St Luke's Roosevelt Hospital Center, Columbia University, New York, NY, USA.
COPD. 2010 Oct;7(5):366-74. doi: 10.3109/15412555.2010.510159.
This review summarizes the current information on the relationship between severe alpha-1 antitrypsin deficiency (AATD), asthma and COPD. AATD is a genetic predisposition to the development of early COPD in susceptible individuals and reduction in known factors that enhance lung function loss is the paramount aim of management. Asthma is one controllable condition that leads to the accelerated decline in lung function. Current literature indicates that asthma signs and symptoms are common in those AATD with or without COPD and that bronchodilator response is a risk factor for FEV(1) decline. Furthermore AATD itself predisposes to airway hyper responsiveness, an essential ingredient for reversible airflow obstruction. In the absence of well-characterized markers to distinguish COPD from asthma, clinical diagnosis leads to a delay in the recognition that asthma symptoms such as wheezing can be an early manifestation of COPD in AATD. In addition failure to appreciate asthma overlap in AATD may lead to inadequate suppression of airway inflammation leading to the development of airflow obstruction. The implications of this are discussed as are potential approaches and recommendations for treatment.
这篇综述总结了严重的α-1 抗胰蛋白酶缺乏症（AATD）、哮喘和 COPD 之间关系的现有信息。AATD 是易感个体发生早期 COPD 的遗传易感性，减少已知的增强肺功能丧失的因素是管理的首要目标。哮喘是导致肺功能加速下降的一种可控制的疾病。目前的文献表明，哮喘的体征和症状在有或没有 COPD 的 AATD 中很常见，并且支气管扩张剂反应是 FEV(1)下降的一个危险因素。此外，AATD 本身易患气道高反应性，这是可逆性气流阻塞的一个重要因素。由于缺乏明确的标志物来区分 COPD 和哮喘，临床诊断导致人们认识到喘息等哮喘症状可能是 AATD 中 COPD 的早期表现的时间延迟。此外，由于未能认识到 AATD 中哮喘的重叠，可能导致气道炎症的抑制不足，从而导致气流阻塞的发展。本文讨论了这些问题的影响，以及治疗的潜在方法和建议。
