Clinical and Radiologic Disease in Smokers With Normal Spirometry.
Clinical and Radiologic Disease in Smokers With Normal Spirometry.
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DOI：
10.1001/jamainternmed.2015.2735
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发表时间：
2015-09
影响因子：
39
通讯作者：
Genetic Epidemiology of COPD (COPDGene) Investigators
中科院分区：
文献类型：
--
作者：
Regan EA;Lynch DA;Curran-Everett D;Curtis JL;Austin JH;Grenier PA;Kauczor HU;Bailey WC;DeMeo DL;Casaburi RH;Friedman P;Van Beek EJ;Hokanson JE;Bowler RP;Beaty TH;Washko GR;Han MK;Kim V;Kim SS;Yagihashi K;Washington L;McEvoy CE;Tanner C;Mannino DM;Make BJ;Silverman EK;Crapo JD;Genetic Epidemiology of COPD (COPDGene) Investigators
肺活量测定中的气流阻塞普遍用于定义慢性阻塞性肺病 (COPD)，当前或既往吸烟者如果没有气流阻塞，可能会认为自己没有疾病。为了在一组不符合 COPD 肺量测定标准的当前和既往吸烟者中确定吸烟相关疾病的临床和放射学证据，我们对他们采用了全球阻塞性肺疾病倡议 (GOLD) 0 的废弃标签。COPD 遗传流行病学 (COPDGene) 横断面观察研究的个体完成了肺量测定、胸部计算机断层扫描 (CT) 扫描、6 分钟步行和问卷调查。参与者是从美国 21 个地点的当地社区招募的。 COPDGene 研究中的 GOLD 0 组 (n = 4388)（呼气第一秒用力呼气量 [FEV1] 与用力肺活量的比率 >0.7 且 FEV1 ≥ 80% 预测值）与 GOLD 1 组 (n = 794)、COPD 组 (n = 3690) 和一组从不吸烟者 (n = 108) 进行比较。招募开始于2008年1月，结束于2011年7月。身体功能障碍、呼吸道症状、CT异常、呼吸系统药物的使用以及呼吸系统特定生活质量降低。 GOLD 0 组的 54.1%（4388 人中的 2375 人）发现一种或多种呼吸相关障碍。 GOLD 0 组的生活质量较差（平均 [SD] 圣乔治呼吸问卷总分，17.0 [18.0] 与从不吸烟者的 3.8 [6.8]；P < .001）和较低的 6 分钟步行距离，并且 GOLD 0 组的 42.3%（300 人中的 127 人）有肺气肿或气道增厚的 CT 证据。 GOLD 0 组的 FEV1 百分比预测分布和平均值较低，但仍处于人群的正常范围内。目前吸烟与更多的呼吸道症状有关，但以前吸烟的人有更严重的肺气肿和气体滞留。年龄的增长与戒烟和更多的疾病 CT 表现有关。患有呼吸系统疾病的人更有可能使用呼吸系统药物，而使用这些药物会导致病情恶化。肺部疾病和损伤在没有肺量测定慢性阻塞性肺病的吸烟者中很常见。根据这些结果，我们预计美国有 3500 万年龄超过 55 岁的当前和曾经吸烟者可能患有未被识别的疾病或损伤。单独使用肺活量测定法时，长期吸烟对肺部和个人的影响被大大低估。
Airflow obstruction on spirometry is universally used to define chronic obstructive pulmonary disease (COPD), and current or former smokers without airflow obstruction may assume that they are disease free. To identify clinical and radiologic evidence of smoking-related disease in a cohort of current and former smokers who did not meet spirometric criteria for COPD, for whom we adopted the discarded label of Global Initiative for Obstructive Lung Disease (GOLD) 0. Individuals from the Genetic Epidemiology of COPD (COPDGene) cross-sectional observational study completed spirometry, chest computed tomography (CT) scans, a 6-minute walk, and questionnaires. Participants were recruited from local communities at 21 sites across the United States. The GOLD 0 group (n = 4388) (ratio of forced expiratory volume in the first second of expiration [FEV1] to forced vital capacity >0.7 and FEV1 ≥80% predicted) from the COPDGene study was compared with a GOLD 1 group (n = 794), COPD groups (n = 3690), and a group of never smokers (n = 108). Recruitment began in January 2008 and ended in July 2011. Physical function impairments, respiratory symptoms, CT abnormalities, use of respiratory medications, and reduced respiratory-specific quality of life. One or more respiratory-related impairments were found in 54.1% (2375 of 4388) of the GOLD 0 group. The GOLD 0 group had worse quality of life (mean [SD] St George’s Respiratory Questionnaire total score, 17.0 [18.0] vs 3.8 [6.8] for the never smokers; P < .001) and a lower 6-minute walk distance, and 42.3% (127 of 300) of the GOLD 0 group had CT evidence of emphysema or airway thickening. The FEV1 percent predicted distribution and mean for the GOLD 0 group were lower but still within the normal range for the population. Current smoking was associated with more respiratory symptoms, but former smokers had greater emphysema and gas trapping. Advancing age was associated with smoking cessation and with more CT findings of disease. Individuals with respiratory impairments were more likely to use respiratory medications, and the use of these medications was associated with worse disease. Lung disease and impairments were common in smokers without spirometric COPD. Based on these results, we project that there are 35 million current and former smokers older than 55 years in the United States who may have unrecognized disease or impairment. The effect of chronic smoking on the lungs and the individual is substantially underestimated when using spirometry alone.