基于症状的COPD筛查问卷在社区老年人群COPD筛查中的应用

目的:对比基于症状的慢性阻塞性肺疾病(COPD)筛查问卷和慢性阻塞性肺疾病全球创议(GOLD)建议的"肺功能检查金标准"在社区老年人群COPD筛查中的应用。方法:2020年1～12月采用分层抽样结合整群抽样的方法抽取宜宾市的社区老年居民712人,采用基于症状的COPD筛查问卷筛查COPD患病情况,对筛查阳性者用肺功能检...     

筛查问卷与肺功能检查在慢性阻塞性肺疾病早期诊断中的研究

目的探讨慢性阻塞性肺疾病(简称慢阻肺)患病率及危险因素,提高慢阻肺早期诊断率。方法使用统一问卷对体检中心483例体检人员进行问卷调查,然后进行肺功能检测。结果慢阻肺组得分较非慢阻肺组高(P0.01)。问卷得分与FEV1/FVC呈负相关(P0.01)。以17分为截断点时,问卷的灵敏度、特异度、假阳性率、假阴性率、正确诊断指数、约登指数、阳性似然比、阴性似然比分别为97.3%、71.3%、28.7%、2.7%、73.3%、0.69、3.39、0.04。ROC分析曲线下面积为0.919,本人群最佳截断点为19.5分。慢阻肺总患病率为7.6%,男性患病率高于女性(P0.01),随年龄增大慢阻肺患病率增大。性别、年龄、吸烟、BMI、学历与患慢阻肺危险性因素有关。结论慢阻肺筛查问卷可以用来初步筛查慢阻肺高危人群,结合肺功能检查可提高慢阻肺早期诊断率。     

吸烟对40岁以上人群的肺功能的影响

目的 观察吸烟对40岁以上人群的肺功能的影响.方法 本研究前瞻性调查了2 682例居民的吸烟状况、规律合并用药情况、性别、年龄、身高、体质量等资料,并进行了肺通气功能检测.结果 随访时间2年.2 290例(85.4%)得到了有效随访,其中1 197例(52.3%)从不吸烟,467例(20.4%)曾经吸烟,626例(27.3%)现吸烟.三组人群的年龄、性别、BMI、肺功能、COPD患者例数及合并用药差异均有统计学意义.随访结果显示,肺功能FEV1、FEV1%pred、FVC、FEV1/FVC均逐年下降.经调整上述差异性变量(年龄、性别、BMI、COPD患者例数、合并用药及基线肺功能),曾吸烟组肺功能FEV1(P=0.030)、FEV1%pred(P=0.011)和FEV1/FVC(P<0.001)较从不吸烟组显著下降.现吸烟组FEV1/FVC较从不吸烟组下降快.结论 从不吸烟居民肺功能下降最慢,提倡不吸烟或尽可能早期戒烟.     

