不同表型的COPD患者对长效b2受体激动剂/吸入型糖皮质激素的治疗应答性比较

【】目的 探讨不同表型的慢性阻塞性肺疾病(COPD)患者对长效b2受体激动剂/吸入型糖皮质激素治疗的应答性。方法 选取2014年2月至2016年10月在我院治疗的COPD患者217例,其中肺气肿型COPD患者94例,慢性支气管炎型COPD患者123例,观察两组治疗前后肺功能情况。结果 慢性支气管炎型组体重指数(BMI)为(24.13±3.72)kg/m2,明显高于肺气肿型组(p＜0.05);肺气肿型组第1秒用力呼气容积占预计值百分比(FEV1%预计值)和残气量占预计值百分比(RV%预计值)分别为(47.52±9.80)%和(138.89±52.29)%,明显低于慢性支气管炎型组(p＜0.05),而深呼气量占预计值百分比(IC%预计值)为(87.71±13.26)%,明显高于慢性支气管炎型组(p＜0.05);慢性支气管炎型组治疗前后第1秒用力呼气容积(FEV1)、肺总量(TLC)、深吸气量(IC)和残气量(RV)改善值分别为(0.35±0.09)L、(-0.53±0.12)L、(0.17±0.06)L和(-0.60±0.11)L,明显优于肺气肿型组(p＜0.05)。结论 不同表型的COPD患者对长效b2受体激动剂/吸入型糖皮质激素的治疗存在差异,其中慢性支气管炎型COPD的治疗效果较好,肺功能改善明显。     

从高危人群中筛查诊断慢性阻塞性肺疾病的效果评估

目的 探讨从高危人群中筛查COPD患者的效率.对单独或联合筛查方法诊断COPD的敏感度、特异度和町靠性进行评估.方法 2003年1-7月对241例自愿接受检查者进行筛查,筛查对象均为40岁以上且必须符合以下标准之一:慢性咳嗽和咳痰、活动后气短和长期大量吸烟史(吸烟量>10包年).由固定的呼吸科医生询问病史,进行体格检查,拍摄X线胸片,测定肺通气功能,进行支气管舒张试验.多组均数之间的比较采用方差分析,组间两两比较采用t检验.从灵敏度、特异度等方面评价临床表现、单独和联合危险因素指标诊断COPD的价值.结果 在241例COPD高危人群中,肺功能检查符合COPD者156例(64.7%),其中126例为首次诊断病例,占全部筛查者的52.3%;轻、中度COPD患者87例(36.1%),重度和极重度COPD患者69例(28.6%).在单因素筛查中,以活动后气短筛查COPD的灵敏度为61.5%,特异度为61.2%.40岁以上且有重度吸烟、慢性咳嗽和咳痰及活动后气短3项之一者,筛查诊断的灵敏度均达到90%以上.结论 对高危人群进行肺功能筛查是方便、快捷的筛查方法,可以提高COPD的早期诊断水平.以临床表现和危险因素联合筛查可以提高COPD诊断的灵敏度和特异度.临床上可以根据筛查的不同目的 选用适宜的联合筛查方法.     

慢性阻塞性肺病诊治进展

慢性阻塞性肺病(COPD)对人民群众健康的影响日益明显。大约90％COPD患者有过慢性支气管炎病史,许多患者兼有慢性支气管炎和肺气肿。COPD与哮喘:Tufts大学内科教授Bartolome Celli博士指出,COPD与哮喘在临床表现方面有显著的差别,但这二种疾病在许多患者中的表现又有很多的相似之处。事实上,COPD患者吸入支气管扩张剂后反应良好,另一方面,不少哮喘患者是长期吸烟者且合并慢性支气管炎。所以,从病理、生理方面鉴别这二种疾病相当重要。 吸烟是引起COPD的主要危险因素,约90％的患者有吸烟史。由于停止吸烟将会阻止肺功能的进一步下降且降低率可恢复至正常,而维持肺功能在较低水平,故戒烟很重要。而     

