Defining chronic obstructive pulmonary disease in older persons

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• 作者：Carlos A. Vaz Fragoso ; John Concato ; Gail McAvay ; Peter H. Van Ness ; Carolyn L. Rochester ; H. Klar Yaggi ; Thomas M. Gill
• 关键词：COPD ; Spirometry ; Respiratory symptoms ; Mortality
• 刊名：Respiratory Medicine
• 出版年：2009
• 出版时间：October 2009
• 年：2009
• 卷：103
• 期：10
• 页码：1468-1476
• 全文大小：201 K

文摘

Summary

Objective

To develop a more age-appropriate spirometric definition of chronic obstructive pulmonary disease (COPD) among older persons.

Methods

Using data from the Third National Health and Nutrition Examination Survey (NHANES III), we developed a two-part spirometric definition of COPD in older persons, aged 65–80 years, that 1) determines a cut-point for the ratio of forced expiratory volume in 1 s to forced vital capacity (FEV₁/FVC) based on mortality risk; and 2) among persons below this critical FEV₁/FVC threshold, determines cut-points for the FEV₁, expressed as a standardized residual percentile (SR-tile) and based on the prevalence of respiratory symptoms and mortality risk. Measurements included spirometry, health questionnaires, and mortality (National Death Index).

Results

There were 2480 older participants with a mean age of 71.7 years; 1372 (55.4 % ) had a smoking history, 1097 (44.2 % ) had respiratory symptoms and, over the course of 12-years, 868 (35.0 % ) had died. Among participants with an FEV₁/FVC < .70 and FEV₁ < 5th SR-tile, representing 7.7 % of the cohort, the risk of death was doubled (adjusted hazard ratio, 2.01; 95 % confidence interval [CI], 1.60–2.54). Among participants with an FEV₁/FVC < .70 and FEV₁ < 10th SR-tile, representing 13.4 % of the cohort, the prevalence of respiratory symptoms was elevated (adjusted odds ratio, 2.44; CI, 1.79–3.33).

Conclusion

In a large, nationally representative sample of community-living older persons, defining COPD based on an FEV₁/FVC < .70, with FEV₁ cut-points at the 10th and 5th SR-tiles, identifies individuals with an increased prevalence of respiratory symptoms and an increased risk of death, respectively.