"Defining Chronic Obstructive Pulmonary Disease in Older Persons"

“老年人慢性阻塞性肺疾病的定义”

• 批准号: 7870190
• 负责人: Carlos A. Vaz Fragoso
• 金额: $ 6.79万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-04-01 至 2012-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7870190
• 关键词: Abbreviations; Accounting; Address; Adrenergic beta-Antagonists; Adverse event; Affect; Age; Aging; American; Angiotensin-Converting Enzyme Inhibitors; Body Composition; Bone Density; Bronchodilator Agents; Cardiovascular system; Caring; Cessation of life; Chest; Chronic; Chronic Obstructive Airway Disease; Clinical; Data; Diabetes Mellitus; Diagnosis; Echocardiography; Elderly; European; Female; Frequencies; Gender; Goals; Gold; Guidelines; Health; Hospitalization; Individual; Integration Host Factors; Lead; Left Ventricular Ejection Fraction; Longevity; Measures; Mediator of activation protein; Mental Depression; Methods; National Health and Nutrition Examination Survey; Obstructive Lung Diseases; Outcome; Patient Care; Performance; Persons; Pharmaceutical Preparations; Pharmacotherapy; Population; Prevalence; Prospective Studies; Pulmonary Function Test/Forced Expiratory Volume 1; Relative (related person); Reporting; Research; Residual state; Risk; Risk Factors; Severities; Smoking; Smoking Status; Societies; Spirometry; Staging; Symptoms; Testing; United States National Institutes of Health; Validation; Vital capacity; World Health Organization; adverse outcome; aged; base; clinical practice; clinically relevant; cohort; community living; disability; evidence base; follow-up; health care service utilization; improved; mortality; population based; public health relevance; pulmonary function; respiratory; response

DESCRIPTION (provided by applicant): As a leading cause of disability and death worldwide, chronic obstructive pulmonary disease (COPD) is defined spirometrically, based solely on a reduced ratio of the forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC), with severity subsequently staged according to the FEV1, expressed as percent predicted (%Pred). Among older persons, current spirometric guidelines for COPD are problematic, however, for at least three reasons. First, the threshold that establishes a reduced FEV1/FVC remains controversial. Second, expressing the FEV1 as %Pred is seriously flawed, because it does not account for differences in the variability of the reference group across the lifespan. Third, current spirometric guidelines have not been rigorously validated using important clinical measures such as mortality and respiratory symptoms. In response, we have developed a two-part spirometric strategy for defining COPD that first determines a cut-point for the FEV1/FVC based on mortality risk; and then, 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 mortality risk and respiratory symptoms. Importantly, the SR-tile method accounts for variability of the reference group. The objective of this R03 application is to validate our spirometric definition of COPD, relative to current guidelines, by using data from two large population-based studies of older persons: the Health, Aging and Body Composition Study and the Cardiovascular Health Study. Validation will be based on longitudinal associations with health-related outcomes, including hospitalizations and mortality, and on cross-sectional associations with clinical features, including respiratory symptoms, physical performance, and medication use. Our long-term goal is to evaluate the risk and host factors, as well as the mediators, that underlie the association between pulmonary function and health-related outcomes, in older persons. This R03 application is an important step because it will validate an age-appropriate method for reporting pulmonary function and for defining COPD. PUBLIC HEALTH RELEVANCE: Among older persons, current spirometric guidelines may lead to misclassification (mainly over- diagnosis) of COPD and, in turn, potentially compromise patient care. We propose to validate a more evidence-based spirometric strategy that will avoid the misidentification of COPD among older persons. This could lead to more judicious use of COPD-specific pharmacotherapy and, as a result, reduce the frequency of medication-related adverse events.

描述（由申请人提供）：慢性阻塞性肺疾病 (COPD) 作为全球范围内残疾和死亡的主要原因，是通过肺活量测定来定义的，仅基于 1 秒用力呼气量 (FEV1) 与用力肺活量 (FEV1) 的比值降低 ( FVC），随后根据 FEV1 对严重程度进行分级，以预测百分比 (%Pred) 表示。然而，在老年人中，目前的慢性阻塞性肺病肺量测定指南存在问题，至少有三个原因。首先，建立降低 FEV1/FVC 的阈值仍然存在争议。其次，将 FEV1 表示为 %Pred 存在严重缺陷，因为它没有考虑参考组在整个生命周期中变异性的差异。第三，目前的肺活量测定指南尚未使用死亡率和呼吸道症状等重要临床指标进行严格验证。为此，我们制定了一个由两部分组成的肺活量测定策略来定义 COPD，首先根据死亡风险确定 FEV1/FVC 的切点；然后，在低于这一临界 FEV1/FVC 阈值的人群中，根据死亡风险和呼吸道症状确定 FEV1 的切点，以标准化剩余百分位数 (SR-tile) 表示。重要的是，SR-tile 方法考虑了参考组的变异性。此 R03 应用程序的目的是通过使用两项大型老年人研究（健康、衰老和身体成分研究以及心血管健康研究）的数据，验证我们对 COPD 的肺活量测定定义（相对于当前指南）。验证将基于与健康相关结果（包括住院和死亡率）的纵向关联，以及与临床特征（包括呼吸道症状、身体表现和药物使用）的横向关联。我们的长期目标是评估老年人肺功能与健康相关结果之间关系的风险和宿主因素以及中介因素。 R03 应用是重要的一步，因为它将验证报告肺功能和定义 COPD 的适合年龄的方法。 公共卫生相关性：在老年人中，当前的肺量测定指南可能会导致 COPD 的错误分类（主要是过度诊断），进而可能影响患者护理。我们建议验证一种更加基于证据的肺活量测定策略，以避免老年人中慢性阻塞性肺病的错误识别。这可能会导致更明智地使用慢性阻塞性肺病特异性药物治疗，从而减少与药物相关的不良事件的发生频率。