沈阳市部分社区慢性阻塞性肺疾病发病情况调查分析

目的了解沈阳社区慢性阻塞性肺疾病(COPD)的流行病学特点及相关危险因素,为COPD的社区防治提供依据。方法以整群、不等比、随机抽样方法,对2003年3月至10月沈阳市东陵区3个社区,40岁以上人群入户问卷调查及肺功能检查。结果资料完整且肺功能检查质控合格者1957例,其中男725例,女1232例。年龄平均(59.37±11.61)岁。COPD患病率为8.02%,其中男性患病率(11.59%)高于女性(5.93%)(P0.01)。60～80岁COPD患病率77.70%,明显高于其他年龄组(P0.01)。Ⅱ级患者占48.41%,明显高于其他级别(P0.01)。有咳嗽、咳痰和(或)气短者仅占31.85%。吸烟与COPD患病的OR值为6.39。吸烟率56.05%均显著高于正常人群(9.61%)(P0.01)。40岁以上COPD患病率显著高于哮喘(1.58%)和(或)COPD合并哮喘患病率(1.74%)。97.45%的患者为首次接受肺功能检查,93.63%为首次诊断为COPD。结论沈阳市社区40岁以上人群COPD患病率显著高于哮喘及COPD合并哮喘者。60～80岁为高发年龄,Ⅰ、Ⅱ级患者占大多数。COPD的发病主要与吸烟相关。COPD漏诊率高,普及肺功能检查是早期诊断的关键。     

上海市闵行区江川地区慢性阻塞性肺疾病发病情况和危险因素的调查分析

目的 了解上海市闵行区江川地区慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患病率及主要相关危险因素,为有效防治COPD提供依据.方法 采用整群随机抽样方法,对该地区40岁以上人群进行问卷调查及肺功能检测,并以肺功能检测结果作为COPD的诊断依据.结果 共有1 330例有效纳入本调查,平均年龄(62.44±11.3)岁,COPD总患病率为9.92%,男性患病率为14.66%,女性为6.77%,男性明显高于女性(χ2=22.254,P<0.000 1).所有COPD病例中,Ⅲ级患者为70例(占53.03%).单因素Logistic回归分析显示,性别、年龄、室内通风、家里灰尘、厨房排气装置、厨房居室分开、猛火炒菜、室外空气污染、职业接触粉尘、被动吸烟、主动吸烟、儿时反复发生支气管-肺部感染与COPD患病有统计学关系,而多因素Logistic回归分析显示年龄、主动吸烟、被动吸烟、室内通风、室外空气污染、职业接触粉尘、儿时反复发生支气管-肺部感染与COPD患病有关.结论 上海市闵行区江川地区COPD患病率较高,COPD的发生与吸烟、室内外空气污染、职业接触粉尘及儿童时期患呼吸道疾病等因素有关.     

COPD的现代概念及疗法

慢性阻塞性肺病(COPD)在美国居死亡原因的第5位,许多患者慢性支气管炎(慢支)、哮喘和和肺气肿并存。虽肺气肿为肺脏的永久性损害,但多数哮喘和支气管炎若能去除病因(如吸烟或感染),则其病理改变尚属可逆。粘液分泌旺盛,寄生死菌的慢性聚集和粘膜水肿而引起气道阻塞是慢支和 COPD     

