支气管舒张反应性和未来慢性气流阻塞关系：一项多国纵向研究
2025/04/06
摘要
背景与目的：支气管舒张试验主要用于诊断哮喘。作者旨在探究其是否与慢性气流阻塞的长期进展相关。
方法：这是一项国际多中心的阻塞性肺疾病负担队列研究，在基线期（2003年1月2日－ 2016年12月26日）纳入年龄≥40岁受试者，并在平均9.1年后（2019年1月29日—2021年10月24日）进行随访。两次调查均收集了呼吸系统症状、健康状况以及环境和生活方式暴露信息，并进行支气管舒张前后的肺功能测定。采用美国ATS/ERS 2022年标准定义基线期支气管舒张反应性，并将随访期使用支气管扩张剂后 FEV1/FVC低于正常下限定义为慢性气流阻塞。使用多元回归模型分析两者的关联。按性别分层并在从不吸烟者中进行敏感性分析。
结果：共纳入3701名成年人数据（女性占56%）。与基线支气管舒张反性阴性组患者相比，支气管舒张反应性阳性组患者发生慢性气流阻塞的风险增加36%（RR: 1.36, 95%CI 1.04, 1.80）。这种效应在女性患者（RR: 1.45, 95%CI 1.09, 1.91）中强于男性患者（RR: 1.07, 95%CI 0.51, 2.24）。有支气管舒张反应性的从不吸烟患者发生慢性气流阻塞的风险也更高（RR: 1.48, 95%CI 1.01, 2.20）。
结论：本研究发现支气管舒张反应性是新发慢性气流阻塞的危险因素。未来需要在其他大型人群队列研究中验证。
关键词： 肺活量测定法；哮喘；流行病学；慢性阻塞性肺病；支气管舒张反应
文献来源：(Knox-Brown B, Algharbi F, Mulhern O, et al. Bronchodilator responsiveness and future chronic airflow obstruction: a multinational longitudinal study[J]. Eclinicalmedicine, 2025, 81: 103123. DOI: 10.1016/j.eclinm.2025.103123.)
Abstract
Background and Objective:Bronchodilator responsiveness testing is mainly used for diagnosing asthma. We aimed to investigate whether it is associated with progression to chronic airflow obstruction over time.
Methods：The multinational Burden of Obstructive Lung Disease cohort study surveyed adults, aged 40 years and above, at baseline and followed them up after a mean of 9.1 years. Recruitment took place between January 2, 2003 and December 26, 2016. Follow-up measurements were collected between January 29, 2019 and October 24, 2021. On both occasions, study participants provided information on respiratory symptoms, health status and several environmental and lifestyle exposures. They also underwent pre- and post-bronchodilator spirometry. We defined bronchodilator responsiveness at baseline using the American Thoracic Society and European Respiratory Society (ATS/ERS) 2022 definition, and the presence of chronic airflow obstruction at follow-up as a post-bronchodilator forced expiratory volume in 1 s to forced vital capacity ratio (FEV1/FVC) less than the lower limit of normal. We used multi-level regression models to estimate the association between baseline bronchodilator responsiveness and incident chronic airflow obstruction. We stratified analyses by gender and performed a sensitivity analysis in never smokers.
Results：We analysed data from 3701 adults with 56% being women. Compared to those without bronchodilator responsiveness at baseline, those with bronchodilator responsiveness had 36% increased risk of developing chronic airflow obstruction (RR: 1.36, 95%CI 1.04, 1.80). This effect was stronger in women (RR: 1.45, 95%CI 1.09, 1.91) than men (RR: 1.07, 95%CI 0.51, 2.24). Never smokers with bronchodilator responsiveness also were at greater risk of incident chronic airflow obstruction (RR: 1.48, 95%CI 1.01, 2.20).
Conclusion：Bronchodilator responsiveness appears to be a risk factor for incident chronic airflow obstruction. It is important that future studies in other large population-based cohorts replicate these findings.
