Difficulties identifying and targeting COPD and population-attributable risk of smoking for COPD: a population study.
Difficulties identifying and targeting COPD and population-attributable risk of smoking for COPD: a population study.
复制标题
识别和针对慢性阻塞性肺病以及慢性阻塞性肺病的人群吸烟风险的困难：一项人群研究。
DOI：
10.1378/chest.128.4.2035
复制
发表时间：
2005
期刊：
影响因子：
9.6
通讯作者：
R. Ruffin
中科院分区：
文献类型：
--
作者：
David H. Wilson;R. Adams;S. Appleton;R. Ruffin
研究目的
呼吸道公共卫生干预措施取决于对目标群体的准确识别，但这可能因所使用的诊断标准而异。因此，我们比较了各种国际标准在识别COPD病例方面的相对性能。吸烟导致的COPD负担只能通过人群归因风险（PAR）研究确定。这些研究在COPD文献中缺乏，是支持COPD公共卫生倡议的必要研究。在这项代表性人群研究中，我们还评估了当前和既往吸烟者的PAR。
设计
一项由2，501名年龄≥ 18岁的南澳大利亚人组成的代表性生物医学人群样本（西北阿德莱德健康[队列]研究）。根据国际呼吸系统权威机构推荐的各种FEV 1/FVC和FEV 1占预计值的百分比来确定COPD的诊断和严重程度。通过电话访谈和自填问卷获得人口学、健康行为和生活质量数据。
设置
阿德莱德西北部。
测量和结果
吸烟（吸烟者和戒烟者）对COPD的PAR范围为51%至70%，取决于所使用的诊断呼吸标准。COPD患病率根据使用的标准而变化：美国胸科学会，5.4%;英国胸科学会，3.5%;欧洲呼吸学会（ERS），5.0%;慢性阻塞性肺疾病全球倡议，5.4%。在查明的案件中也存在重大分歧。另一种方法使用ERS参考值，从平均值中减去一个残差SD，得出COPD患病率估计值为6.9%，与既定呼吸标准的一致性水平提高，表明其可能作为筛选标准。
结论
使用PAR可以量化与吸烟和戒烟史相关的COPD风险，但PAR也提示其他尚未量化的风险。鉴于肺功能测定标准的范围和相关的高水平诊断不足，很难将COPD病例作为公共卫生干预的目标。
STUDY OBJECTIVES
Respiratory public health interventions depend on accurate identification of the target group, yet this may vary depending on the diagnostic criteria used. We therefore compared the relative performance of various international criteria in identifying COPD cases. The burden of COPD due to smoking can only be determined from population-attributable risk (PAR) studies. These studies, lacking in the COPD literature, are necessary research in support of public health initiatives for COPD. In this representative population study, we also assessed the PAR for current and ex-smokers.
DESIGN
A representative biomedical population sample of 2,501 South Australians aged > or = 18 years (The Northwest Adelaide Health [Cohort] Study). COPD diagnosis and severity were determined according to various FEV1/FVC and FEV1 percentage of predicted criteria recommended by international respiratory authorities. Demographic, health behavior, and quality-of-life data were obtained by telephone interview and self-completed questionnaire.
SETTING
Northwest Adelaide.
MEASUREMENTS AND RESULTS
The PAR of smoking (smokers and ex-smokers) for COPD ranged from 51 to 70% depending on the diagnostic respiratory criteria used. COPD prevalence varied depending on the criteria used: American Thoracic Society, 5.4%; British Thoracic Society, 3.5%; European Respiratory Society (ERS), 5.0%; Global Initiative for Chronic Obstructive Lung Disease, 5.4%. There was also substantial disagreement in the cases identified. An alternative approach using ERS reference values one residual SD from the mean produced a COPD prevalence estimate of 6.9%, with improved level of agreement with the established respiratory criteria suggesting their potential as screening criteria.
CONCLUSIONS
The COPD risks associated with smoking and ex-smoking history were quantifiable using PAR, but PAR also suggests other, yet unquantified, risks. Targeting COPD cases for public health interventions is difficult given the range of spirometry criteria and the associated high level of underdiagnosis.