福州市40岁及以上人群慢性阻塞性肺疾病流行病学调查分析

目的了解福州市40岁及以上人群慢性阻塞性肺疾病(COPD)的流行病学分布特点及相关危险因素,为COPD的防治提供指导。方法采用整群随机抽样方法,对福州市5个辖区(鼓楼区、仓山区、晋安区、台江区和马尾区)部分40岁及以上的人群进行调查,对调查对象进行问卷调查、体检及肺功能检测,对获得的数据进行COPD相关单因素和多因素统计学分析。结果实际完成调查1055例,符合COPD诊断者112例,总体患病率为10.6%(112/1055),其中男性患病率为13.0%(70/538),女性患病率为8.1%(42/517);应用多因素Logistic回归分析,年龄(χ2=27.051,P<0.01)、性别(χ2=4.374,P<0.05)、体质量指数(BMI)(χ2=27.925,P<0.01)、吸烟(χ2=13.900,P<0.01)、儿时咳嗽史(χ2=80.580,P<0.01)、家族史(χ2=42.961,P<0.01)、室内油烟(χ2=13.603,P<0.01)、厨房通风(χ2=12.111,P<0.05)差异均有统计学意义,是COPD的危险因素。结论福州市40岁及以上人群COPD的总体患病率为10.6%,影响COPD患病的主要因素有男性、年龄大、低BMI、吸烟、有儿时咳嗽史及呼吸病家族史、室内油烟重及厨房通风条件差。COPD的相关危险因素涉及个体、家庭和社会生活的多个方面,COPD的防治工作应有针对性地进行,以降低COPD的患病率,提高患者的生活质量。     

接尘工龄、年龄与煤工尘肺合并COPD患者的相关性研究

目的研究接尘工龄、年龄与煤工尘肺合并慢性阻塞性肺疾病(COPD)的相关性。方法测定30例煤工尘肺患者的肺功能并分析临床症状,采用多因素回归分析法分析各种危险因素对煤工尘肺合并COPD的作用。结果煤工尘肺患者中COPD患病率为44.14%;Logistic检验可知年龄、吸烟指数、接尘工龄是煤工尘肺合并COPD高危因素(P<0.05);COPD组年龄、吸烟指数、接尘工龄与非COPD组比较,差异有统计学意义(P<0.05)。结论年龄、吸烟指数、接尘工龄、尘肺期别均为煤工尘肺患者合并COPD高危因素。     

两种方法筛查宜宾市60岁以上居民慢性阻塞性肺疾病的一致性研究

目的比较基于症状的COPD筛查问卷和慢性阻塞性肺疾病全球倡议(GOLD)2017标准在60岁以上居民COPD筛查中的一致性。方法于2019年1~12月采用多阶段抽样抽取宜宾市60岁以上居民744例,分别采用基于症状的COPD筛查问卷和肺功能检查调查COPD的患病情况,比较2种方法在诊断结果上的一致性。结果以基于症状的COPD筛查问卷评分≥16.5分(可疑)和≥19.5分(高危)为截点,诊断COPD人数分别为127例(17.1%)和86例(11.6%),不同年龄、BMI和吸烟量的可疑人数和高危人数检出率差异均有统计学意义,年龄越大、BMI越低、吸烟量越多者,检出率越高(P<0.05)。采用肺功能检查GOLD 2017标准共确诊COPD 81例,患病率为10.9%,不同年龄、BMI和吸烟量居民患病率差异有统计学意义(P<0.05)。以GOLD 2017为金标准,分别以基于症状的COPD筛查问卷评分16.5分和19.5分为截点诊断COPD,其kappa值分别为0.512和0.791,灵敏度分别为74.1%和84.0%,特异度分别为89.9%和97.3%。结论基于症状的COPD筛查问卷适用于60岁以上人群的COPD筛查,以19.5分为截点能比较准确地反映个体的肺功能状况,具有较高的一致性、灵敏度和特异度。     

