美国哥伦比亚大学医学中心R. Graham Barr团队分析了老年人气道发育不协调与慢性阻塞性肺病的相关性。2020年6月9日，相关论文发表在《美国医学会杂志》上。
在MESA队列中，2531名动脉粥样硬化患者的平均年龄为69岁，女性占52.7%，其中有237名（9.4%）患COPD，气道与肺的平均比率为0.033，FEV1平均下降33 mL/y。在2294名未患COPD的参与者中，中位6.2年间有98名（4.3%）发生COPD。气道-肺部比率最低四分位数的参与者COPD发生率显著高于最高四分位数的参与者，分别为每1000人年9.8例和1.2例；但FEV1下降无显著差异，分别下降31和33 mL/y。
在CanCOLD队列中，1272名阻塞性肺病参与者的平均年龄为67岁，其中女性占44.3%。中位3.1年间，752名患者中有113名（15.0％）发生COPD，FEV1平均下降36 mL/y。气道-肺部比率最低四分位数的参与者COPD发生率显著高于最高四分位数的参与者，分别为每1000人年80.6例和24.2例，但FEV1下降并没有显著差异，分别为34和36 mL/y。
在SPIROMICS队列中，接受中位随访2.1年的1206名参与者的平均年龄为65岁，女性占44.9%，气道-肺部比率最低四分位数的参与者平均FEV1下降了37 mL/y，与MESA参与者相比无显著差异，但最高四分位数的参与者下降了55 mL/y，显著快于MESA参与者。
Title: Association of Dysanapsis With Chronic Obstructive Pulmonary Disease Among Older Adults
Author: Benjamin M. Smith, Miranda Kirby, Eric A. Hoffman, Richard A. Kronmal, Shawn D. Aaron, Norrina B. Allen, Alain Bertoni, Harvey O. Coxson, Chris Cooper, David J. Couper, Gerard Criner, Mark T. Dransfield, MeiLan K. Han, Nadia N. Hansel, David R. Jacobs, Joel D. Kaufman, Ching-Long Lin, Ani Manichaikul, Fernando J. Martinez, Erin D. Michos, Elizabeth C. Oelsner, Robert Paine, Karol E. Watson, Andrea Benedetti, Wan C. Tan, Jean Bourbeau, Prescott G. Woodruff, R. Graham Barr
Abstract: Importance Smoking is a major risk factor for chronic obstructive pulmonary disease (COPD), yet much of COPD risk remains unexplained.
Objective To determine whether dysanapsis, a mismatch of airway tree caliber to lung size, assessed by computed tomography (CT), is associated with incident COPD among older adults and lung function decline in COPD.
Design, Setting, and Participants A retrospective cohort study of 2 community-based samples: the Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study, which involved 2531 participants (6 US sites, 2010-2018) and the Canadian Cohort of Obstructive Lung Disease (CanCOLD), which involved 1272 participants (9 Canadian sites, 2010-2018), and a case-control study of COPD: the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS), which involved 2726 participants (12 US sites, 2011-2016).
Exposures Dysanapsis was quantified on CT as the geometric mean of airway lumen diameters measured at 19 standard anatomic locations divided by the cube root of lung volume (airway to lung ratio).
Main Outcomes and Measures Primary outcome was COPD defined by postbronchodilator ratio of forced expired volume in the first second to vital capacity (FEV1:FVC) less than 0.70 with respiratory symptoms. Secondary outcome was longitudinal lung function. All analyses were adjusted for demographics and standard COPD risk factors (primary and secondhand tobacco smoke exposures, occupational and environmental pollutants, and asthma).
Results In the MESA Lung sample (mean [SD] age, 69 years [9 years]; 1334 women [52.7%]), 237 of 2531 participants (9.4%) had prevalent COPD, the mean (SD) airway to lung ratio was 0.033 (0.004), and the mean (SD) FEV1 decline was 33 mL/y (31 mL/y). Of 2294 MESA Lung participants without prevalent COPD, 98 (4.3%) had incident COPD at a median of 6.2 years. Compared with participants in the highest quartile of airway to lung ratio, those in the lowest had a significantly higher COPD incidence (9.8 vs 1.2 cases per 1000 person-years; rate ratio [RR], 8.12; 95% CI, 3.81 to 17.27; rate difference, 8.6 cases per 1000 person-years; 95% CI, 7.1 to 9.2; P<.001) but no significant difference in FEV1 decline (31 vs 33 mL/y; difference, 2 mL/y; 95% CI, 2 to 5; P=.30). Among CanCOLD participants (mean [SD] age, 67 years [10 years]; 564 women [44.3%]), 113 of 752 (15.0%) had incident COPD at a median of 3.1 years and the mean (SD) FEV1 decline was 36 mL/y (75 mL/y). The COPD incidence in the lowest airway to lung quartile was significantly higher than in the highest quartile (80.6 vs 24.2 cases per 1000 person-years; RR, 3.33; 95% CI, 1.89 to 5.85; rate difference, 56.4 cases per 1000 person-years; 95% CI, 38.0 to 66.8; P<.001), but the FEV1 decline did not differ significantly (34 vs 36 mL/y; difference, 1 mL/y; 95% CI, 15 to 16; P=.97). Among 1206 SPIROMICS participants (mean [SD] age, 65 years [8 years]; 542 women [44.9%]) with COPD who were followed up for a median 2.1 years, those in the lowest airway to lung ratio quartile had a mean FEV1 decline of 37 mL/y (15 mL/y), which did not differ significantly from the decline in MESA Lung participants (P=.98), whereas those in highest quartile had significantly faster decline than participants in MESA Lung (55 mL/y [16 mL/y ]; difference, 17 mL/y; 95% CI, 32 to 3; P=.004).
Conclusions and Relevance Among older adults, dysanapsis was significantly associated with COPD, with lower airway tree caliber relative to lung size associated with greater COPD risk. Dysanapsis appears to be a risk factor associated with COPD.