Department of Respiratory Care and Sleep Control Medicine,.
Department of Respiratory Medicine, Hikone Municipal Hospital, Shiga.
Allergol Int. 2010 Sep;59(3):257-265. doi: 10.2332/allergolint.10-RA-0184. Epub 2010 Jul 25.
Asthma and chronic obstructive pulmonary disease (COPD) are chronic respiratory disorders involving obstructive airway defects. There have been many discussions on their similarities and differences. Although airflow limitation expressed as forced expiratory volume in one second (FEV(1)) has been considered to be the main diagnostic assessment in both diseases, it does not reflect the functional impairment imparted to the patients by these diseases. Therefore, multidimensional approaches using multiple measurements in assessing disease control or severity have been recommended, and multiple endpoints in addition to FEV(1) have been set recently in clinical trials so as not to miss the overall effects. In particular, as improving symptoms and health status as well as pulmonary function are important goals in the management of asthma and COPD, some patient-reported measurements such as health-related quality of life or dyspnea should be included. Nonetheless, there have been few reviews on the long-term clinical course comparing asthma and COPD as predicted by measurements other than airflow limitation. Here, we therefore analyzed and compared longitudinal changes in both physiological measurements and patient-reported measurements in asthma and COPD. Although both diseases showed similar long-term progressive airflow limitation similarly despite guideline-based therapies, disease progression was different in asthma and COPD. In asthma, patient-reported assessments of health status, disability and psychological status remained clinically stable over time, in contrast to the significant deterioration of these parameters in COPD. Thus, because a single measurement of airflow limitation is insufficient to monitor these diseases, multidimensional analyses are important not only for disease control but also for understanding disease progression in asthma and COPD.
哮喘和慢性阻塞性肺疾病（COPD）是慢性呼吸系统疾病，涉及气道阻塞缺陷。关于它们的相似点和不同点已经有很多讨论。虽然以一秒用力呼气量（FEV1）表示的气流受限被认为是这两种疾病的主要诊断评估指标，但它并不能反映这些疾病给患者带来的功能损害。因此，已经推荐了使用多种测量方法评估疾病控制或严重程度的多维方法，并且在临床试验中除了 FEV1 之外还设定了多个终点，以避免错过整体效果。特别是，由于改善症状和健康状况以及肺功能是哮喘和 COPD 管理的重要目标，因此应该包括一些患者报告的测量，如健康相关生活质量或呼吸困难。尽管如此，关于除气流受限以外的测量预测哮喘和 COPD 的长期临床病程的综述很少。在这里，我们因此分析和比较了哮喘和 COPD 中生理测量和患者报告测量的纵向变化。尽管两种疾病尽管基于指南的治疗，但都表现出类似的长期进行性气流受限，但哮喘和 COPD 的疾病进展不同。在哮喘中，患者报告的健康状况、残疾和心理状态评估随着时间的推移保持临床稳定，而 COPD 中这些参数则显著恶化。因此，由于气流受限的单一测量不足以监测这些疾病，因此多维分析不仅对于疾病控制而且对于理解哮喘和 COPD 的疾病进展都很重要。
