Prevalence of abnormal spirometry in individuals with a smoking history and no known obstructive lung disease.
Prevalence of abnormal spirometry in individuals with a smoking history and no known obstructive lung disease.
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有吸烟史且无已知阻塞性肺病的个体肺活量测定异常的患病率。
DOI：
10.1016/j.rmed.2023.107126
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发表时间：
2023
影响因子：
4.3
通讯作者：
Hokanson,
中科院分区：
文献类型：
--
作者：
Tran,ThuonghienV;Kinney,GregoryL;Comellas,Alejandro;Hoth,KarinF;Baldomero,ArianneK;Mamary,AJames;Curtis,JeffreyL;Hanania,Nicola;Casaburi,Richard;Young,KendraA;Kim,Victor;Make,Barry;Wan,EmilyS;Diaz,AlejandroA;Hokanson,
前言最近的证据表明，未确诊的慢性阻塞性肺疾病（COPD）的患病率很高。这些个体有加重和延迟治疗的风险。我们分析了一个高危人群的患病率异常肺功能测定，以提供清晰到谁应该接受早期spirometry.MethodsWe分析数据从COPD基因研究。纳入吸烟≥10包-年的受试者。排除了自我报告或医生诊断为COPD、哮喘、慢性支气管炎、肺气肿和/或正在使用吸入器的个体。简约的多变量逻辑回归模型确定了与肺功能异常相关的因素，定义为气流阻塞（AFO）或保留比率受损肺功能。使用逐步向后变量消除过程（最小化Akaike信息标准（AIC））为最终模型选择变量。同样，在5年的随访期间，我们评估了与事件诊断的COPD.ResultsOf 5055人，1064（21%）未确诊的AFO的相关因素。年龄、包年、当前吸烟和急性支气管炎史与AFO相关，而体重指数、女性和黑人则呈负相关。在2800名5年随访的参与者中，532名（19%）被诊断为COPD。相关风险因素包括mMRC ≥2、慢性排痰性咳嗽、随访期间呼吸道疾病加重和肺功能测定异常。年龄呈负相关。ConclusionsThe患病率未确诊的COPD是高的高危人群。我们发现多种因素与未确诊的COPD和随访时的COPD诊断相关。这些结果可用于识别未确诊COPD的风险，以促进早期诊断和治疗。
IntroductionRecent evidence suggests a high prevalence of undiagnosed chronic obstructive pulmonary disease (COPD). These individuals are at risk of exacerbations and delayed treatment. We analyzed an at-risk population for the prevalence of abnormal spirometry to provide clarity into who should undergo early spirometry.MethodsWe analyzed data from the COPDGene study. Participants with ≥10 pack-years of smoking were included. Individuals with self-reported or physician-diagnosed COPD, asthma, chronic bronchitis, emphysema and/or were on inhalers were excluded. Parsimonious multivariable logistic regression models identified factors associated with abnormal spirometry, defined as either airflow obstruction (AFO) or preserved ratio impaired spirometry. Variables were selected for the final model using a stepwise backward variable elimination process which minimized Akaike information criterion (AIC). Similarly, during the 5-year follow-up period, we assessed factors associated with incident diagnosis of COPD.ResultsOf 5055 individuals, 1064 (21%) had undiagnosed AFO. Age, pack-years, current smoking and a history of acute bronchitis were associated with AFO while body mass index, female sex, and Black race were inversely associated. Among 2800 participants with 5-year follow-up, 532 (19%) had an incident diagnosis of COPD. Associated risk factors included mMRC ≥2, chronic productive cough, respiratory exacerbations during the follow-up period, and abnormal spirometry. Age was inversely associated.ConclusionsThe prevalence of undiagnosed COPD is high in at-risk populations. We found multiple factors associated with undiagnosed COPD and incident diagnosis of COPD at follow up. These results can be used to identify those at risk for undiagnosed COPD to facilitate earlier diagnosis and treatment.