上海市崇明区与杨浦区COPD高危人群相关情况的比较分析

目的通过比较崇明区与杨浦区高危人群的COPD患病情况,探讨高危人群COPD患病情况的区域差异,提高综合防治水平。方法将崇明区3842例调查人群按高危人群标准再次筛选出1798例和杨浦区1253例COPD高危对象进行患病情况分析比较,并对COPD高危对象采取定点集中,病史询问、基本信息登记,及肺功能测定。结果将崇明区3842例调查人群筛选出1798例高危人群,其中男性1102例,女性696例,COPD患者261例,患病率14. 5%。杨浦区共调查高危人群1253例,男性793例,女性460例,COPD患者212例,患病率16. 9%。在两地人群中,杨浦区COPD患病率为16. 9%,崇明区为14. 5%,崇明区低于杨浦区,崇明区吸烟比例为63%,要高于杨浦区,女性吸烟比例为11. 8%,低于杨浦区(P 0. 01)。崇明区共有14例有职业暴露情况,杨浦区有90例,崇明区的比例明显低于杨浦区(P 0. 01);在两地的COPD患者中,崇明区也少于杨浦区。崇明区有214例存在呼吸道基础疾病,杨浦区有92例,分析发现崇明区高于杨浦区,在两地COPD患者中的比例崇明区也高于杨浦区,统计学存在差异(P 0. 05)。两地心血管疾病、其他疾病情况无差异,两地既往诊断情况无统计学差异(P 0. 05)。根据BMI分组,低体重组两地COPD的患病率都较高,崇明区为29. 0%,杨浦区为33. 9%,且占各自所在地区的首位,但两地间比较无统计学差异(P 0. 05);正常体重组,崇明区COPD患病率低于杨浦区,差异有统计学意义(P 0. 05);肥胖组则相反,崇明区COPD患病率高于杨浦区(P 0. 01)。结论 COPD患病情况及危险因素存在区域差异,崇明区以吸烟为首要危险因素,职业暴露等情况较少;杨浦区以吸烟、空气污染、职业暴露为主要的危险因素,崇明区在呼吸道基础疾病方面高于杨浦区,其他疾病方面差异不大,并在两地都发现营养不良可能为COPD发病的潜在重要因素之一。     

慢性阻塞性肺疾病合并慢性肾脏病危险因素分析

目的探讨住院COPD患者合并慢性肾脏病的患病率及危险因素。方法对2012年1月至2013年11月住院确诊的COPD患者进行慢性肾脏病的患病率及危险因素回顾性凋查。结果在资料完整的948例COPD患者人群中,慢性肾脏病总的患病率约为24．5％,COPD合并慢性肾脏病组PaCO2、吸烟指数、血尿酸水平、糖尿病及高血压病患病率较无合并慢性肾脏病组高,而PaO2、体质量指数较无合并慢性肾脏病组低,差异有统计学意义。COPD患者合并慢性肾脏病与COPD严重程度分级无明显的相关性。经多因素Logistic回归分析表明：低氧血症、高碳酸血症、糖尿病、高血压病是COPD合并慢性肾脏病的危险因素（OR值分别为2．34、3．25、2．67和1．8,9,5％（71分别为2．01～2．75、2．95～3．77、1．99～3．27、1．18～2．63,P值均〈0．05）。结论COPD合并慢性肾脏病的患病率高,低氧血症、高碳酸血症、糖尿病、高血压病是COPD合并慢性肾脏病的危险因素,应引起重视。     

126例支气管舒张试验临床分析

目的分析126例呼吸系统疾病支气管舒张试验的临床意义。方法：慢性支气管炎62例,支气管哮喘48例,急性支气管炎7例,支气管扩张5例,矽肺4例,吸入沙丁胺醇气雾剂200μg行支气管舒张试验。结果多种呼吸系统疾病可出现支气管舒张试验阳性,哮喘的阳性率达75%,明显高于COPD（34.62%）和慢性支气管炎（35.48%）;116例吸入沙丁胺醇后FEV1有不同程度的改善。结论支气管舒张试验是鉴别哮喘和COPD的重要客观依据,诊断必须结合临床。     

