"Defining Chronic Obstructive Pulmonary Disease in Older Persons"

“老年人慢性阻塞性肺疾病的定义”

• 批准号: 8041017
• 负责人: Carlos A. Vaz Fragoso
• 金额: $ 6.52万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-04-01 至 2013-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8041017
• 关键词: Abbreviations; Accounting; Address; Adrenergic beta-Antagonists; Adverse event; Affect; Age; Aging; American; Angiotensin-Converting Enzyme Inhibitors; Body Composition; Bone Density; Bronchodilator Agents; Cardiovascular system; Caring; Cessation of life; Chest; Chronic; Chronic Obstructive Airway Disease; Clinical; Data; Diabetes Mellitus; Diagnosis; Echocardiography; Elderly; European; Female; Frequencies; Gender; Goals; Guidelines; Health; Hospitalization; Individual; Integration Host Factors; Lead; Left Ventricular Ejection Fraction; Longevity; Measures; Mediator of activation protein; Mental Depression; Methods; National Health and Nutrition Examination Survey; Obstructive Lung Diseases; Outcome; Patient Care; Patients; Performance; Persons; Pharmaceutical Preparations; Pharmacotherapy; Population; Prevalence; Prospective Studies; Pulmonary Function Test/Forced Expiratory Volume 1; Relative (related person); Reporting; Research; Residual state; Risk; Risk Factors; Severities; Smoking; Smoking Status; Societies; Spirometry; Staging; Symptoms; United States National Institutes of Health; Validation; Vital capacity; World Health Organization; adverse outcome; aged; base; clinical practice; clinically relevant; cohort; community living; disability; evidence base; follow-up; health care service utilization; improved; mortality; population based; public health relevance; pulmonary function; respiratory; response; standardize guidelines

DESCRIPTION (provided by applicant): As a leading cause of disability and death worldwide, chronic obstructive pulmonary disease (COPD) is defined spirometrically, based solely on a reduced ratio of the forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC), with severity subsequently staged according to the FEV1, expressed as percent predicted (%Pred). Among older persons, current spirometric guidelines for COPD are problematic, however, for at least three reasons. First, the threshold that establishes a reduced FEV1/FVC remains controversial. Second, expressing the FEV1 as %Pred is seriously flawed, because it does not account for differences in the variability of the reference group across the lifespan. Third, current spirometric guidelines have not been rigorously validated using important clinical measures such as mortality and respiratory symptoms. In response, we have developed a two-part spirometric strategy for defining COPD that first determines a cut-point for the FEV1/FVC based on mortality risk; and then, among persons below this critical FEV1/FVC threshold, determines cut-points for the FEV1, expressed as a standardized residual percentile (SR-tile)- and based on mortality risk and respiratory symptoms. Importantly, the SR-tile method accounts for variability of the reference group. The objective of this R03 application is to validate our spirometric definition of COPD, relative to current guidelines, by using data from two large population-based studies of older persons: the Health, Aging and Body Composition Study and the Cardiovascular Health Study. Validation will be based on longitudinal associations with health-related outcomes, including hospitalizations and mortality, and on cross-sectional associations with clinical features, including respiratory symptoms, physical performance, and medication use. Our long-term goal is to evaluate the risk and host factors, as well as the mediators, that underlie the association between pulmonary function and health-related outcomes, in older persons. This R03 application is an important step because it will validate an age-appropriate method for reporting pulmonary function and for defining COPD. PUBLIC HEALTH RELEVANCE: Among older persons, current spirometric guidelines may lead to misclassification (mainly over- diagnosis) of COPD and, in turn, potentially compromise patient care. We propose to validate a more evidence-based spirometric strategy that will avoid the misidentification of COPD among older persons. This could lead to more judicious use of COPD-specific pharmacotherapy and, as a result, reduce the frequency of medication-related adverse events.

描述（由申请人提供）：作为全球残疾和死亡的主要原因，慢性阻塞性肺疾病（COPD）的定义仅基于在1秒（FEV1）中强制呼气量的比率降低，而不是强制性生命能力（FVC），并根据fev1的严重程度（FEV1），根据fev1的严重程度，预期为百分比（预期）。但是，在老年人中，目前的COPD肺活量测定指南是有问题的，但至少有三个原因。首先，建立降低的FEV1/FVC的阈值仍然存在争议。其次，将FEV1表示为％pred存在严重缺陷，因为它不能解释整个寿命的参考组变异性的差异。第三，使用重要的临床措施（例如死亡率和呼吸系统症状），尚未严格验证当前的肺活量测定指南。作为响应，我们开发了一种两部分的肺活量测定策略来定义COPD，该策略首先根据死亡率风险确定FEV1/FVC的切点；然后，在此关键FEV1/FVC阈值以下的人中，确定了FEV1的切点，以标准的残留百分比（SR-TILE）表示，并基于死亡率风险和呼吸道症状。重要的是，SR-tile方法解释了参考组的可变性。该R03应用的目的是通过使用来自两项基于人群的大型老年人研究的数据来验证我们对COPD的肺活量测定定义：健康，衰老和身体成分研究和心血管健康研究。验证将基于与健康相关结果的纵向关联，包括住院和死亡率，以及具有临床特征的横断面关联，包括呼吸症状，身体性能和使用药物。我们的长期目标是评估老年人中肺功能和与健康相关的结果之间关联的基础的风险和宿主因素以及调解人。该R03应用是一个重要的步骤，因为它将验证适合年龄的方法来报告肺功能和定义COPD。 公共卫生相关性：在老年人中，当前的肺活量测定指南可能导致COPD的错误分类（主要是过度诊断），进而可能损害患者护理。我们建议验证一种更基于证据的肺活量测定策略，该策略将避免在老年人中对COPD的错误识别。这可能会导致对COPD特异性药物疗法的更明智地使用，因此，降低了与药物相关的不良事件的频率。

项目成果

Comment on: Wollmer P, Engström G. Fixed ratio or lower limit of normal (LLN) as cut-off value for FEV1/VC: An outcome study. Respiratory Medicine (2013) 107, 1460-1462.: Fixed ratio or lower limit of normal (LLN) as cut-off value for FEV1/VC.

评论：Wollmer P、Engström G。固定比率或正常下限 (LLN) 作为 FEV1/VC 的截止值：一项结果研究。

• DOI: 10.1016/j.rmed.2013.09.024
• 发表时间: 2015
• 期刊: Respiratory medicine
• 影响因子: 4.3
• 作者: VazFragoso,CarlosA;Pretto,JeffreyJ;Quanjer,PhilipH
• 通讯作者: Quanjer,PhilipH

[Impact of pre-operative uric acid on acute kidney injury after cardiac surgery in elderly patients].

术前尿酸对老年患者心脏术后急性肾损伤的影响

• 发表时间: 2014
• 期刊: Zhonghua xin xue guan bing za zhi
• 作者: Xu,Jiaqi;Chen,Yuanhan;Liang,Xinling;Hu,Penghua;Cai,Lu;An,Shengli;Li,Zhilian;Shi,Wei
• 通讯作者: Shi,Wei