Predictive value of prebronchodilator and postbronchodilator spirometry for COPD features and outcomes.
Predictive value of prebronchodilator and postbronchodilator spirometry for COPD features and outcomes.
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DOI：
10.1136/bmjresp-2017-000213
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发表时间：
2017
影响因子：
4.1
通讯作者：
Comellas AP
中科院分区：
文献类型：
--
作者：
Fortis S;Eberlein M;Georgopoulos D;Comellas AP
我们比较了支气管扩张剂前和支气管扩张剂后肺活量测定对慢性阻塞性肺疾病（COPD）特征和预后的预测价值。我们分析了10192例有吸烟史的受试者的COPDGene数据。我们建立了包含以下因变量的回归模型：临床、功能和影像学特征，以及以下自变量：支气管扩张前气流阻塞（PREO）和支气管扩张后气流阻塞（POSTO），支气管扩张前和支气管扩张后FEV1%预测。我们使用赤池信息准则（Akaike information criterion， AIC）比较了模型的性能。使用PREO的COPD患病率更高。支气管扩张剂后肺活量测定（POSTN） （PREO-POSTN）中约8.5%有PREO但无气流阻塞，3%的受试者在支气管扩张剂前肺活量测定（PREN）中无气流阻塞但有postto （PREN- postto）。我们发现PREO-POSTN和pren - postto受试者的COPD特征和结局没有差异。虽然，支气管扩张剂前和支气管扩张剂后的肺活量测定都与慢性支气管炎、呼吸困难、运动能力和COPD影像学表现相关，但包括支气管扩张剂后肺活量测定的模型在预测这些COPD特征方面优于使用支气管扩张剂前测量的模型。支气管扩张剂前和支气管扩张剂后肺活量测定对呼吸恶化、1 s内用力呼气量变化、5年期间呼吸困难和运动能力的预测价值相对相似，但支气管扩张剂后肺活量测定能更好地预测基于AIC的死亡率。支气管扩张剂后肺活量测定可能是COPD特征和预后更准确的预测指标。
We compared the predictive value of prebronchodilator and postbronchodilator spirometry for chronic obstructive pulmonary disease (COPD) features and outcomes. We analysed COPDGene data of 10 192 subjects with smoking history. We created regressions models with the following dependent variables: clinical, functional and radiographic features, and the following independent variables: prebronchodilator airflow obstruction (PREO) and postbronchodilator airflow obstruction (POSTO), prebronchodilator and postbronchodilator FEV1% predicted. We compared the model performance using the Akaike information criterion (AIC). The COPD prevalence was higher using PREO. About 8.5% had PREO but no airflow obstruction in postbronchodilator spirometry (POSTN) (PREO-POSTN) and 3% of all subjects had no aiflow obstruction in prebronchodilator spirometry (PREN) but POSTO (PREN-POSTO). We found no difference in COPD features and outcomes between PREO-POSTN and PREN-POSTO subjects. Although, both prebronchodilator and postbronchodilator spirometries are both associated with chronic bronchitis, dyspnoea, exercise capacity and COPD radiographic findings, models that included postbronchodilator spirometric measures performed better than models with prebronchodilator measures to predict these COPD features. The predictive value of prebronchodilator and postbronchodilator spirometries for respiratory exacerbations, change in forced expiratory volume in 1 s, dyspnoea and exercise capacity during a 5-year period is relatively similar, but postbronchodilator spirometric measures are better predictors of mortality based on AIC. Postbronchodilator spirometry may be a more accurate predictor of COPD features and outcomes.