Outcomes for symptomatic non-obstructed individuals and individuals with mild (GOLD stage 1) COPD in a population based cohort.

Autor: Perez-Padilla R; National Institute of Respiratory Diseases, Mexico City, Mexico, perezpad@gmail.com., Wehrmeister FC; Federal University of Pelotas, Pelotas, Brazil., de Oca MM; Pulmonary Division, Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela., Lopez MV; Faculty of Medicine, University of the Republic, Montevideo, Uruguay., Jardim JR; Federal University of Sao Paulo, Sao Paulo, Brazil., Muiño A; Faculty of Medicine, University of the Republic, Montevideo, Uruguay., Valdivia G; Pontificia Universidad Catolica de Chile, Santiago, Chile., Menezes AMB; Federal University of Pelotas, Pelotas, Brazil.
Jazyk: angličtina
Zdroj: International journal of chronic obstructive pulmonary disease [Int J Chron Obstruct Pulmon Dis] 2018 Oct 26; Vol. 13, pp. 3549-3561. Date of Electronic Publication: 2018 Oct 26 (Print Publication: 2018).
DOI: 10.2147/COPD.S175527
Abstrakt: Background: We aimed to study the adverse outcomes of symptomatic and asymptomatic non-obstructed individuals and those with mild COPD longitudinally in participants from three Latin-American cities.
Methods: Two population-based surveys of adults with spirometry were conducted for these same individuals with a 5- to 9-year interval. We evaluated the impact of respiratory symptoms (cough, phlegm, wheezing or dyspnea) in non-obstructed individuals, and among those classified as Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 1, COPD on exacerbation frequency, mortality and FEV 1 decline, compared with asymptomatic individuals without airflow obstruction or restriction.
Results: Non-obstructed symptomatic individuals had a marginal increased risk of mortality (HR 1.3; 95% CI 0.9-1.94), increased FEV 1 decline (-4.5 mL/year; 95% CI -8.6, -0.4) and increased risk of 2+ exacerbations in the previous year (OR 2.6; 95% CI 1.2-6.5). Individuals with GOLD stage 1 had a marginal increase in mortality (HR 1.5; 95% CI 0.93-2.3) but a non-significant impact on FEV 1 decline or exacerbations compared with non-obstructed individuals.
Conclusions: The presence of respiratory symptoms in non-obstructed individuals was a predictor of mortality, lung-function decline and exacerbations, whereas the impact of GOLD stage 1 was mild and inconsistent. Respiratory symptoms were associated with asthma, current smoking, and the report of heart disease. Spirometric case-finding and treatment should target individuals with moderate-to-severe airflow obstruction and those with restriction, the groups with consistent increased mortality.
Competing Interests: Disclosure The authors report no conflicts of interest in this work.
Databáze: MEDLINE
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