慢性肺炎衣原体感染是慢性阻塞性肺病（COPD）的危险因子

目的研究慢性Cpn感染和慢性阻塞性肺病（COPD）之间可能的相关性。方法观察组为年龄在58岁以上的轻度至重度的COPD患者165例和年龄、性别匹配的80例对照组,并测定其FEVl、FVC和圣乔治呼吸问卷（SGRQ）计分。用直接免疫荧光（DIF）法检测外周血单核细胞（PBMC）中的肺炎衣原体特异性抗原（Cpn—Ag）,同时用间接微量免疫荧光（MIF）法检测Cpn抗体（IgA,IgG和IgM）。结果观察组Cpn的感染率为63．0％（104／165）,对照组15．0％（12／80）。代表急性感染的Cpn—Ag和Cpn-IgM抗体的检出率观察组亦显著高于对照组（P〈O．001）,代表慢性感染的Cpn—IgA和IgG抗体的检出率观察组也显著高于对照组（P％0．001）。阿奇霉素治疗后观察组病人的临床症状均有显著改善：SGRQ记分和FEV。／FVC（％）显著增加,与此同时观察组只有Cpn—IgM滴度显著下降（P〈O．001）。慢性Cpn感染与吸烟及较高的年龄有关但与性别无关。结论慢性Cpn感染可能是COPD发展的独立危险因素。     

Prevalence of COPD in five Colombian cities situated at low, medium, and high altitude (PREPOCOL study)

BACKGROUND: The prevalence of COPD in Colombia is unknown. This study aimed to investigate COPD prevalence in five Colombian cities and measure the association between COPD and altitude. METHODS: A cross-sectional design and a random, multistage, cluster-sampling strategy were used to provide representative samples of adults aged >or= 40 years. Each participant was interviewed (validated Spanish version of the Ferris Respiratory Questionnaire) and performed spirometry before and after 200 microg of inhaled salbutamol, using a portable spirometer according to American Thoracic Society recommendations. COPD definitions were as follows: (1) spirometric: fixed ratio (primary definition): FEV1/FVC < 70% after bronchodilator; (2) medical: a diagnosis of chronic bronchitis, emphysema, or COPD made by a physician; (3) clinical: cough and phlegm >or= 3 months every year during >or= 2 consecutive years (chronic bronchitis). Analysis was performed using statistical software. RESULTS: A total of 5,539 orsubjects were included. The overall COPD prevalence using the primary definition (spirometric) was 8.9%, ranging from 6.2% in Barranquilla to 13.5% in Medellín. The prevalence measured by the spirometric definition was higher than medical (2.8%) and clinical (3.2%) definitions. After the logistic regression analysis, the factors related with COPD were age >or= 60 years, male gender, history of tuberculosis, smoking, wood smoke exposure >or= 10 years, and very low education level. There was a nonsignificant tendency toward larger prevalence with higher altitude. CONCLUSION: COPD is an important health burden in Colombia. Additional studies are needed to establish the real influence of altitude on COPD prevalence.     

Underdiagnosis of chronic obstructive pulmonary disease in Northern Sweden.

OBJECTIVE: To assess underdiagnosis of chronic obstructive pulmonary disease. MATERIAL AND METHODS: Two cross-sectional studies of respiratory symptoms and diseases in two population samples of the same age living in the same areas in northern Sweden were performed 6 years apart. In 1986, 5698 (86%) out of 6610 subjects aged 35-36, 50-51 and 65-66 years responded to a postal questionnaire. In 1992 an identical study was performed, and 5617 subjects (87%) out of 6434 responded. Lung function measurements were performed in stratified samples. RESULTS: Of the subjects diagnosed with chronic bronchitis only 25% in 1986 and 23% in 1992 had been diagnosed prior to the study as having chronic bronchitis, emphysema or chronic obstructive pulmonary disease (COPD). Chronic airflow limitation (CAL), used as a surrogate variable for COPD and defined as FEV1/VC <70% and FEV1 <80% of predicted value, was found in 171 subjects in 1986-1987 (12% of the examined subjects), and 166 subjects in 1993-1994 (11%). In 1986-1987, 26% of the subjects with CAL had been diagnosed as having chronic bronchitis or emphysema prior to the survey, while a diagnosis of either asthma, chronic bronchitis or emphysema, or use of asthma medicines, was found in 58%. The corresponding figures in 1993-1994 were 31% and 63%, respectively. The great majority of the subjects with CAL had recurrent wheeze, dyspnoea and chronic productive cough. CONCLUSION: Approximately 60% of the subjects with chronic airflow limitation had been diagnosed prior to the survey as having asthma, chronic bronchitis or emphysema, or were using asthma medicines. The results were similar in 1986-1987 and 1993-1994.     

