支气管扩张剂在哮喘和慢性阻塞性肺疾病中的可逆性：三项大型人群研究的结果
2019/07/11
摘要
背景：支气管扩张剂反应（BDR）测试用作阻塞性气道疾病的诊断方法。这项研究的目的是比较不同的方法来测量哮喘和慢性阻塞性肺疾病（COPD）患者的BDR，并研究BDR与症状负担和表型特征相关的程度。
方法：来自三项大型国际人口研究的35 628名年龄为16岁及以上的受试者中，给予200μg沙丁胺醇前和给予后15分钟测量一秒钟用力呼气量（FEV1）和用力肺活量（FVC）。受试者分为三组：哮喘（n = 2833），COPD（n = 1146）和无气道疾病（n = 31 649）。使用流量相关的三个定义（FEV1增加）和体积相关的三个定义（FVC增加）来比较三组情况。
结果：支气管扩张剂可逆性（用药后FEV1≥12％且FEV1绝对值增加≥200mL）的患病率在哮喘和COPD患者分别是17.3％和18.4％，在没有气道疾病的人群中为5.1％。哮喘患者支气管扩张剂的可逆性与喘息（OR（95％CI）：1.36（1.04-1.79）），特应性（OR 1.36（1.04-1.79））和更高的FeNO相关，而在COPD中，调整支气管扩张剂前FEV1后，无论是流量相关还是体积相关的支气管扩张剂可逆性与症状负担，急性加重或健康状况无关。
结论：对于COPD患者，支气管扩张剂的可逆性至少与哮喘患者一样常见。这表明在人口研究中，可逆性测量值对于区分哮喘和COPD的价值有限。然而，在哮喘中，支气管扩张剂可逆性可能是表型标志物。
Bronchodilator reversibility in asthma and COPD: Findings from three large population studies.
anson C, Malinovschi A, Amaral AFS, Accordini S, Bousquet J, Sonia Buist A, Canonica GW, Dahlén B, Garcia-Aymerich J, Gnatiuc L, Kowalski ML, Patel J, Tan W, Torén K, Zuberbier T, Burney P, Jarvis D.
Abstract
BACKGROUND:Bronchodilator response (BDR) testing is used as a diagnostic method in obstructive airway diseases. The aim of this investigation was to compare different methods for measuring BDR in participants with asthma and COPD and to study to the extent to which BDR was related to symptom burden and phenotypic characteristics.
METHODS:Forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) was measured before and 15 min after 200 μg of salbutamol in 35 628 subjects aged 16 years and older from three large international population studies. The subjects were categorised in three groups: current asthma (n=2833), COPD (n=1146), and no airway disease (n=31 649). Three definitions for flow related (increase in FEV1) and three for volume related (increase in FVC) were used.
RESULTS:The prevalence of bronchodilator reversibility expressed as increase FEV1≥12% and 200 mL was 17.3% and 18.4% in participants with asthma and COPD, respectively, while the corresponding prevalence was 5.1% in those with no airway disease. In asthma, bronchodilator reversibility was associated with wheeze (OR (95% CI): 1.36 (1.04-1.79)), atopy (OR 1.36 (1.04-1.79)) and higher FeNO while in COPD neither flow nor volume related bronchodilator reversibility was associated with symptom burden, exacerbations or health status after adjusting for prebronchodilator FEV1.
CONCLUSIONS:Bronchodilator reversibility was at least as common in participants with COPD as those with asthma. This indicates that measures of reversibility are of limited value for distinguishing asthma from COPD in population studies. In asthma, however, bronchodilator reversibility may be a phenotypic marker.
背景：支气管扩张剂反应（BDR）测试用作阻塞性气道疾病的诊断方法。这项研究的目的是比较不同的方法来测量哮喘和慢性阻塞性肺疾病（COPD）患者的BDR，并研究BDR与症状负担和表型特征相关的程度。
方法：来自三项大型国际人口研究的35 628名年龄为16岁及以上的受试者中，给予200μg沙丁胺醇前和给予后15分钟测量一秒钟用力呼气量（FEV1）和用力肺活量（FVC）。受试者分为三组：哮喘（n = 2833），COPD（n = 1146）和无气道疾病（n = 31 649）。使用流量相关的三个定义（FEV1增加）和体积相关的三个定义（FVC增加）来比较三组情况。
结果：支气管扩张剂可逆性（用药后FEV1≥12％且FEV1绝对值增加≥200mL）的患病率在哮喘和COPD患者分别是17.3％和18.4％，在没有气道疾病的人群中为5.1％。哮喘患者支气管扩张剂的可逆性与喘息（OR（95％CI）：1.36（1.04-1.79）），特应性（OR 1.36（1.04-1.79））和更高的FeNO相关，而在COPD中，调整支气管扩张剂前FEV1后，无论是流量相关还是体积相关的支气管扩张剂可逆性与症状负担，急性加重或健康状况无关。
结论：对于COPD患者，支气管扩张剂的可逆性至少与哮喘患者一样常见。这表明在人口研究中，可逆性测量值对于区分哮喘和COPD的价值有限。然而，在哮喘中，支气管扩张剂可逆性可能是表型标志物。
(中日友好医院呼吸与危重症医学科 王瑞茵 摘译 林江涛 审校)
(Eur Respir J. 2019 Jun 20. pii: 1900561. doi: 10.1183/13993003.00561-2019. [Epub ahead of print])
(Eur Respir J. 2019 Jun 20. pii: 1900561. doi: 10.1183/13993003.00561-2019. [Epub ahead of print])
Bronchodilator reversibility in asthma and COPD: Findings from three large population studies.
anson C, Malinovschi A, Amaral AFS, Accordini S, Bousquet J, Sonia Buist A, Canonica GW, Dahlén B, Garcia-Aymerich J, Gnatiuc L, Kowalski ML, Patel J, Tan W, Torén K, Zuberbier T, Burney P, Jarvis D.
Abstract
BACKGROUND:Bronchodilator response (BDR) testing is used as a diagnostic method in obstructive airway diseases. The aim of this investigation was to compare different methods for measuring BDR in participants with asthma and COPD and to study to the extent to which BDR was related to symptom burden and phenotypic characteristics.
METHODS:Forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) was measured before and 15 min after 200 μg of salbutamol in 35 628 subjects aged 16 years and older from three large international population studies. The subjects were categorised in three groups: current asthma (n=2833), COPD (n=1146), and no airway disease (n=31 649). Three definitions for flow related (increase in FEV1) and three for volume related (increase in FVC) were used.
RESULTS:The prevalence of bronchodilator reversibility expressed as increase FEV1≥12% and 200 mL was 17.3% and 18.4% in participants with asthma and COPD, respectively, while the corresponding prevalence was 5.1% in those with no airway disease. In asthma, bronchodilator reversibility was associated with wheeze (OR (95% CI): 1.36 (1.04-1.79)), atopy (OR 1.36 (1.04-1.79)) and higher FeNO while in COPD neither flow nor volume related bronchodilator reversibility was associated with symptom burden, exacerbations or health status after adjusting for prebronchodilator FEV1.
CONCLUSIONS:Bronchodilator reversibility was at least as common in participants with COPD as those with asthma. This indicates that measures of reversibility are of limited value for distinguishing asthma from COPD in population studies. In asthma, however, bronchodilator reversibility may be a phenotypic marker.
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