致编辑:
We read with interest the article by Camp等。[[1]发表在European Respiratory Journal。在这项研究中,基于定性和定量计算机断层扫描(CT)扫描措施,作者确定,暴露于生物量烟雾的女性的肺气肿少于暴露于烟草烟雾的女性,并被肺活量测定法观察到类似的阻塞[1]。In addition, they described the presence of bronchiectasis in 14% of the biomass-exposed women compared to 0% of the tobacco-exposed women, without differences between the groups in the quantitative measures of air trapping or airway thickness on the inspiratory scans [1]。最后,作者得出的结论是,这是第一项研究,显示出生物量的活着女性中慢性阻塞性肺疾病(COPD)表型的差异相对烟草烟[1]。However, there have been previous studies investigating the differences in clinical presentation, pulmonary function tests and CT scan findings between COPD related to wood smoke and tobacco smoke [[2-5]。在2008年,Torres-DUque等。[[6]关于生物质燃料和呼吸系统疾病的证据,介绍了有关与吸烟和生物质烟有关的COPD之间的相似性和差异的现有信息。
哥伦比亚最近的一项研究[3]比较了与木烟和烟草烟有关的严重COPD中的CT扫描和功能性发现。两组的气流障碍物测量,肺部体积的过度充气和气道阻力的增加相似。根据CT扫描,我们证明,与吸烟相关的COPD的女性不同,患有木烟相关的COPD和严重阻塞的女性没有肺气肿,但确实有明显的气道参与,表现为周长的增厚(75%(75%)相对10%, p=0,008) and bronchial dilation (67%相对10%,p = 0,024)。此外,它们具有灌木丛的模式(25%)和亚段性障碍症(33%),在与烟草烟相关的COPD的患者中都没有发现。与CT的发现一致,与木烟相关的COPD的妇女的散射能力降低了一氧化碳的散射能力(dLCO)和dLCO/肺泡体积比比吸烟相关的女性和类似的阻塞等级[3]。在没有肺气肿的没有阻塞的患者中,这种功能发现已有报道,可能是由于严重的支气管阻塞和在确定单次呼吸期间启发的气体混合不完全的原因dLCO。With these results, we postulated that the airflow obstruction in wood smoke COPD is mainly caused by severe airway involvement rather than by a loss of elastic recoil due to emphysema. Similar to our results, a recent study from Brazil [4]表明,在木烟雾COPD组中,CT扫描最常见的发现是支气管壁增厚(66.7%),支气管扩张(54.8%),马赛克灌注图案(45.2%),实质带,实质带,树上的bud模式和层状肺不张(p <0.001相对the control group for all) and, in contrast, emphysema was uncommon. The authors described a positive association between bronchial wall thickening and hour-years of wood smoke exposure [4]。
In another study in women with similar age and baseline airflow obstruction, it was demonstrated that the bronchial hyperresponsiveness level was more severe in wood smoke COPD than in tobacco smoke COPD using the methacholine challenge test (p<0.028) [5]。With these findings, it was suggested that the observed greater airway involvement induced by the chronic exposure to wood smoke could explain the differences in bronchial hyperresponsiveness between the two groups [5]。
In conclusion, the study from Camp等。[[1]补充了有关临床表现,肺功能测试以及与烟雾相关的COPD之间的CT发现的显着差异的现有信息,从而增强了木烟COCD可以配置不同的表型的事实。这些研究的信息[[[1-5]有助于更好地理解COPD,并建议在COPD一词中包括不同的刺激物引起的病理生理上不同的疾病。
Footnotes
利益冲突:没有声明。
- receiveddecember 20, 2013.
- 公认2014年1月11日。
- ©ERS 2014