Fabbri Leonardo M, Romagnoli Micaela, Corbetta Lorenzo, Casoni Gianluca, Busljetic Kamelija, Turato Graziella, Ligabue Guido, Ciaccia Adalberto, Saetta Marina, Papi Alberto
Research Center on Asthma and COPD, University of Ferrara, Italy.
Am J Respir Crit Care Med. 2003 Feb 1;167(3):418-24. doi: 10.1164/rccm.200203-183OC. Epub 2002 Nov 8.
To determine whether patients with fixed airflow obstruction have distinct pathologic and functional characteristics depending on a history of either asthma or chronic obstructive pulmonary disease (COPD), we characterized 46 consecutive outpatients presenting with fixed airflow obstruction by clinical history, pulmonary function tests, exhaled nitric oxide, sputum analysis, bronchoalveolar lavage, bronchial biopsy, and high-resolution computed tomography chest scans. Subjects with a history of COPD (n = 27) and subjects with a history of asthma (n = 19) had a similar degree of fixed airflow obstruction (FEV1: 56 +/- 2 versus 56 +/- 3% predicted) and airway hyperresponsiveness (PC20FEV1: 2.81 [3.1] versus 1.17 [3.3]). Subjects with a history of asthma had significantly more eosinophils in peripheral blood, sputum, bronchoalveolar lavage, and airway mucosa; fewer neutrophils in sputum and bronchoalveolar lavage fluid; a higher CD4+/CD8+ ratio of T cells infiltrating the airway mucosa; and a thicker reticular layer of the epithelial basement membrane. They also had significantly lower residual volume, higher diffusing capacity, higher exhaled nitric oxide, lower high-resolution computed tomography scan emphysema score, and greater reversibility to bronchodilator and steroids. In conclusion, despite similar fixed airflow obstruction, subjects with a history of asthma have distinct characteristics compared with subjects with a history of COPD and should be properly identified and treated.
为了确定存在固定性气流受限的患者是否因哮喘或慢性阻塞性肺疾病（COPD）病史而具有不同的病理和功能特征，我们通过临床病史、肺功能测试、呼出一氧化氮、痰液分析、支气管肺泡灌洗、支气管活检和胸部高分辨率计算机断层扫描，对46例连续就诊的存在固定性气流受限的门诊患者进行了特征分析。有COPD病史的受试者（n = 27）和有哮喘病史的受试者（n = 19）具有相似程度的固定性气流受限（第一秒用力呼气容积[FEV1]：预测值的56±2%对56±3%）和气道高反应性（使FEV1下降20%的激发浓度[PC20FEV1]：2.81[3.1]对1.17[3.3]）。有哮喘病史的受试者外周血、痰液、支气管肺泡灌洗和气道黏膜中的嗜酸性粒细胞明显更多；痰液和支气管肺泡灌洗液中的中性粒细胞更少；浸润气道黏膜的T细胞的CD4+/CD8+比值更高；上皮基底膜的网状层更厚。他们的残气量也明显更低，弥散能力更高，呼出一氧化氮更高，胸部高分辨率计算机断层扫描肺气肿评分更低，对支气管扩张剂和类固醇的反应性更高。总之，尽管存在相似的固定性气流受限，但有哮喘病史的受试者与有COPD病史的受试者相比具有不同的特征，应予以正确识别和治疗。
