"Defining Chronic Obstructive Pulmonary Disease in Older Persons"

描述(由申请人提供)：慢性阻塞性肺疾病(COPD)是世界范围内导致残疾和死亡的主要原因，其定义仅基于1秒用力呼气量(FEV1)与用力肺活量(FVC)的比率降低，严重程度随后根据FEV1分级，以预测百分比(%Pred)表示。然而，在老年人中，目前的COPD肺活量测定指南是有问题的，至少有三个原因。首先，建立降低FEV1/FVC的门槛仍然存在争议。其次，将FEV1表达为%Pred是有严重缺陷的，因为它没有考虑到参照组在整个寿命期间的变异性。第三，目前的肺活量测定指南没有使用死亡率和呼吸道症状等重要的临床指标进行严格的验证。对此，我们制定了两部分肺活量测定方法来确定COPD，首先根据死亡风险确定FEV1/FVC的临界点；然后，在低于这一关键FEV1/FVC阈值的人群中，根据死亡风险和呼吸道症状确定FEV1的临界点，以标准化残差百分位数(SR-TILE)表示。重要的是，SR-TILE方法考虑了参照组的可变性。此R03应用程序的目标是通过使用两项基于老年人的大型人群研究的数据，相对于当前的指南，验证我们对COPD的肺活量定义。这两项研究是：健康、老龄化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，以及与临床特征的横向关联，包括呼吸道症状、体能表现和药物使用。我们的长期目标是评估风险和宿主因素以及中介因素，这些因素是老年人肺功能和健康相关结果之间联系的基础。R03应用程序是重要的一步，因为它将验证报告肺功能和定义COPD的适合年龄的方法。 与公共卫生相关：在老年人中，目前的肺活量测定指南可能导致对COPD的错误分类(主要是过度诊断)，进而可能危及患者的护理。我们建议验证一种更循证的肺活量测定策略，以避免在老年人中误诊COPD。这可能导致更明智地使用针对COPD的药物治疗，从而减少与药物相关的不良事件的频率。

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.