曼加利亚市沿海地区慢性呼吸系统疾病、气流阻塞、睡眠呼吸暂停风险及新型烟草使用的患病率：一项针对979名成年人的横断面研究

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中文摘要

背景： 在社区环境中，肺量计检测的气流阻塞常未被识别，构成慢性呼吸系统疾病管理中的重大诊断缺口。来自罗马尼亚沿海社区——其特征为人口高度流动，包括居民、季节性工人和游客——的基于人群的流行病学数据仍然匮乏。本研究旨在估计筛查检出的支气管舒张剂前气流阻塞和慢性呼吸系统疾病的患病率，描述包括新型烟草制品使用在内的吸烟行为，识别睡眠呼吸暂停高风险个体，并考察五个黑海沿海地区的预防保健和医疗利用模式。
方法： 作为2025年8月11日至16日开展的社区呼吸筛查活动的一部分，对罗马尼亚康斯坦察县五个沿海地区的979名成年人进行了横断面调查：Neptun（n = 147）、Olimp（n = 178）、Saturn（n = 187）、Mangalia（n = 257）和Jupiter（n = 210）。数据通过涵盖22个领域的结构化问卷收集，包括医学诊断、肺量计测量（FEV1/FVC%）、睡眠质量、打鼾、人体测量参数、合并症和医疗利用。气流阻塞定义为FEV1/FVC比值 < 70%。主要关注结局为筛查检出的支气管舒张剂前气流阻塞的患病率，包括在既往无呼吸系统诊断的个体中。睡眠呼吸暂停风险定义为习惯性打鼾与目击呼吸暂停事件的共同报告，用作两项筛查替代指标。
结果： 在979名参与者（51.4%女性；平均年龄47.3 ± 13.5岁）中，9.3%至少患有一种CRD：哮喘（4.4%）、慢性支气管炎（3.0%）、COPD（1.7%）和肺气肿（0.3%）。CRD患病率随年龄增加，从<40岁个体的6.1%升至71-80岁个体的24.2%。在973名有肺量计数据的参与者中，17.9%显示气流阻塞（FEV1/FVC < 70%），包括15.7%既往无呼吸系统诊断者，代表既往未识别的气流受限而非确诊的慢性疾病。基于习惯性打鼾和目击呼吸暂停事件两项替代指标的筛查定义OSA风险阳性见于10.9%（n = 107），在肥胖参与者中更常见（19.5% vs. 7.9%；绝对差异11.6个百分点；p < 0.001）。35.2%报告当前吸烟，8.9%报告使用新型烟草制品。流感疫苗接种覆盖率为20.0%，而肺炎球菌疫苗接种率为3.4%。
结论： 六分之一既往无呼吸系统诊断的成年人显示肺量计气流受限，提示在初级保健中开展机会性肺量计检查可显著改善罗马尼亚沿海社区的病例发现。通过基于症状的筛查替代指标评估的OSA风险存在于10.9%的参与者中，在所评估变量中较高BMI是最强的独立预测因素。高吸烟患病率（35.2%）和极低的肺炎球菌疫苗接种覆盖率（3.4%）是额外的可改变公共卫生目标。这些发现支持统一的社区呼吸筛查方法，整合肺量计、睡眠呼吸暂停风险分层和疫苗接种审计，尤其是在服务人口结构高度流动的沿海人群的初级保健环境中。

英文摘要

BACKGROUND: Spirometric airflow obstruction frequently remains unrecognised in community settings, representing a major diagnostic gap in chronic respiratory disease management. Population-based epidemiological data from Romanian coastal communities-characterised by a highly dynamic population including residents, seasonal workers, and tourists-remain scarce. This study aimed to estimate the prevalence of screening-detected pre-bronchodilator airflow obstruction and chronic respiratory diseases, characterise smoking behaviours including novel tobacco product use, identify individuals at elevated risk for sleep apnea, and examine patterns of preventive care and healthcare utilisation across five Black Sea coastal localities.
METHODS: A cross-sectional survey was conducted among 979 adults from five coastal localities in Constanța County, Romania, as part of a community-based respiratory screening campaign conducted 11-16 August 2025: Neptun (n = 147), Olimp (n = 178), Saturn (n = 187), Mangalia (n = 257), and Jupiter (n = 210). Data were collected using a structured questionnaire covering 22 domains, including medical diagnoses, spirometric measurements (FEV1/FVC%), sleep quality, snoring, anthropometric parameters, comorbidities, and healthcare utilisation. Airflow obstruction was defined as an FEV1/FVC ratio < 70%. The primary outcome of interest was the prevalence of screening-detected pre-bronchodilator airflow obstruction, including among individuals without a prior respiratory diagnosis. Sleep apnea risk was defined by the co-reporting of habitual snoring and witnessed apneic episodes, used as a two-item screening proxy.
RESULTS: Among 979 participants (51.4% female; mean age 47.3 ± 13.5 years), 9.3% had at least one CRD: asthma (4.4%), chronic bronchitis (3.0%), COPD (1.7%), and emphysema (0.3%). CRD prevalence increased with age, from 6.1% in individuals <40 years to 24.2% in those aged 71-80 years. Of 973 participants with spirometry data, 17.9% demonstrated airflow obstruction (FEV1/FVC < 70%), including 15.7% without a prior respiratory diagnosis, representing previously unrecognised airflow limitation rather than confirmed chronic disease. Screening-defined OSA-risk positivity, based on a two-item proxy of habitual snoring and witnessed apnoeic episodes, was identified in 10.9% (n = 107) and was more common among obese participants (19.5% vs. 7.9%; absolute difference 11.6 percentage points; p < 0.001). Current smoking was reported by 35.2%, and 8.9% reported the use of novel tobacco products. Influenza vaccination coverage was 20.0%, while pneumococcal vaccination uptake was 3.4%.
CONCLUSIONS: One in six adults without a prior respiratory diagnosis demonstrated spirometric airflow limitation, suggesting that opportunistic spirometry in primary care could substantially improve case detection in Romanian coastal communities. OSA risk, assessed by symptom-based screening proxy, was present in 10.9% of participants, with higher BMI as the strongest independent predictor among the variables assessed. High smoking prevalence (35.2%) and critically low pneumococcal vaccination coverage (3.4%) represent additional modifiable public health targets. These findings support a unified community respiratory screening approach incorporating spirometry, sleep apnea risk stratification, and vaccination audit, particularly in primary care settings serving coastal populations with dynamic demographics.