Changes in Forced Expiratory Volume in 1 Second over Time in COPD
Changes in Forced Expiratory Volume in 1 Second over Time in COPD
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DOI：
10.1056/nejmoa1105482
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发表时间：
2011-09-29
影响因子：
158.5
通讯作者：
Rennard, Stephen I.
中科院分区：
文献类型：
--
作者：
Vestbo, Jorgen;Edwards, Lisa D.;Rennard, Stephen I.
慢性阻塞性肺疾病（COPD）的主要特征是1秒用力呼气容积（FEV（1））下降速度加快，但已确定疾病的患者中这种变化的变异性和决定因素的数据是稀缺的。一个随机系数模型被用来评估两个FEV 1水平及其随时间变化的可能预测因子。FEV 1的平均（+/- SE）变化率是每年下降33 +/- 2 ml，在研究的患者中有显著差异。下降率的患者间标准差为每年59 ml。在3年的研究期间，38%的患者的FEV 1估计每年下降超过40 ml，31%的患者每年下降21 - 40 ml，23%的患者的FEV 1变化范围从每年下降20 ml到每年增加20 ml，8%的患者每年增加超过20 ml。目前吸烟者的FEV 1平均下降率比目前不吸烟者高21 +/- 4 ml/年，肺气肿患者的FEV 1平均下降率比不吸烟者高13 +/- 4 ml/年，17 +/-支气管扩张剂可逆性患者的FEV 1变化率比不可逆性患者高4 ml/年。可变，在当前吸烟者、支气管扩张剂可逆性患者和肺气肿患者中下降率增加。（由GlaxoSmithKline资助; ECLIPSE-ClinicalTrials.gov编号，NCT 00292552。
BACKGROUNDA key feature of chronic obstructive pulmonary disease (COPD) is an accelerated rate of decline in forced expiratory volume in 1 second (FEV(1)), but data on the variability and determinants of this change in patients who have established disease are scarce.METHODSWe analyzed the changes in FEV1 after administration of a bronchodilator over a 3-year period in 2163 patients. A random-coefficient model was used to evaluate possible predictors of both FEV1 levels and their changes over time.RESULTSThe mean (+/- SE) rate of change in FEV1 was a decline of 33 +/- 2 ml per year, with significant variation among the patients studied. The between-patient standard deviation for the rate of decline was 59 ml per year. Over the 3-year study period, 38% of patients had an estimated decline in FEV1 of more than 40 ml per year, 31% had a decline of 21 to 40 ml per year, 23% had a change in FEV1 that ranged from a decrease of 20 ml per year to an increase of 20 ml per year, and 8% had an increase of more than 20 ml per year. The mean rate of decline in FEV1 was 21 +/- 4 ml per year greater in current smokers than in current nonsmokers, 13 +/- 4 ml per year greater in patients with emphysema than in those without emphysema, and 17 +/- 4 ml per year greater in patients with bronchodilator reversibility than in those without reversibility.CONCLUSIONSThe rate of change in FEV1 among patients with COPD is highly variable, with increased rates of decline among current smokers, patients with bronchodilator reversibility, and patients with emphysema. (Funded by GlaxoSmithKline; ECLIPSE-ClinicalTrials.gov number, NCT00292552.)