慢性阻塞性肺疾病患者诱导痰内树突细胞及趋化因子受体6水平与FEV1%的相关性

目的探讨慢性阻塞性肺疾病(COPD)患者诱导痰内树突细胞(DCs)及趋化因子受体6(CCR6)水平与FEV1占预计值百分比(FEV1%)的相关性分析。方法选择2008年1月到2009年3月在该院住院治疗的患者51例,将患者依照病情的轻重程度分为无吸烟组5例、吸烟但无COPD组5例、GOLDⅠ组11例、GOLDⅡ组17例以及GOLDⅢ^Ⅳ组13例。对比各组患者肺功能情况,各组患者痰CD40、CD86及CCR6水平,分析DCs、CCR6与FEV1%的相关性。结果 GOLDⅠ组和GOLDⅡ组及GOLDⅢⅣ组13例。对比各组患者肺功能情况,各组患者痰CD40、CD86及CCR6水平,分析DCs、CCR6与FEV1%的相关性。结果 GOLDⅠ组和GOLDⅡ组及GOLDⅢ^Ⅳ组的FEV1%,FEV1/FVC均显著低于无吸烟组以及吸烟但无COPD组;GOLDⅡ组和GOLDⅢⅣ组的FEV1%,FEV1/FVC均显著低于无吸烟组以及吸烟但无COPD组;GOLDⅡ组和GOLDⅢ^Ⅳ组的FEV1%与FEV1/FVC水平亦分别显著低于GOLDⅠ组水平;GOLDⅢⅣ组的FEV1%与FEV1/FVC水平亦分别显著低于GOLDⅠ组水平;GOLDⅢ^Ⅳ组的FEV1%与FEV1/FVC水平显著低于GOLDⅡ组水平(均P<0.05)。GOLDⅠ组和GOLDⅡ组及GOLDⅢⅣ组的FEV1%与FEV1/FVC水平显著低于GOLDⅡ组水平(均P<0.05)。GOLDⅠ组和GOLDⅡ组及GOLDⅢ^Ⅳ组的CD40、CD86、CCR6均显著高于无吸烟组以及吸烟但无COPD组;GOLDⅡ组和GOLDⅢⅣ组的CD40、CD86、CCR6均显著高于无吸烟组以及吸烟但无COPD组;GOLDⅡ组和GOLDⅢ^Ⅳ组的CD40与CD86,以及CCR6水平亦分别显著高于GOLDⅠ组水平;GOLDⅢⅣ组的CD40与CD86,以及CCR6水平亦分别显著高于GOLDⅠ组水平;GOLDⅢ^Ⅳ组的CD40、CD86、CCR6水平显著高于GOLDⅡ组水平(均P<0.05)。Spearman法分析发现,DCs与FEV1%呈负相关关系(r=-0.913,P=0.000),CCR6与FEV1%呈负相关(r=-0.892,P=0.000)。结论 COPD患者的诱导痰内DCs及CCR6水平均与FEV1%呈负相关,临床治疗时值得关注。     

社区慢性阻塞性肺疾病的筛查流程和技术手段

目的探讨一套有效的慢性阻塞性肺疾病的筛查流程和技术手段。方法采用统一的流行病调查表,以整群随机抽样的方法,以家庭为单位,对古美社区的居民进行问卷调查,并进行实验室、影像学及社区肺功能检查,对其结果进行调查分析。结果共调查413例调查对象,男194例,女219例,平均年龄(68.38±7.39)岁;用Vitalograph COPD-6进行社区肺功能检查,共筛出37例阳性患者,占总筛查人数的9.0%;剔除第1秒末用力肺活量(FEV1)与用力肺活量(FVC)比值异常的患者(比值为7.8%)后,共筛出36例阳性患者,占总筛查人数的8.7%。后续差异性和回归分析均以剔除异常值后的数据进行处理。经χ~2检验,筛查对象有无气喘、吸烟累计是否超过5包,会带来Vitalograph'COPD-6检查结果的显著差异(P<0.05);经t检验,年龄、淋巴细胞比值、中性粒细胞比值与Vitalograph COPD-6检查结果显著相关(P<0.05)。多因素Logistic回归结果显示,年龄大、有气喘、淋巴细胞比值低,会显著增加Vitalograph COPD-6检查结果阳性风险(P<0.05)。结论古美社区COPD患病率8.7%,气喘、吸烟、年龄、淋巴细胞比值、中性粒细胞比值与Vitalograph COPD-6检查结果显著相关。有效的社区筛查诊断工具,应该将高危因素问卷、生化检查和肺功能初筛进行结合检测,可能具有一定的意义。     

