論文No1362
Childhood Lung Function Predicts Adult Chronic Obstructive Pulmonary Disease and Asthma–Chronic Obstructive Pulmonary Disease Overlap Syndrome
Dinh S. Bui, John A. Burgess, Adrian J. Lowe, Jennifer L. Perret, Caroline J. Lodge, Minh Bui, Stephen Morrison, Bruce R. Thompson, Paul S. Thomas, Graham G. Giles, Judith Garcia-Aymerich, Debbie Jarvis, Michael J. Abramson, E. Haydn Walters, Melanie C. Matheson, Shyamali C. Dharmage
AJRCCM, Vol. 196, No. 1 | Jul 01, pp39-26, 2017
＜背景＞
COPDは増加しているが、若年時代のリスク因子についてはデータが少ない。
＜目的＞
小児期の肺機能が成人のCOPDフェノタイプに与える影響について調べる。
＜方法＞
気管支拡張薬投与前の肺機能を7歳のタスマニアの子供のコホート(8583名）に1968年に行い、45歳時に再度測定した。
一群(1389名）には気管支拡張薬投与前と後に肺機能を行った。
解析にあたって、COPDは気管支拡張薬投与後のFEV1/FVCが正常下限未満と肺機能的に定義した。
喘息COPDオーバーラップ症候群(ACOS)はCOPDと喘息が共存している状態と定義した。
小児期の肺機能と喘息／COPD／ACOSの関連を多変数回帰分析で検討した。
＜結果＞
45歳時点で、959名は喘息もCOPDもなかった。
269名は喘息のみ存在し、59名はCOPDのみ存在し、68名はACOSであった。
補正後の喘息のみの頻度は13.5%,COPDのみの頻度は4.1%,ACOSの頻度は2.9%であった。
７歳時点のFEV1の最低四分位はACOSと関連していた(odds ratio, 2.93; 95% confidence interval, 1.32–6.52)。
しかしCOPDのみ、喘息のみとは関連しなかった。
７歳時点のFEV1/FVCの最低四分位はACOS(odds ratio, 16.3; 95% confidence interval, 4.7–55.9)、COPD(odds ratio, 5.76; 95% confidence interval, 1.9–17.4)と関連したが、喘息のみとは関連しなかった。
＜感想＞
７歳時点の肺機能が低いと中年になった際のCOPD,ACOSのリスク因子になったようです。
Rationale: The burden of chronic obstructive pulmonary disease (COPD) is increasing, yet there are limited data on early life risk factors.
Objectives: To investigate the role of childhood lung function in adult COPD phenotypes.
Methods: Prebronchodilator spirometry was performed for a cohort of 7-year-old Tasmanian children (n = 8,583) in 1968 who were resurveyed at 45 years, and a selected subsample (n = 1,389) underwent prebronchodilator and post-bronchodilator spirometry. For this analysis, COPD was spirometrically defined as a post-bronchodilator FEV1/FVC less than the lower limit of normal. Asthma–COPD overlap syndrome (ACOS) was defined as the coexistence of both COPD and current asthma. Associations between childhood lung function and asthma/COPD/ACOS were examined using multinomial regression.
Measurements and Main Results: At 45 years, 959 participants had neither current asthma nor COPD (unaffected), 269 had current asthma alone, 59 had COPD alone, and 68 had ACOS. The reweighted prevalence of asthma alone was 13.5%, COPD alone 4.1%, and ACOS 2.9%. The lowest quartile of FEV1 at 7 years was associated with ACOS (odds ratio, 2.93; 95% confidence interval, 1.32–6.52), but not COPD or asthma alone. The lowest quartile of FEV1/FVC ratio at 7 years was associated with ACOS (odds ratio, 16.3; 95% confidence interval, 4.7–55.9) and COPD (odds ratio, 5.76; 95% confidence interval, 1.9–17.4), but not asthma alone.
Conclusions: Being in the lowest quartile for lung function at age 7 may have long-term consequences for the development of COPD and ACOS by middle age. Screening of lung function in school age children may identify a high-risk group that could be targeted for intervention. Further research is needed to understand possible modifiers of these associations and develop interventions for children with impaired lung function.