澳大利亚一项跨越60年的前瞻性、社区队列中成人咳嗽亚型与临床特征和肺功能之间的关系：基于TAHS的分析
2024/07/31
摘要
背景：咳嗽是常见但存在异质性的问题。在普通人群中，我们对咳嗽的特征和过程知之甚少。本研究目的是在一项社区队列中，研究咳嗽亚型及其从童年到60岁的特征和潜在可治疗特质。
方法：我们对塔斯马尼亚纵向健康研究（Tasmanian Longitudinal Health Study, TAHS）的数据进行了分析，使用作为TAHS的一部分收集的数据来区分咳嗽患者在53岁时的咳嗽亚型。TAHS是一项始于1968年2月23日的基于社区的前瞻性队列研究，每隔10年对澳大利亚塔斯马尼亚的参与者进行随访，目前为止从平均年龄7岁随访至平均年龄53岁。在本分析中，自我报告问卷中至少有一个咳嗽相关问题回答为“是”的参与者被定义为当前咳嗽患者，并被纳入咳嗽症状的潜在类别分析；所有9个咳嗽相关问题的回答均为“否”的参与者被认为没有咳嗽，被排除在本分析之外。从7岁到53岁，对参与者的两组纵向特征进行评估：已建立的FEV1、用力肺活量（forced vital capacity, FVC）及FEV1/FVC比值的纵向轨迹；哮喘；过敏（基于群体的轨迹分析或潜在类别分析）以及不同时间点的症状（包括哮喘、当前咳痰性咳嗽、曾经有慢性咳痰性咳嗽、当前吸烟和二手烟暴露）。
发现：纳入TAHS基线的8583名参与者中，追踪到6128（71.4%）名参与者并邀请他们参与在2012年9月3日至2016年11月8日之间的一次随访。6128名参与者中有3609（58.9%）名参与者反馈了咳嗽问卷。该分析中参与者的平均年龄为53岁（标准差1.0）。3609名参与者中，2213（61.3%）名被定义为当前咳嗽患者，1396（38.7%）名被定义为非咳嗽患者并在潜在类别分析中被排除。2213名纳入分析的当前咳嗽患者中，1148（51.9%）名为女性，1065（48.1%）名为男性。分析在2213名参与者中定义了6类不同的咳嗽亚型：206（9.3%）名患者为轻微咳嗽，1189（53.7%）名患者为仅感冒时咳嗽，305（13.8%）名患者为伴过敏的咳嗽，213（9.6%）名患为有间歇性咳痰性咳嗽，147（6.6%）名患者为慢性干咳，153（6·9%）名患者为慢性咳痰性咳嗽。与仅有轻微咳嗽的人群相比，与其他亚型咳嗽类似，从7岁到53岁，慢性咳痰性咳嗽和间歇性咳痰性咳嗽亚型的人群有更差的肺功能轨迹（持续性低FEV1轨迹：分别为2.9%、6.4%和16.1%，P分别为0.0011和< 0.0001；FEV1/FVC早期低水平-迅速降低轨迹：分别为2.9%、12.1%和13.0%，P分别为0.012和0.0007），更高患病率的咳嗽（53岁时，分别为0.0%、32.4% [26.1-38.7]和50.3% [42.5-58.2]）和哮喘（53岁时，分别为6.3% [3.7-10.6]、26.9% [21.3-33.3]和41.7% [24.1-49.7]）。
解释：本研究定义了6类咳嗽亚型的潜在可治疗特质（如哮喘、过敏以及主动或被动吸烟导致咳痰性咳嗽）。如果我们的研究得到其他研究的支持，初级保健中对咳痰性咳嗽的必要管理（如常规肺通气功能检测）可能与干咳不同。未来基于人群的研究可以应用本研究的框架来解决社区咳嗽的异质性和复杂性的问题。
Association of novel adult cough subclasses with clinical characteristics and lung function across six decades of life in a prospective, community-based cohort in Australia: an analysis of the Tasmanian Longitudinal Health Study (TAHS)
Zhang JW, Caroline J Lodge CJ, Walters EH, Anne B Chang AB, Bui DS, Lowe AJ, Hamilton GS, Thomas PS, Senaratna CV, James AL, Thompson BR, Erbas B, Abramson MJ, Perret JL, Dharmage SC
Lancet Respir Med. 2024;12(2):129-140. doi: 10.1016/S2213-2600(23)00340-5.
Abstract
Background: Cough is a common yet heterogeneous condition. Little is known about the characteristics and course of cough in general populations. We aimed to investigate cough subclasses, their characteristics from childhood across six decades of life, and potential treatable traits in a community-based cohort.