吸烟和生物燃料所致慢性阻塞性肺疾病患者临床特征差异研究

目的 观察吸烟和生物燃料所致慢性阻塞性肺疾病(COPD)患者临床特征的差异。方法 回顾性分析2011年3月至2014年3月在广州呼吸疾病研究所206例由吸烟和81例生物燃料导致的慢阻肺患者的临床资料,分别比较了两组患者的一般情况、临床症状、呼吸困难评分和合并症等方面的差异;肺功能和分级及急性加重的差异。结果 (1)一般情况的差异：吸烟所致慢阻肺患者中男性和女性的比例分别为83.5%和16.5%,生物燃料所致慢阻肺的患者中男性和女性的比例分别为14.8%和85.2%(χ2=27.2,P<0.05)。吸烟所致慢阻肺患者多见于男性,而生物燃料所致慢阻肺患者多见于女性;性别矫正后,生物燃料所致的女性COPD患者的体重指数(BMI)低于吸烟所致的女性COPD患者的BMI。其他指标如年龄两组差异无统计学意义。(2)临床症状差异：生物燃料和吸烟所致慢阻肺患者的呼吸困难指数mMRC差异无统计学意义;生物燃料所致慢阻肺患者出现喘息症状多于吸烟所致慢阻肺的患者,分别为38.3%和11.1%(χ2=17.9,P<0.05)。生物燃料所致慢阻肺患者合并过敏性疾病(如过敏性鼻炎、支气管哮喘)比例高于吸烟所致慢阻肺的患者,分别为43.2%和18%(χ2=16.1,P<0.05);而吸烟所致慢阻肺患者合并肺癌比例高于生物燃料所致慢阻肺的患者,分别为7.77%和3.7%(χ2=9.7,P<0.05)。(3)肺功能分级的差异：慢阻肺分级上,性别校正后生物燃料所致慢阻肺患者分级更多见于B级或D级,症状多。(4)急性加重的差异：生物燃料所致和吸烟所致的慢阻肺患者1年内急性加重次数无显著差异。结论 吸烟和生物燃料所致的慢阻肺在临床特征上有很多差异：生物燃料所致慢阻肺患者多见于女性,BMI低,临床症状较多,合并症以过敏性鼻炎和支气管哮喘较多,慢阻肺分级多见于B级或D级。吸烟所致慢阻肺患者多见于男性,合并症以肺癌较多。     

上海市郊县社区居民肺通气功能测定及对COPD肺功能诊断金标准的探讨

目的探讨肺通气功能与年龄分层的相关性,以及社区居民肺通气功能测试普查的意义。方法随机抽取崇明县多个社区、自然村居民,进行肺通气测定、COPD相关症状和有害气体接触史的问卷调查。结果共调查3842位居民,符合COPD诊断标准共378例,总患病率为9.8%,其中否认有呼吸道症状和COPD危险因素(有害气体接触史,包括主动吸烟、被动吸烟、接触生物燃料、职业有害气体接触史等)92例(24.3%)。随着年龄的增加,肺功能测试者的通气功能呈下降趋势且具有统计学意义(P0.05)。结论成年人FEV1/FVC随着年龄的增加而下降,以FEV1/FVC0.7作为COPD的诊断标准,对既无症状又无有害气体接触史的居民进行普查有COPD过度诊断的风险。     

四川省阿坝州红原县年龄≥40岁常住居民慢性阻塞性肺疾病患病情况调查及影响因素分析

目的 调查四川省阿坝州红原县年龄≥40岁常住居民慢性阻塞性肺疾病（COPD）患病情况，并探讨其影响因素。方法 通过随机抽样法抽取四川省阿坝州红原县年龄≥40岁常住居民，采用入户调查的方式对调查对象进行肺功能检测及问卷调查，确定COPD患病情况。比较不同调查因素的COPD患病率，对有显著差异的因素行多因素Logistic回归分析，确定患COPD的独立影响因素。结果 共抽取红原县年龄≥40岁常住居民456例，436例质控合格，其中53例确诊COPD,COPD总患病率为12.16%。调查对象不同性别、民族、年龄、吸烟状况、吸烟年限、文化程度、取暖方式、肺结核病史、BMI患病率差异均有统计学意义（P均<0.05）。多因素Logistic回归分析结果显示，COPD患病的独立影响因素包括民族、年龄、吸烟状况、取暖方式、文化程度和肺结核病史（P均<0.05）。结论 四川省阿坝州红原县年龄≥40岁常住居民COPD患病率为12.16%，高于全国患病率；民族、年龄、吸烟状况、取暖方式、文化程度和肺结核病史是红原县COPD患病的独立影响因素。     

焦虑、抑郁对慢性阻塞性肺疾病评分的影响

目的 探讨焦虑、抑郁对COPD患者肺功能及CAT评分的影响,并研究最新的慢性阻塞性肺疾病全球倡议（GOLD）不同分级中焦虑、抑郁的分布情况。方法 152例COPD患者门诊、入院接受肺功能检查,并对其进行慢性阻塞性肺疾病评分（the COPD Assessment Test CAT）、改良英国MRC呼吸困难指数评分、医院焦虑和抑郁量表（HADS）评估,了解COPD患者焦虑和/或抑郁的发病率;分析不同水平焦虑、抑郁对COPD患者肺功能、CAT得分的影响。结果 152例患者中,焦虑和/或抑郁的患病率为36.8%（56例）,女性患病人数较男性多,同时随着年龄的增加,其患病率也增高;无焦虑、抑郁组肺功能各项指标都明显优于有焦虑和/或抑郁组（P〈0.05）;无焦虑、抑郁组CAT得分明显低于有焦虑和/或抑郁组（P〈0.05）,相同肺功能水平组间,症状重组焦虑和/或抑郁的患病率明显高于症状轻组（P〈0.05）。结论 COPD患者常伴有焦虑、抑郁情绪;焦虑、抑郁情绪严重影响COPD患者的肺功能、生活质量;按2011年GOLD指南提出的COPD不同分级中,焦虑和/或抑郁的患病情况是不同的,即其症状越重,焦虑和/或抑郁的患病率越高,而与气流受限程度无关。     

