Clinical Significance of Symptoms in Smokers with Preserved Pulmonary Function.
Clinical Significance of Symptoms in Smokers with Preserved Pulmonary Function.
复制标题
DOI：
10.1056/nejmoa1505971
复制
发表时间：
2016-05-12
期刊：
影响因子：
--
通讯作者：
SPIROMICS Research Group
中科院分区：
文献类型：
--
作者：
Woodruff PG;Barr RG;Bleecker E;Christenson SA;Couper D;Curtis JL;Gouskova NA;Hansel NN;Hoffman EA;Kanner RE;Kleerup E;Lazarus SC;Martinez FJ;Paine R 3rd;Rennard S;Tashkin DP;Han MK;SPIROMICS Research Group
目前，慢性阻塞性肺疾病(COPD)的诊断需要1秒用力呼气量(FEV1)与用力肺活量(FVC)的比率小于0.70，这是通过使用支气管扩张剂后的肺活量测定来评估的。然而，许多不符合这一定义的吸烟者都有呼吸道症状。我们进行了一项观察性研究，涉及2736名从未吸烟的现任或前任吸烟者和对照组，并使用COPD评估测试(CAT；分数从0到40，分数越高表示症状越严重)测量他们的呼吸道症状。我们研究了吸烟者是否与现在或既往吸烟者相比，呼吸恶化的风险更高，这些吸烟者目前或曾经吸烟者有无症状(CAT评分，≥10)，以及有症状的吸烟者在6分钟步行距离、肺功能或胸部高分辨率计算机断层扫描方面与无症状组相比是否有不同的发现。50%的现吸烟者或曾经吸烟者出现呼吸道症状，但肺功能未受影响。有症状的吸烟者的平均呼吸恶化(±SD)率显著高于无症状的吸烟者和从不吸烟的对照组(分别为0.001.2 7±0.6 7和0.0 8±0.31和0.0 3±0.2 1，P<；两种比较均为0.0 2 7±0.2 1)。HRCT显示，与无症状的现任或既往吸烟者相比，有症状的现任或既往吸烟者与无症状的现任或既往吸烟者相比，活动受限程度更大，FEV1、FVC和吸气量略低，无肺气肿的气道壁增厚更大。在有症状的现在或以前吸烟者中，42%使用支气管扩张剂，23%使用吸入性糖皮质激素。尽管他们不符合目前的COPD标准，但有症状的现在或以前吸烟者的肺功能得到保护，他们的病情恶化，活动受限，并有呼吸道疾病的证据。他们目前在没有任何证据的情况下使用一系列呼吸系统药物。(由国家心肺血液研究所和国家卫生研究院基金会资助；SPIROMICS ClinicalTrials.gov编号，NCT01969344。)
Currently, the diagnosis of chronic obstructive pulmonary disease (COPD) requires a ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) of less than 0.70 as assessed by spirometry after bronchodilator use. However, many smokers who do not meet this definition have respiratory symptoms. We conducted an observational study involving 2736 current or former smokers and controls who had never smoked and measured their respiratory symptoms using the COPD Assessment Test (CAT; scores range from 0 to 40, with higher scores indicating greater severity of symptoms). We examined whether current or former smokers who had preserved pulmonary function as assessed by spirometry (FEV1:FVC ≥0.70 and an FVC above the lower limit of the normal range after bronchodilator use) and had symptoms (CAT score, ≥10) had a higher risk of respiratory exacerbations than current or former smokers with preserved pulmonary function who were asymptomatic (CAT score, <10) and whether those with symptoms had different findings from the asymptomatic group with respect to the 6-minute walk distance, lung function, or high-resolution computed tomographic (HRCT) scan of the chest. Respiratory symptoms were present in 50% of current or former smokers with preserved pulmonary function. The mean (±SD) rate of respiratory exacerbations among symptomatic current or former smokers was significantly higher than the rates among asymptomatic current or former smokers and among controls who never smoked (0.27± 0.67 vs. 0.08±0.31 and 0.03±0.21 events, respectively, per year; P<0.001 for both comparisons). Symptomatic current or former smokers, regardless of history of asthma, also had greater limitation of activity, slightly lower FEV1, FVC, and inspiratory capacity, and greater airway-wall thickening without emphysema according to HRCT than did asymptomatic current or former smokers. Among symptomatic current or former smokers, 42% used bronchodilators and 23% used inhaled glucocorticoids. Although they do not meet the current criteria for COPD, symptomatic current or former smokers with preserved pulmonary function have exacerbations, activity limitation, and evidence of airway disease. They currently use a range of respiratory medications without any evidence base. (Funded by the National Heart, Lung, and Blood Institute and the Foundation for the National Institutes of Health; SPIROMICS ClinicalTrials.gov number, NCT01969344.)