Methods: For our analysis of the Tasmanian Longitudinal Health Study (TAHS), a prospective, community-based cohort study that began on Feb 23, 1968, and has so far followed up participants in Tasmania, Australia, at intervals of 10 years from a mean age of 7 years to a mean age of 53 years, we used data collected as part of the TAHS to distinguish cough subclasses among current coughers at age 53 years. For this analysis, participants who answered Yes to at least one cough-related question via self-report questionnaire were defined as current coughers and included in a latent class analysis of cough symptoms; participants who answered No to all nine cough-related questions were defined as non-coughers and excluded from this analysis. Two groups of longitudinal features were assessed from age 7 years to age 53 years: previously established longitudinal trajectories of FEV1, forced vital capacity [FVC], FEV1/FVC ratio, asthma, and allergies-identified via group-based trajectory analysis or latent class analysis-and symptoms at different timepoints, including asthma, current productive cough, ever chronic productive cough, current smoking, and second-hand smoking.
Findings: Of 8583 participants included at baseline in the TAHS, 6128 (71·4%) were traced and invited to participate in a follow-up between Sept 3, 2012, and Nov 8, 2016; 3609 (58·9%) of these 6128 returned the cough questionnaire. The mean age of participants in this analysis was 53 years (SD 1·0). 2213 (61·3%) of 3609 participants were defined as current coughers and 1396 (38·7%) were categorised as non-coughers and excluded from the latent class analysis. 1148 (51·9%) of 2213 participants in this analysis were female and 1065 (48·1%) were male. Six distinct cough subclasses were identified: 206 (9·3%) of 2213 participants had minimal cough, 1189 (53·7%) had cough with colds only, 305 (13·8%) had cough with allergies, 213 (9·6%) had intermittent productive cough, 147 (6·6%) had chronic dry cough, and 153 (6·9%) had chronic productive cough. Compared with people with minimal cough, and in contrast to other cough subclasses, people in the chronic productive cough and intermittent productive cough subclasses had worse lung function trajectories (FEV1persistent low trajectory 2·9%, 6·4%, and 16·1%; p=0·0011, p<0·0001; FEV1/FVC early low–rapid decline trajectory 2·9%, 12·1%, and 13·0%; p=0·012, p=0·0007) and a higher prevalence of cough (age 53 years 0·0%, 32·4% [26·1–38·7], and 50·3% [42·5–58·2]) and asthma (age 53 years 6·3% [3·7–10·6], 26·9% [21·3–33·3], and 41·7% [24·1–49·7]) from age 7 years to age 53 years.
Interpretation: We identified potential treatable traits for six cough subclasses (eg, asthma, allergies, and active and passive smoking for productive cough). The required management of productive cough in primary care (eg, routine spirometry) might differ from that of dry cough if our findings are supported by other studies. Future population-based studies could apply our framework to address the heterogeneity and complexity of cough in the community.
背景：咳嗽是常见但存在异质性的问题。在普通人群中，我们对咳嗽的特征和过程知之甚少。本研究目的是在一项社区队列中，研究咳嗽亚型及其从童年到60岁的特征和潜在可治疗特质。
方法：我们对塔斯马尼亚纵向健康研究（Tasmanian Longitudinal Health Study, TAHS）的数据进行了分析，使用作为TAHS的一部分收集的数据来区分咳嗽患者在53岁时的咳嗽亚型。TAHS是一项始于1968年2月23日的基于社区的前瞻性队列研究，每隔10年对澳大利亚塔斯马尼亚的参与者进行随访，目前为止从平均年龄7岁随访至平均年龄53岁。在本分析中，自我报告问卷中至少有一个咳嗽相关问题回答为“是”的参与者被定义为当前咳嗽患者，并被纳入咳嗽症状的潜在类别分析；所有9个咳嗽相关问题的回答均为“否”的参与者被认为没有咳嗽，被排除在本分析之外。从7岁到53岁，对参与者的两组纵向特征进行评估：已建立的FEV1、用力肺活量（forced vital capacity, FVC）及FEV1/FVC比值的纵向轨迹；哮喘；过敏（基于群体的轨迹分析或潜在类别分析）以及不同时间点的症状（包括哮喘、当前咳痰性咳嗽、曾经有慢性咳痰性咳嗽、当前吸烟和二手烟暴露）。
发现：纳入TAHS基线的8583名参与者中，追踪到6128（71.4%）名参与者并邀请他们参与在2012年9月3日至2016年11月8日之间的一次随访。6128名参与者中有3609（58.9%）名参与者反馈了咳嗽问卷。该分析中参与者的平均年龄为53岁（标准差1.0）。3609名参与者中，2213（61.3%）名被定义为当前咳嗽患者，1396（38.7%）名被定义为非咳嗽患者并在潜在类别分析中被排除。2213名纳入分析的当前咳嗽患者中，1148（51.9%）名为女性，1065（48.1%）名为男性。分析在2213名参与者中定义了6类不同的咳嗽亚型：206（9.3%）名患者为轻微咳嗽，1189（53.7%）名患者为仅感冒时咳嗽，305（13.8%）名患者为伴过敏的咳嗽，213（9.6%）名患为有间歇性咳痰性咳嗽，147（6.6%）名患者为慢性干咳，153（6·9%）名患者为慢性咳痰性咳嗽。与仅有轻微咳嗽的人群相比，与其他亚型咳嗽类似，从7岁到53岁，慢性咳痰性咳嗽和间歇性咳痰性咳嗽亚型的人群有更差的肺功能轨迹（持续性低FEV1轨迹：分别为2.9%、6.4%和16.1%，P分别为0.0011和< 0.0001；FEV1/FVC早期低水平-迅速降低轨迹：分别为2.9%、12.1%和13.0%，P分别为0.012和0.0007），更高患病率的咳嗽（53岁时，分别为0.0%、32.4% [26.1-38.7]和50.3% [42.5-58.2]）和哮喘（53岁时，分别为6.3% [3.7-10.6]、26.9% [21.3-33.3]和41.7% [24.1-49.7]）。
解释：本研究定义了6类咳嗽亚型的潜在可治疗特质（如哮喘、过敏以及主动或被动吸烟导致咳痰性咳嗽）。如果我们的研究得到其他研究的支持，初级保健中对咳痰性咳嗽的必要管理（如常规肺通气功能检测）可能与干咳不同。未来基于人群的研究可以应用本研究的框架来解决社区咳嗽的异质性和复杂性的问题。
(四川大学华西医院呼吸与危重症医学科 张丽1 王霁2 王刚2)
(Lancet Respir Med. 2024;12(2):129-140. doi: 10.1016/S2213-2600(23)00340-5.)
