Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Bundang CHA Hospital, College of Medicine, CHA University, Seongnam, South Korea.
Respir Med. 2010 Apr;104(4):542-9. doi: 10.1016/j.rmed.2009.10.024. Epub 2009 Nov 17.
Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous disorder in which a number of different pathological processes lead to recognition of patient subgroups that may have individual characteristics and distinct responses to treatment.
We tested the hypothesis that responses of lung function to 3 months of combined inhalation of long-acting beta-agonist and corticosteroid might differ among patients with various COPD subtypes.
We classified 165 COPD patients into four subtypes according to the severity of emphysema and airflow obstruction: emphysema-dominant, obstruction-dominant, mild-mixed, and severe-mixed. The emphysema-dominant subtype was defined by an emphysema index on computed tomography of more than 20% and FEV(1) more than 45% of the predicted value. The obstruction-dominant subtype had an emphysema index < or = 20% and FEV(1) < or = 45%, the mild-mixed subtype had an emphysema index < or = 20% and FEV(1) > 45%, and the severe-mixed subtype had an emphysema index > 20% and FEV(1) < or = 45%. Patients were recruited prospectively and treated with 3 months of combined inhalation of long-acting beta-agonist and corticosteroid.
After 3 months of combined inhalation of long-acting beta-agonist and corticosteroid, obstruction-dominant subtype patients showed a greater FEV(1) increase and more marked dyspnea improvement than did the emphysema-dominant subgroup. The mixed-subtype patients (both subgroups) also showed significant improvement in FEV(1) compared with the emphysema-dominant subgroup. Emphysema-dominant subtype patients showed no improvement in FEV(1) or dyspnea after the 3-month treatment period.
The responses to 3 months of combined inhalation of long-acting beta-agonist and corticosteroid differed according to COPD subtype.
慢性阻塞性肺疾病（COPD）是一种复杂且异质性的疾病，其中许多不同的病理过程导致了患者亚组的识别，这些亚组可能具有个体特征和对治疗的不同反应。
我们检验了以下假设，即在不同 COPD 亚型患者中，长效β激动剂和皮质激素联合吸入治疗 3 个月对肺功能的反应可能存在差异。
我们根据肺气肿和气流阻塞的严重程度将 165 例 COPD 患者分为 4 种亚型：肺气肿为主型、阻塞为主型、轻度混合型和重度混合型。肺气肿为主型的定义为 CT 上肺气肿指数大于 20%，FEV1 大于预计值的 45%。阻塞为主型的肺气肿指数小于等于 20%，FEV1 小于等于 45%；轻度混合型的肺气肿指数小于等于 20%，FEV1 大于 45%；重度混合型的肺气肿指数大于 20%，FEV1 小于等于 45%。前瞻性招募患者，并给予 3 个月的长效β激动剂和皮质激素联合吸入治疗。
联合吸入长效β激动剂和皮质激素治疗 3 个月后，阻塞为主型患者的 FEV1 增加更多，呼吸困难改善更明显，与肺气肿为主亚组相比。混合亚型患者（两组）与肺气肿为主亚组相比，FEV1 也有显著改善。在 3 个月的治疗期间，肺气肿为主型患者的 FEV1 和呼吸困难均无改善。
3 个月的长效β激动剂和皮质激素联合吸入治疗的反应根据 COPD 亚型而不同。