The prevalence of chronic obstructive pulmonary disease in Uppsala, Sweden--the Burden of Obstructive Lung Disease (BOLD) study: cross-sectional population-based study

Objectives: To estimate chronic obstructive pulmonary disease (COPD) prevalence in Uppsala and the impact of risk factors on disease prevalence using the standardised methods of the Burden of Obstructive Lung Disease (BOLD) study initiative. Methods: Randomly selected participants, aged 40 years or more (n = 548) responded to a questionnaire regarding smoking habits, respiratory symptoms, medical history, and exposure to airway irritants. Spirometry, with a post‐bronchodilator test, was performed and COPD defined as post‐bronchodilatory forced expiratory volume in 1 s (FEV₁)/forced vital capacity (FVC) < 0.70 or FEV₁/FVC < lower limit of normality (LLN). Circulatory inflammatory markers were measured. Results: COPD prevalence was 16.2%, which was the fourth lowest prevalence of COPD, compared with 12 other BOLD centres. Main risk factors for COPD were increasing age [odds ratio (OR) = 2.08 per 10 years] and smoking (OR = 1.33 per 10 pack years). Higher education was protective (OR = 0.70 per 5 years). Previous tuberculosis was an almost significant risk factor for COPD (P = 0.08). Subjects with COPD reported more respiratory symptoms but only 29% had previous doctor diagnosed COPD, asthma, chronic bronchitis or emphysema. Participants with COPD had higher levels of C‐reactive protein (P = 0.01), but no difference was observed in interleukin 6 (IL‐6) levels. Using LLN instead of the fixed FEV₁/FVC ratio reduced the prevalence of COPD to 10%. Conclusion: COPD prevalence in Uppsala was similar to other BOLD centres in high‐income countries. Apart from known COPD risk factors (age, smoking, lower educational level), a history of tuberculosis may be associated with COPD even in high‐income countries. COPD remains under‐diagnosed, as only 29% of subjects with COPD had a previously diagnosed lung disorder. Please cite this paper as: Danielsson P, Ólafsdóttir IS, Benediktsdóttir B, Gíslason T and Janson C. The prevalence of chronic obstructive pulmonary disease in Uppsala, Sweden – the Burden of Obstructive Lung Disease (BOLD) study: cross‐sectional population‐based study. Clin Respir J 2012; 6: 120–127.     

Not 15 but 50% of smokers develop COPD?--Report from the Obstructive Lung Disease in Northern Sweden Studies

BACKGROUND: The prevalence of chronic obstructive pulmonary disease (COPD) according to guidelines of today seems considerably higher than has been reported also in recent literature. AIM: To estimate the prevalence of COPD as defined by British Thoracic Society (BTS) criteria and the recent global initiative for chronic obstructive lung disease (GOLD) criteria. Further aims were to assess the proportion of underdiagnosis and of symptoms in subjects with COPD, and to study risk factors for COPD. METHODS: In 1996, 5892 of the Obstructive Lung Disease in Northern Sweden (OLIN) Study's first cohort could be traced to a third follow-up survey, and 5189 completed responses (88%) were received corresponding to 79% of the original cohort from December 1985. Of the responders, a random sample of 1500 subjects were invited to a structured interview and a lung function test, and 1237 of the invited completed a lung function test with acceptable quality. RESULTS: In ages >45 years, the prevalence of COPD according to the BTS guidelines was 8%, while it was 14% according to the GOLD criteria. The absolutely dominating risk factors were increasing age and smoking, and approximately a half of elderly smokers fulfilled the criteria for COPD according to both the BTS and the GOLD criteria. Family history of obstructive airway disease was also a risk factor, while gender was not. Of those fulfilling the BTS criteria for COPD, 94% were symptomatics, 69% had chronic productive cough, but only 31% had prior to the study been diagnosed as having either chronic bronchitis, emphysema, or COPD. The corresponding figures for COPD according GOLD were 88, 51, and 18%. CONCLUSIONS: In ages >45 years, the prevalence of COPD according to the BTS guidelines was 8%, and it was 14% according to the GOLD criteria. Fifty percent of elderly smokers had developed COPD. The large majority of subjects having COPD were symptomatic, while the proportion of those diagnosed as having COPD or similar diagnoses was small.     