Key words：Spirometry; Asthma; Epidemiology; COPD ; Bronchodilator
背景与目的：支气管舒张试验主要用于诊断哮喘。作者旨在探究其是否与慢性气流阻塞的长期进展相关。
方法：这是一项国际多中心的阻塞性肺疾病负担队列研究，在基线期（2003年1月2日－ 2016年12月26日）纳入年龄≥40岁受试者，并在平均9.1年后（2019年1月29日—2021年10月24日）进行随访。两次调查均收集了呼吸系统症状、健康状况以及环境和生活方式暴露信息，并进行支气管舒张前后的肺功能测定。采用美国ATS/ERS 2022年标准定义基线期支气管舒张反应性，并将随访期使用支气管扩张剂后 FEV1/FVC低于正常下限定义为慢性气流阻塞。使用多元回归模型分析两者的关联。按性别分层并在从不吸烟者中进行敏感性分析。
结果：共纳入3701名成年人数据（女性占56%）。与基线支气管舒张反性阴性组患者相比，支气管舒张反应性阳性组患者发生慢性气流阻塞的风险增加36%（RR: 1.36, 95%CI 1.04, 1.80）。这种效应在女性患者（RR: 1.45, 95%CI 1.09, 1.91）中强于男性患者（RR: 1.07, 95%CI 0.51, 2.24）。有支气管舒张反应性的从不吸烟患者发生慢性气流阻塞的风险也更高（RR: 1.48, 95%CI 1.01, 2.20）。
结论：本研究发现支气管舒张反应性是新发慢性气流阻塞的危险因素。未来需要在其他大型人群队列研究中验证。
关键词： 肺活量测定法；哮喘；流行病学；慢性阻塞性肺病；支气管舒张反应
文献来源：(Knox-Brown B, Algharbi F, Mulhern O, et al. Bronchodilator responsiveness and future chronic airflow obstruction: a multinational longitudinal study[J]. Eclinicalmedicine, 2025, 81: 103123. DOI: 10.1016/j.eclinm.2025.103123.)
（ 南方医科大学南方医院 黄海伦 龚钊乾 赵文驱 赵海金）
Abstract
Background and Objective:Bronchodilator responsiveness testing is mainly used for diagnosing asthma. We aimed to investigate whether it is associated with progression to chronic airflow obstruction over time.
Methods：The multinational Burden of Obstructive Lung Disease cohort study surveyed adults, aged 40 years and above, at baseline and followed them up after a mean of 9.1 years. Recruitment took place between January 2, 2003 and December 26, 2016. Follow-up measurements were collected between January 29, 2019 and October 24, 2021. On both occasions, study participants provided information on respiratory symptoms, health status and several environmental and lifestyle exposures. They also underwent pre- and post-bronchodilator spirometry. We defined bronchodilator responsiveness at baseline using the American Thoracic Society and European Respiratory Society (ATS/ERS) 2022 definition, and the presence of chronic airflow obstruction at follow-up as a post-bronchodilator forced expiratory volume in 1 s to forced vital capacity ratio (FEV1/FVC) less than the lower limit of normal. We used multi-level regression models to estimate the association between baseline bronchodilator responsiveness and incident chronic airflow obstruction. We stratified analyses by gender and performed a sensitivity analysis in never smokers.
Results：We analysed data from 3701 adults with 56% being women. Compared to those without bronchodilator responsiveness at baseline, those with bronchodilator responsiveness had 36% increased risk of developing chronic airflow obstruction (RR: 1.36, 95%CI 1.04, 1.80). This effect was stronger in women (RR: 1.45, 95%CI 1.09, 1.91) than men (RR: 1.07, 95%CI 0.51, 2.24). Never smokers with bronchodilator responsiveness also were at greater risk of incident chronic airflow obstruction (RR: 1.48, 95%CI 1.01, 2.20).
Conclusion：Bronchodilator responsiveness appears to be a risk factor for incident chronic airflow obstruction. It is important that future studies in other large population-based cohorts replicate these findings.
Key words：Spirometry; Asthma; Epidemiology; COPD ; Bronchodilator
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