2018慢性阻塞性肺疾病全球倡议病情评估的意义与思考

正2001年第一版慢性阻塞性肺疾病全球倡议(GOLD)发布,为慢性阻塞性肺疾病(COPD,简称慢阻肺)的规范化诊治提供了指导。2006年GOLD对慢阻肺的定义、肺功能评估、发病机制、治疗策略等方面进行了更新,根据肺功能将慢阻肺分为四级。2011年GOLD对慢阻肺评估方式和管理模式有了较大的更新,保留了肺功能分级系统,加入症状、急性加重风险综合评估。GOLD 2017更新了慢阻肺定     

Lung function testing in the elderly—Can we still use FEV1/FVC<70% as a criterion of COPD?

BACKGROUND: Chronic obstructive pulmonary disease (COPD) can be diagnosed when the FEV(1)/FVC ratio is below 70%, according to global initiative for chronic obstructive lung disease (GOLD). COPD is known as a disease which is frequently under-diagnosed. However, there is a risk of over diagnosis when this diagnostic threshold is applied among the elderly. AIMS: To contribute to the discussion about the criteria for diagnosing COPD, by describing lung function and pulmonary symptoms in a population aged 60 years or more, and in particular the changes in the mean and 5% percentile of the FEV(1)/FVC ratio by increasing age. METHODS: A cross sectional population-based study was performed in the city of Troms?, Norway, in 2001-2002. Spirometry was performed in 4102 people 60 years and older (54.6% women), who also filled in a questionnaire. RESULTS: Decreased FEV(1)% predicted and FEV(1)/FVC ratio were associated with smoking, increasing age, and reported pulmonary and cardiovascular diseases. Dyspnoea and coughing were also strongly associated with smoking and reported pulmonary and cardiovascular diseases, but coughing did not become more frequent by increasing age. In never smokers aged 60-69 years the frequency of FEV(1)/FVC ratio<70% was approximately 7% compared to 16-18% in those 70 years or more (p<0.001). FEV(1)/FVC ratio<70% among never smokers aged 60-69 years was just as frequent as FEV(1)/FVC ratio <65% in never smokers older than 70 years. CONCLUSION: Adjustments of the GOLD criteria for diagnosing COPD are needed, and FEV(1)/FVC ratios down to 65% should be regarded as normal when aged 70 years and older.     

Validation of symptom-based COPD questionnaires in Japanese subjects

Background and objective:   Symptom-based questionnaires may be helpful in diagnosing patients with COPD. The aim of this study was to determine whether two COPD questionnaires designed in Western countries were applicable to Japanese and other Asian patients.
Methods:   The participants were Japanese people aged 40 years and over. Each subject answered questions on demographics and symptoms and underwent spirometry before and after administration of a bronchodilator. Questionnaire A was designed to identify previously undiagnosed COPD and questionnaire B was designed to differentiate between COPD and asthma.
Results:   The numbers of COPD patients who answered questionnaires A and B were 33 of 169 (19.5%) and 112 of 168 (66.7%), respectively. Comparison of the COPD group with the non-COPD group revealed a significant difference in total score in both questionnaire A and questionnaire B (both P  < 0.001). The area under the receiver operating characteristic curve (AUC-ROC) for questionnaire A was 0.791. With a cut-off value of 16.5 points, the sensitivity and specificity were 0.939 and 0.404, and with a 19.5-point cut-off, sensitivity and specificity were 0.848 and 0.647, respectively. The AUC-ROC for questionnaire B was 0.765. With cut-off values of 18.5 and 24.5 points, the respective sensitivities and specificities were 0.946 and 0.393, and 0.741 and 0.607.
Conclusions:   A simple self-administered questionnaire can help to diagnose COPD in Japanese subjects. When these questionnaires are used in Japan, cut-off values should be set somewhat higher than in Western countries.     

