剛成年時的肺功能與後來發生COPD有關


  【24drs.com】發表於7月9日新英格蘭醫學期刊的一篇回溯世代分析認為,剛成年時肺功能不佳足以造成後來發生慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)。
  
  這篇包括超過2,500名丹麥與美國人的研究發現,發生COPD者約有半數的人在40歲前即有偏低的第一秒用力呼氣量(FEV1),這之後則是呈現正常衰退。
  
  丹麥菲德列茲堡醫院的「哥本哈根市心臟研究(Copenhagen City Heart Study)」、哈維德夫醫院的呼吸小組、社會醫學小組、公衛研究中心、Peter Lange醫師領導的研究者們寫道,這篇研究結果認為,FEV1從正常值加速衰退的典型軌跡,不是COPD的專屬特徵,發生COPD者有相當比率在剛成年時即有偏低的FEV1值。
  
  編輯評論中,波士頓哈佛醫學院、布萊根婦女醫院Channing網絡醫學小組的Frank E. Speizer醫師,以及哈佛公衛學院的James H. Ware博士指出,與抽菸無關的因素,如環境汙染、職業曝露、遺傳與氣喘都會影響剛成年時的肺功能以及之後的衰退;此外,FEV1的部份變化比率反映的應該是疾病活性,而不是疾病嚴重度。
  
  為了明確地釐清這些額外的COPD風險組成,將需要各年齡層者反覆測量的充分數據;少有研究者或機構能進行像我們這個研究。
  
  編輯者結論指出,就目前而言,有兩個訊息相當清楚。人口研究和臨床情況的肺功能測量,對於有阻塞情況者發生COPD的風險與疾病狀態嚴重度,都能繼續提供最佳的預測方法。此外,仍然要繼續關注抽菸行為,這依舊是發生此疾病的主要風險因素。
  
  目前的研究中,研究者分析了以下三個世代的資料:「Framingham Offspring Cohort」、「哥本哈根市心臟研究」、「Lovelace Smokers Cohort」。每個世代的研究對象在開始時都有一系列的肺功能檢測,整體而言,平均追蹤22年之後,264名研究對象中,在40歲前進行過肺功能檢測者,在至少十年後再度進行檢測時,共有12%符合COPD準則。
  
  相較於FEV1較高者,40歲前的FEV1 值小於預測值之80%者的COPD發生率顯著較高(26% vs 7%;P < 0.001)。
  
  在類似的菸害曝露情況下,發生COPD者有48%在40歲前有正常的FEV1值,之後發生FEV1值迅速衰退的情況,平均衰退率為每年53 mL。另外52%的人,40歲前的FEV1值偏低,FEV1值的後續平均衰退幅度較小,為每年27 mL。
  
  資料來源:http://www.24drs.com/
  
  Native link:Early Adult Lung Function Linked to Development of COPD

Early Adult Lung Function Linked to Development of COPD

By Susan London
Medscape Medical News

Poorer lung function in early adulthood may be sufficient to predispose an individual to chronic obstructive pulmonary disease (COPD) later in life, suggests a retrospective cohort study published in the July 9 issue of the New England Journal of Medicine.

The study of more than 2500 individuals from the Danish and US populations found that about half of those who ultimately developed COPD had a low forced expiratory volume in 1 second (FEV1) before the age of 40 years, but a normal decline in this measure thereafter.

"[T]he results of this study suggest that the classic trajectory of an accelerated decline in FEV1 from a normal level is not an obligate feature of COPD and that a substantial proportion of the persons in whom COPD develops have a low FEV1 level in early adulthood," write the investigators, led by Peter Lange, MD, DrMedSc, from the Institute of Public Health, Section of Social Medicine, the Respiratory Section at the Hvidovre Hospital, and the Copenhagen City Heart Study at the Frederiksberg Hospital, all in Denmark.

In an accompanying editorial, Frank E. Speizer, MD, from the Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, and James H. Ware, PhD, from the Harvard School of Public Health, also in Boston, note that factors unrelated to smoking, such as environmental pollution, occupational exposures, genetics, and asthma, may affect pulmonary function in early adulthood, as well as its decline thereafter. In addition, some of the rate of change of FEV1 may reflect disease activity, rather than disease severity.

"To sort out these additional components of COPD risk definitively will require large data sets with repeated measurements of diverse population groups across the life course. Few groups of investigators or institutions have or can make the commitment to carry out such studies," they write.

"For the present, two messages remain clear," the editorialists conclude. "Spirometric measurements, both in population studies and in the clinical setting, continue to provide the best predictive measure of both the risk of COPD development and the severity of disease status in those with obstruction. Furthermore, it is important to continue to focus on cigarette smoking, which remains the major risk factor for the development of disease."

In the current study, the researchers analyzed data from three cohorts: the Framingham Offspring Cohort, the Copenhagen City Heart Study, and the Lovelace Smokers Cohort. Participants in each cohort had serial spirometry beginning at baseline. Overall, 12% of 264 participants who underwent spirometry before age 40 years and again at least a decade later met criteria for COPD after an average of 22 years of follow-up.

The incidence of COPD was significantly higher among individuals who had an FEV1 of less than 80% of the predicted value before 40 years of age compared with those who had a higher FEV1 during that time of their life (26% vs 7%; P < 0.001).

Forty-eight percent of the participants who developed COPD had had a normal FEV1 before age 40 years and experienced a rapid drop in FEV1 thereafter, with a mean decline of 53 mL per year. The other 52% had had a low FEV1 before age 40 years and experienced a significantly smaller subsequent mean decline in FEV1 of 27 mL per year, even though they had similar smoking exposure.

The Copenhagen City Heart Study was supported by GlaxoSmithKline, the Capital Region of Copenhagen, the Danish Heart Foundation, the Danish Lung Foundation, and the Velux Foundation. The Lovelace Smokers Cohort was supported by the State of New Mexico (appropriation from the Tobacco Settlement Fund) and by grants from the National Institutes of Health. Full conflict-of-interest information is available on the journal's website.

N Engl J Med. 2015;373:111-122, 185-186.

    
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