(Lancet Respir Med. 2024;12(2):129-140. doi: 10.1016/S2213-2600(23)00340-5.)
Association of novel adult cough subclasses with clinical characteristics and lung function across six decades of life in a prospective, community-based cohort in Australia: an analysis of the Tasmanian Longitudinal Health Study (TAHS)
Zhang JW, Caroline J Lodge CJ, Walters EH, Anne B Chang AB, Bui DS, Lowe AJ, Hamilton GS, Thomas PS, Senaratna CV, James AL, Thompson BR, Erbas B, Abramson MJ, Perret JL, Dharmage SC
Lancet Respir Med. 2024;12(2):129-140. doi: 10.1016/S2213-2600(23)00340-5.
Abstract
Background: Cough is a common yet heterogeneous condition. Little is known about the characteristics and course of cough in general populations. We aimed to investigate cough subclasses, their characteristics from childhood across six decades of life, and potential treatable traits in a community-based cohort.
Methods: For our analysis of the Tasmanian Longitudinal Health Study (TAHS), a prospective, community-based cohort study that began on Feb 23, 1968, and has so far followed up participants in Tasmania, Australia, at intervals of 10 years from a mean age of 7 years to a mean age of 53 years, we used data collected as part of the TAHS to distinguish cough subclasses among current coughers at age 53 years. For this analysis, participants who answered Yes to at least one cough-related question via self-report questionnaire were defined as current coughers and included in a latent class analysis of cough symptoms; participants who answered No to all nine cough-related questions were defined as non-coughers and excluded from this analysis. Two groups of longitudinal features were assessed from age 7 years to age 53 years: previously established longitudinal trajectories of FEV1, forced vital capacity [FVC], FEV1/FVC ratio, asthma, and allergies-identified via group-based trajectory analysis or latent class analysis-and symptoms at different timepoints, including asthma, current productive cough, ever chronic productive cough, current smoking, and second-hand smoking.
Findings: Of 8583 participants included at baseline in the TAHS, 6128 (71·4%) were traced and invited to participate in a follow-up between Sept 3, 2012, and Nov 8, 2016; 3609 (58·9%) of these 6128 returned the cough questionnaire. The mean age of participants in this analysis was 53 years (SD 1·0). 2213 (61·3%) of 3609 participants were defined as current coughers and 1396 (38·7%) were categorised as non-coughers and excluded from the latent class analysis. 1148 (51·9%) of 2213 participants in this analysis were female and 1065 (48·1%) were male. Six distinct cough subclasses were identified: 206 (9·3%) of 2213 participants had minimal cough, 1189 (53·7%) had cough with colds only, 305 (13·8%) had cough with allergies, 213 (9·6%) had intermittent productive cough, 147 (6·6%) had chronic dry cough, and 153 (6·9%) had chronic productive cough. Compared with people with minimal cough, and in contrast to other cough subclasses, people in the chronic productive cough and intermittent productive cough subclasses had worse lung function trajectories (FEV1persistent low trajectory 2·9%, 6·4%, and 16·1%; p=0·0011, p<0·0001; FEV1/FVC early low–rapid decline trajectory 2·9%, 12·1%, and 13·0%; p=0·012, p=0·0007) and a higher prevalence of cough (age 53 years 0·0%, 32·4% [26·1–38·7], and 50·3% [42·5–58·2]) and asthma (age 53 years 6·3% [3·7–10·6], 26·9% [21·3–33·3], and 41·7% [24·1–49·7]) from age 7 years to age 53 years.
Interpretation: We identified potential treatable traits for six cough subclasses (eg, asthma, allergies, and active and passive smoking for productive cough). The required management of productive cough in primary care (eg, routine spirometry) might differ from that of dry cough if our findings are supported by other studies. Future population-based studies could apply our framework to address the heterogeneity and complexity of cough in the community.
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