Defining Impaired Respiratory Health A Paradigm Shift for Pulmonary Medicine
Defining Impaired Respiratory Health A Paradigm Shift for Pulmonary Medicine
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DOI：
10.1164/rccm.201801-0120pp
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发表时间：
2018-08-15
影响因子：
24.7
通讯作者：
Kalhan, Ravi
中科院分区：
文献类型：
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作者：
Reyfman, Paul A.;Washko, George R.;Kalhan, Ravi
呼吸系统社区通常将呼吸健康定义为没有明显的肺部疾病。这种过于简单化的定义限制了预防慢性肺部疾病的强有力方法的发展。相比之下，心血管学界富有成效地概念化了“理想的心血管健康”，这是一系列因素，包括几个直接沿着从健康到疾病转变的因果路径的因素，以防止心脏病的发展(1，2)。“理想健康”的基本概念意味着存在一个互补的“受损健康”概念，它是从健康到疾病的连续体中的中间点。沿着这一连续统一体考虑心血管健康有助于确定健康损失的风险因素，能够描述在临床实践中用作筛查工具的中间内型，如炎症加重和高胆固醇血症，并导致日益有效的预防措施的迅速扩展，以促进心血管健康的维持。心血管研究人员和临床医生已经利用这一概念框架为公共卫生政策提供信息，将预防纳入初级保健，并教育社区。近年来，除了吸烟和环境暴露外，人们还发现了几种可能导致肺部疾病的危险因素。然而，这些研究并不是在整个生命周期内进行的，这使得构建此类风险因素如何影响呼吸健康的时间表具有挑战性。此外，这些因素经常在以疾病为中心的研究中的“健康”对照受试者的背景下被识别(3-5)，或者使用集中于心血管疾病的队列研究中关于呼吸道症状、生理学和成像的有限信息(6-9)。例如，尽管弗雷明翰心脏研究代表了从三代受试者70多年的观察中收集的数据，但它不是作为呼吸系统队列研究设计的，也没有收集呼吸系统的详细表型信息(10)。确实存在的呼吸队列通常包括不超过10年的观察(11)。鉴于缺乏专门关注呼吸健康的生命历程研究，将一个人如何从理想的呼吸健康转变为呼吸健康受损的中间表型是一个挑战，因为它是慢性阻塞性肺疾病(COPD)或慢性阻塞性肺疾病(COPD)等慢性呼吸系统疾病的潜在先兆，尽管不是普遍的。
The respiratory community generally defines respiratory health as the absence of overt lung disease. This overly simplistic definition has limited the development of a robust approach to the prevention of chronic lung disease. In contrast, the cardiovascular community has productively conceptualized “ideal cardiovascular health,” a set of factors, including several directly along the causal pathway of transitions from health to disease, that protect against the development of cardiac disease (1, 2). The fundamental concept of “ideal health” suggests the existence of a complementary concept of “impaired health” that is an intermediate point on the continuum from health to disease. Considering cardiovascular health along such a continuum has facilitated identification of risk factors for loss of health, has enabled delineation of intermediate endotypes such as heightened inflammation and hypercholesterolemia that are deployed in clinical practice as screening tools, and has led to a rapid expansion of increasingly effective preventive measures to promote maintenance of cardiovascular health. Cardiovascular researchers and clinicians have used this conceptual framework to inform public health policy, integrate prevention into primary care, and educate communities. In recent years, several potential risk factors for developing lung disease apart from smoking and environmental exposures have been identified. These investigations, however, have not been longitudinal across the lifespan, making it challenging to construct a timeline for how such risk factors influence respiratory health. Furthermore, these factors have frequently been identified either in the context of “healthy” control subjects in diseasefocused studies (3–5) or using limited information about respiratory symptoms, physiology, and imaging derived from cohort studies focused on cardiovascular conditions (6–9). Although the Framingham Heart Study, for example, represents data collected from three generations of subjects followed over 70 years of observation, it was not designed as a respiratory cohort study and did not collect detailed phenotypic information for the respiratory system (10). The respiratory cohorts that do exist typically encompass no more than 10 years of observation (11).Given the absence of life-course studies focused exclusively on respiratory health, it is a challenge to conceptualize how an individual might transition from ideal respiratory health to an intermediate phenotype of impaired respiratory health as a potential, albeit not universal, precursor to chronic respiratory disease such as chronic obstructive pulmonary disease (COPD) or