provide insufficient data to inform the COPD arena. Importantly, there are no primary care COPD cohorts with case-found patients and few with patients representing the full range of disease severity, particularly those with mild to moderate disease and diverse socioeconomic mix. In recent years, several studies have also focused on patients reporting respiratory symptoms but who have normal lung function [former Global Initiative for chronic Obstructive Lung Disease (GOLD) severity stage 029]. The evidence on progression to COPD is limited and contradictory 23, 30, 31 and methods for assessing symptoms are inconsistent. 23, 32 Thus there is also a paucity of evidence on the clinical relevance and natural history for this patient group. Better understanding of natural history and prognostic factors is needed to facilitate consultations and to inform management decisions and health service planning. Existing COPD prognostic indices (PI) mainly focus on