Exhaled Breath Temperature as a Novel Marker of Future Development of COPD: Results of a Follow-Up Study in Smokers

Although only less than one-third of smokers develop COPD, early marker(s) of COPD development are lacking. The aim of this research was to assess the ability of an average equilibrium exhaled breath temperature (EBT) in identifying susceptibility to cigarette smoke so as to predict COPD development in smokers at risk. The study was a part of a multicenter prospective cohort study in current smokers (N = 140, both sexes, 40–65 years, ≥20 pack-years) with no prior diagnosis of COPD. Diagnostic workup includes history, physical, quality of life, hematology and highly sensitive CRP, EBT before and after smoking a cigarette, lung function with bronchodilator test, and 6-minute walk test. Patients without a diagnosis of COPD and in GOLD 1 stage at initial assessment were reassessed after 2 years. COPD was additionally diagnosed based on lower level of normal (LLN) lung function criteria. Utility of EBT for disease progression was analyzed using receiver operator curve (ROC) and logistic regression analyses. Change in EBT after smoking a cigarette at initial visit (ΔEBT) was significantly predictive for disease progression (newly diagnosed COPD; newly diagnosed COPD + severity progression) after 2 years (p < 0.05 for both). ΔEBT had an AUC of 0.859 (p = 0.011) with sensitivity of 66.7% and specificity of 98.1% for newly diagnosed COPD using LLN criteria. We conclude that EBT shows potential for predicting the future development of COPD in current smokers. This was best seen using LLN to diagnose COPD, adding further evidence to question the use of GOLD criteria for diagnosing COPD.     

COPD ‘diagnosis’ based on spirometric reference equations

Introduction: Chronic obstructive pulmonary disease (COPD) is suspected if the ratio between forced expired volume in 1 s (FEV₁) and forced vital capacity is below 0.7 after bronchodilatation, according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD). As this ratio varies with age and gender, the lower limit of normality (LLN) of appropriate reference equations appears more adequate. Objectives: To study the prevalences of suspected COPD according to the GOLD criterion and various reference equations in a well‐defined population sample. Methods: Spirometries obtained in a random population sample of 598 men, 50 or 60 years of age, were analysed. The prevalences of suspected COPD were calculated according to the GOLD criterion and the LLNs of four Nordic and two European reference equations. Results: The GOLD criterion resulted in prevalences of COPD of 9.3% and 23.7% in the 50‐ and 60‐year‐old never‐smokers, respectively. Depending on the reference equation, the calculated prevalences of COPD varied between 9.3% and 23.4% and 12.0% and 39.1% among all of the 50‐ and 60‐year‐old men, respectively. Conclusions: The GOLD criterion is inadequate because of substantial overestimation in 60‐year‐old never‐smokers. LLNs of the various reference equations are unreliable because of obvious lack of consistency. Spirometric criteria for airway obstruction, and suspicion of COPD, therefore need to be revised. Please cite this paper as: Olofson J, Bake B, Tengelin MN and Houltz B. COPD ‘diagnosis’ based on spirometric reference equations. The Clinical Respiratory Journal 2008; 2: 214–219.     

Acute Exacerbation According to GOLD 2017 Categories in Patients with Chronic Obstructive Pulmonary Disease

IntroductionThe association between GOLD categorizations and future exacerbations has not been fully investigated. This study elucidates whether the GOLD 2017 classification is associated with different future exacerbation risk in patients with chronic obstructive pulmonary disease (COPD) compared with the previous GOLD categorization. Another objective was to investigate the impacts of the symptoms and FEV1 on the predicted future exacerbation independently of previous exacerbation history.MethodsWe analyzed patients from three prospective COPD cohorts (SNUH, KOCOSS, and KOLD) and evaluated the risk of moderate to severe exacerbation among different models, including GOLD grade (FEV1), GOLD 2011, and GOLD 2017.ResultsIn total, 611 COPD patients were included (36 from SNUH, 257 from KOCOSS, and 318 from KOLD). GOLD 2017 classification, excluding FEV1% for categorization criteria, showed no differences in future exacerbation risk compared with GOLD grade and GOLD 2011 based on c-statistics. Among those with no frequent exacerbation history and FEV1 ≥50%, the group with more symptoms was significantly associated with future exacerbations than the group with less symptoms. A lower FEV1 (FEV1 <50%) was not associated with a higher future exacerbation risk than a higher FEV1 (FEV1 ≥50%), regardless of prior exacerbation history and symptom group.ConclusionThe GOLD 2017 classification was not different from GOLD grade and GOLD 2011 regarding the association with future exacerbation risk, and there were no significant differences in exacerbation risk according to FEV1%. This suggests that FEV1 might not be an important factor in future exacerbation risk. These results partly support the GOLD 2017 assessment tool.     