Global burden of COPD: systematic review and meta-analysis.

The aim of this study was to quantify the global prevalence of chronic obstructive pulmonary disease (COPD) by means of a systematic review and random effects meta-analysis. PubMed was searched for population-based prevalence estimates published during the period 1990-2004. Articles were included if they: 1) provided total population or sex-specific estimates for COPD, chronic bronchitis and/or emphysema; and 2) gave method details sufficiently clearly to establish the sampling strategy, approach to diagnosis and diagnostic criteria. Of 67 accepted articles, 62 unique entries yielded 101 overall prevalence estimates from 28 different counties. The pooled prevalence of COPD was 7.6% from 37 studies, of chronic bronchitis alone (38 studies) was 6.4% and of emphysema alone (eight studies) was 1.8%. The pooled prevalence from 26 spirometric estimates was 8.9%. The most common spirometric definitions used were those of the Global Initiative for Chronic Obstructive Lung Disease (13 estimates). There was significant heterogeneity, which was incompletely explained by subgroup analysis (e.g. age and smoking status). The prevalence of physiologically defined chronic obstructive pulmonary disease in adults aged > or =40 yrs is approximately 9-10%. There are important regional gaps, and methodological differences hinder interpretation of the available data. The efforts of the Global Initiative for Chronic Obstructive Lung Disease and similar groups should help to standardise chronic obstructive pulmonary disease prevalence measurement.     

Obstructive lung disease among the urban homeless

STUDY OBJECTIVES: Homelessness is a growing problem in the United States that may significantly impair physical health. The homeless have a high prevalence of cigarette smoking, poor nutrition, and adverse environmental exposures, which could contribute to obstructive lung disease (OLD). Despite this risk, the prevalence of OLD among the homeless remains unknown. We aimed to systematically assess the prevalence of OLD among the urban homeless. DESIGN, SETTING, AND PARTICIPANTS: We conducted a cross-sectional study of the prevalence of OLD among homeless individuals in San Francisco. By random sampling, we recruited 68 adults living in one homeless shelter to participate in a structured interview survey and spirometry assessment. We used a multifaceted approach to assess OLD, including respiratory symptoms, self-reported physician diagnosis of asthma, chronic bronchitis, emphysema, or COPD, and spirometry (defined as FEV1 < 80% predicted and FEV1/FVC ratio < 0.70). RESULTS: Sixty-eight adults completed the survey, and 67 adults completed the spirometry. Homeless adults were likely to be homeless < 1 year and homeless for the first time. There was a high prevalence of cigarette smoking (75% ever smokers, 68% current smokers). The prevalence of symptoms suggestive of OLD was high, including cough (29%), wheezing (40%), chronic bronchitis symptoms (21%), and dyspnea on exertion (29%). A substantial proportion of homeless subjects indicated a prior diagnosis of asthma (24%), chronic bronchitis (19%), and COPD (4%). Based on spirometry, the prevalence of OLD was 15% (95% confidence interval, 8 to 26%), which was more than double the expected prevalence in the general US population. CONCLUSIONS: As OLD is a leading cause of death in the United States, it is important to identify it early for treatment. Homeless individuals have a higher-than-expected prevalence of OLD. Public health interventions should target the homeless population for prevention and treatment of OLD.