肺功能检查、痰诱导和支气管激发试验：在临床实践中鉴别哮喘和 COPD 表型的诊断工具。

Pulmonary function tests, sputum induction, and bronchial provocation tests: diagnostic tools in the challenge of distinguishing asthma and COPD phenotypes in clinical practice.

机构信息

Sotiria Hospital for Diseases of the Chest, Department of Respiratory Medicine, University of Athens, Medical School, Athens, Greece.

出版信息

Int J Chron Obstruct Pulmon Dis. 2010 Sep 7;5:287-96. doi: 10.2147/copd.s9055.

DOI:10.2147/copd.s9055

PMID:20856828

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2939684/

Abstract

BACKGROUND

despite a number of important differences in the pathogenesis, course, and prognosis, asthma and chronic obstructive pulmonary disease (COPD) have many features in common. Furthermore, smoking induces considerable overlap in pathogenesis and clinical features between these conditions. This study aimed to reveal what inflammatory patterns prevail in clinically established diagnosis groups, including overlap phenotypes of asthma and COPD, and to evaluate the correlation with airway reversibility and hyperreactivity in these overlapping conditions.

METHODS

a total of 110 patients (17 healthy subjects; 16 "healthy" smokers; 46 asthma patients: 24 smokers and 22 non-smokers; and 31 COPD patients: 10 COPD patients with reversibility and 21 without) participated in the study. Induced sputum, reversibility testing, methacholine and adenosine 5'monophosphate (AMP) provocation challenges, and skin prick testing were performed. Airways inflammation was assessed by differential cell counts, and cytokines (interleukin-8 [IL-8] and tumor necrosis factor-alpha [TNF-α]) were measured in induced sputum by enzyme-linked immunosorbent assay (ELISA).

RESULTS

COPD patients with reversibility had increased sputum neutrophils, IL-8, and TNF-α levels compared to smoking asthmatics. No difference was found in inflammatory cells and cytokines between COPD subgroups. Sputum neutrophilia was inversely correlated with the change in forced expiratory volume in one second (ΔFEV(1)) in smoking asthmatic patients (r = -0.563, P = 0.036). No correlation was found between airway hyperresponsiveness (AHR), either with methacholine or AMP, and inflammation in asthmatic patients, regardless of smoking. Reversibility was not correlated with inflammation in COPD patients. However, the response to AMP challenge was correlated with sputum neutrophils (r = 0.844, P = 0.001).

CONCLUSION

although overlaps exist in the disease characteristics of asthma and COPD, the combination of lung function testing, sputum induction, and AHR reveals information that facilitates the distinction between these diseases, allowing clinicians to better tailor their therapy.

摘要

背景

尽管哮喘和慢性阻塞性肺疾病（COPD）在发病机制、病程和预后方面存在许多重要差异，但它们也有许多共同特征。此外，吸烟会导致这些疾病在发病机制和临床特征上存在很大的重叠。本研究旨在揭示在临床确定的诊断组中占主导地位的炎症模式，包括哮喘和 COPD 的重叠表型，并评估这些重叠疾病中与气道可逆性和高反应性的相关性。

方法

共有 110 名患者（17 名健康受试者；16 名“健康”吸烟者；46 名哮喘患者：24 名吸烟者和 22 名非吸烟者；31 名 COPD 患者：10 名 COPD 患者有可逆性，21 名无）参与了这项研究。进行了诱导痰、可逆性测试、乙酰甲胆碱和腺苷 5'单磷酸（AMP）激发挑战以及皮肤点刺测试。通过差异细胞计数评估气道炎症，通过酶联免疫吸附试验（ELISA）测量诱导痰中的细胞因子（白细胞介素-8 [IL-8]和肿瘤坏死因子-α [TNF-α]）。

结果

与吸烟哮喘患者相比，有可逆性的 COPD 患者的痰中性粒细胞、IL-8 和 TNF-α 水平升高。COPD 亚组之间的炎症细胞和细胞因子没有差异。痰中性粒细胞与吸烟哮喘患者用力呼气量一秒率（ΔFEV1）的变化呈负相关（r = -0.563，P = 0.036）。无论吸烟与否，气道高反应性（AHR）与乙酰甲胆碱或 AMP 均与哮喘患者的炎症无关。COPD 患者的可逆性与炎症无关。然而，AMP 挑战的反应与痰中性粒细胞相关（r = 0.844，P = 0.001）。