Ten-year cumulative incidence of COPD and risk factors for incident disease in a symptomatic cohort

STUDY OBJECTIVES: To determine the 10-year cumulative incidence of COPD in a cohort of subjects with respiratory symptoms (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage 0) using the British Thoracic Society (BTS) and GOLD spirometric criteria. Furthermore, we sought to evaluate risk and gender factors for incident COPD. DESIGN AND SETTING: A postal questionnaire was administered in 1986 to all 6,610 subjects in eight areas of northern Sweden who had been born in 1919 to 1920 (group 1), 1934 to 1935 (group 2), and 1949 to 1950 (group 3). The response rate was 86%. All of the subjects reporting respiratory symptoms were invited to participate in a structured interview and pulmonary function test (PFT), and 1,506 (91%) participated. In 1996, 90% could be traced for follow-up, of whom 1,165 (86%) of the invited subjects participated and 1,109 subjects (534 women) were able to perform technically adequate PFTs in both 1986 and 1996. RESULTS: The 10-year cumulative incidence of COPD was estimated at 8.2% (using BTS criteria) and 13.5% (using GOLD criteria). Significant risk factors for incident COPD (using BTS and GOLD criteria) in a multivariate analysis were higher age (group 1 odds ratio [OR]: BTS criteria, 3.49; GOLD criteria, 3.37; group 2 OR: BTS criteria, 4.50; GOLD criteria, 5.70) and smoking (OR: BTS criteria, 5.37; GOLD criteria, 4.56), but not gender or heredity. Respiratory symptoms were significantly associated with incident COPD when added to the same model. In analogous analyses that were conducted separately for men and women, smoking yielded an OR of 8.52 among women (95% confidence interval [CI], 3.43 to 21.2) compared with 3.14 among men (95% CI, 1.26 to 7.84). The symptoms cough, sputum production, and chronic productive cough reached statistical significance in women, while dyspnea and wheeze did so in men. CONCLUSION: In this cohort, the 10-year cumulative incidence of COPD was 8.2% (using BTS criteria) and 13.5% (using GOLD criteria). Increasing age, smoking, and bronchitic symptoms, but not gender, were risk factors for incident COPD. GOLD stage 0 therefore appears to identify subjects who are at risk of COPD, but men and women presented different risk profiles.     

The local prevalence of COPD by post-bronchodilator GOLD criteria in Korea.

OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is a disease characterised by not fully reversible airflow limitation. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) committee decided to diagnose COPD using post-bronchodilator spirometry values. We aimed to examine the prevalence and risk factors of COPD in Ansan, an industrialised city of Korea, by using the post-bronchodilator GOLD criteria. We then investigated the implications of brenchodilation on the prevalence of COPD. DESIGN: A total of 3642 participants in the Korean Health and Genome Study were interviewed about age, income, smoking status and respiratory symptoms and completed pulmonary function tests, including postbronchodilator spirometry. RESULTS: COPD prevalence by post-bronchodilator spirometry was 3.7% (134/3642), which was significantly different from that estimated using pre-bronchodilator criteria (7.7%, 282/3642). Exclusion of subjects with significant bronchodilator response (BDR) significantly lowered the prevalence of COPD to 3.3% (117/3572), compared with including subjects with post-bronchodilatory residual obstruction with significant BDR. Prevalence was associated with old age, smoking history, male sex and respiratory symptoms. CONCLUSION: COPD prevalence by post-bronchodilator GOLD criteria was 3.7%, which was much lower than that of pre-bronchodilator criteria. The bronchodilator reversibility test substantially affects estimations of COPD prevalence.     

Changes in the Burden of Comorbidities in Patients with COPD and Asthma–COPD Overlap According to the GOLD 2017 Recommendations

Purpose

Comorbidities associated with chronic obstructive pulmonary disease (COPD) affect quality of life and increase mortality. Asthma–COPD overlap (ACO) may express a different profile of comorbidities compared to COPD alone. It is unclear how recent changes in GOLD recommendations affect the profile of comorbidities in COPD and ACO.

Methods

Eight hundred and thirty-four patients with COPD were recruited from 67 Hungarian secondary care outpatient clinics, 469 of them had ACO. Comorbidities were defined by respiratory specialists based on medical history, patient report, and medications. COPD grades were defined according to the old 2016 and the new 2017 GOLD document. Comorbidities were compared along COPD ABCD groups determined by the old and new GOLD.

Results

66 and 72% of the COPD patients in groups C and D (GOLD 2016) were recategorized to groups A and B (GOLD 2017), respectively. There was no difference in the prevalence of disorders along the 2016 GOLD categories except for osteoporosis in ACO (p?=?0.01). When the patients were categorized according to the 2017 GOLD criteria, the prevalence of osteoporosis (p?=?0.01) was different among the four groups in all COPD patients. Subgroup analysis of non-ACO COPD patients revealed inter-group differences for cardiac arrhythmia (p?<?0.01). No alteration was seen in the prevalence of coronary artery disease, hypertension, diabetes, or the total number of comorbidities.

Conclusion

A significant number of patients are recategorized according to the GOLD 2017 criteria. This change only marginally affects the profile of comorbidities; still this needs to be considered when assessing the patients in daily practice.

     

基于广东省人群调查的慢性阻塞性肺疾病严重度分布构成及其生活质量状况

目的 评估人群COPD的严重程度分布构成及其生活质量状况.方法 基于广东省城乡40岁及以上的人群的COPD横断面调查.入选的人群都进行问卷调查和肺功能检测,支气管扩张试验后1秒率（FEV1/FVC） ＜0.70者诊断为COPD.生活质量采用12个条目的简短生活质量量表（12-itemShort-Form health survey questionnaire,SF-12）进行评估,严重程度按慢性阻塞性肺疾病全球防治创议（GOLD）的A、B、C、D分级,采用改良的英国医学研究委员会气促评分量表、气流受限程度（FEV1,FEV1％pred）和过去一年症状加重的次数进行综合评估.结果 流调人群中经肺功能检查确诊的COPD A、B、C、D各组的构成分别为36.0％ （109/303）、25.4％（77/303）、12.5％ （38/303）和26.1％（79/303）;其躯体成分评分分别为49.28±4.25、43.21±7.94、44.67±7.90和37.45±9.68,各组之间总体差异有统计学意义（F =39.593,P＜0.001）,各组之间两两比较,除B组与C组之间差异无统计学意义外,其余各组之间差异有统计学意义（P值均＜0.05）;心理成分评分分别为57.62±3.31、57.89±4.25、57.22±4.83、55.63±7.95,各组之间总体差异有统计学意义（F=2.978,P=0.032）,各组之间两两比较,除D组与A、C两组之间差异有统计学意义外（P值均＜0.05）,其余各组之间差异无统计学意义.结论 人群中COPD严重度各组分布构成以A组最高,C组最少,生活质量以A组受损最少,D组受损最严重.     

慢性阻塞性肺疾病病患的认知功能探讨

目的评估慢性阻塞性肺疾病(慢阻肺)病患的认知功能状态,以及与临床资料的相关性。方法从2014年10月-2018年12月,160例符合标准的受试者入组;认知评估使用蒙特利尔(MoCA)量表,获取临床资料并完成相关性分析。结果约46%的慢阻肺病患存在认知功能障碍。四组受试者的MOCA总分为:健康对照组26.47±1.31、慢阻肺病患轻度组24.77±2.61、中度组22.39±3.64、重度组21.92±2.65;相比对照组,慢阻肺受试者的认知得分降低(p<0.05),表现在注意、定向、抽象思维、延迟记忆、视空间与执行功能。组间比较亦有统计学差异;同时慢阻肺受试者的MoCA总分和肺功能中FEV 1有正相关(r=0.377,P<0.001),与血气分析中PaO 2有正相关性(r=0.295,P<0.05),与PaCO 2无相关性(r=0.059,P>0.05)。结论慢阻肺病患存在特定的认知障碍。低氧血症、肺功能中的FEV 1降低可能是造成慢阻肺认知障碍的病理生理学机制。