真实生活中哮喘-COPD 重叠综合征的共病模式及其影响。
Comorbidome, Pattern, and Impact of Asthma-COPD Overlap Syndrome in Real Life.
机构信息
Instituto de Investigacíón Sanitaria de Palma, Hospital Universitario Son Espases, Palma de Mallorca, Spain; Unit of Pharmacoepidemiology and Pharmacoeconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands; Department of Primary Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Instituto de Investigacíón Sanitaria de Palma, Hospital Universitario Son Espases, Palma de Mallorca, Spain; Primary Care Health Service, Servei de Salut de les Illes Balears, Palma de Mallorca, Spain.
出版信息
Chest. 2016 Apr;149(4):1011-20. doi: 10.1016/j.chest.2015.12.002. Epub 2015 Dec 14.
BACKGROUND
Asthma-COPD overlap syndrome (ACOS) has been described and acknowledged as a distinct clinical entity; however, its characteristics in daily clinical practice are largely unknown. The aim of this study was to identify the prevalence of ACOS in the real-life population, its pattern of comorbidities, and its impact on hospitalization risk.
METHODS
Data for this retrospective cohort study were extracted from the Majorca Real-Life Investigation in COPD and Asthma cohort, including primary care, hospitalization, and pharmacy data from the Balearic Islands, Spain. Patients who had received a physician-confirmed diagnosis of both asthma and COPD were identified as having ACOS and compared with a COPD-only population. In subanalyses, more stringent diagnostic criteria (Global Initiative for Asthma-Global Initiative for Chronic Obstructive Lung Disease) were applied. The pattern and impact of comorbidities on all-cause hospitalization were compared by multivariate logistic regression.
RESULTS
In total, 5,093 patients with ACOS (prevalence, 5.55 per 1,000 inhabitants) were compared with 22,778 patients with COPD (30.40 per 1,000 inhabitants). Patients with ACOS were more frequently female (53.4%) than were patients with COPD (30.8%), younger (ACOS, 64.0 years; COPD, 65.8 years), and differed by nonsmoking status (ACOS, 41.4%; COPD, 22.1%) (all, P < .001). In adjusted analyses, allergic rhinitis (OR, 1.81; 95% CI, 1.63-2.00), anxiety (OR, 1.18; 95% CI, 1.10-1.27), gastroesophageal reflux disease (OR, 1.18; 95% CI, 1.04-1.33), and osteoporosis (OR, 1.14; 95% CI, 1.04-1.26) were more frequent in ACOS than COPD. In contrast, chronic kidney disease (OR, 0.79; 95% CI, 0.66-0.95) and ischemic heart disease (OR, 0.88; 95% CI, 0.79-0.98) were less frequent. In patients with ACOS, cardiovascular diseases showed the strongest association with hospitalization.
CONCLUSIONS
ACOS is prevalent in the general population, and it affects to a large extent females with less smoking exposure compared with patients with COPD only. Cardiovascular comorbidities in particular contribute most to overall hospitalization risk of patients with ACOS.
背景
哮喘-慢性阻塞性肺疾病重叠综合征（ACOS）已被描述并被认为是一种独特的临床实体；然而，其在日常临床实践中的特征在很大程度上尚不清楚。本研究旨在确定重叠综合征在真实人群中的患病率、其合并症模式及其对住院风险的影响。
方法
本回顾性队列研究的数据来自西班牙巴利阿里群岛的 Mallorca 真实生活中的 COPD 和哮喘研究，包括初级保健、住院和药房数据。经医生确诊患有哮喘和 COPD 的患者被确定为重叠综合征患者，并与仅患有 COPD 的患者进行比较。在亚分析中，应用了更严格的诊断标准（全球哮喘倡议-全球慢性阻塞性肺疾病倡议）。通过多变量逻辑回归比较了所有合并症的模式和对全因住院的影响。
结果
共有 5093 例重叠综合征患者（患病率为每 1000 名居民 5.55 例）与 22778 例 COPD 患者（患病率为每 1000 名居民 30.40 例）进行了比较。与 COPD 患者相比，重叠综合征患者中女性更为常见（53.4% vs. 30.8%），年龄更小（重叠综合征患者 64.0 岁，COPD 患者 65.8 岁），且吸烟状况不同（重叠综合征患者 41.4%，COPD 患者 22.1%）（均<0.001）。在调整分析中，过敏性鼻炎（OR，1.81；95%CI，1.63-2.00）、焦虑（OR，1.18；95%CI，1.10-1.27）、胃食管反流病（OR，1.18；95%CI，1.04-1.33）和骨质疏松症（OR，1.14；95%CI，1.04-1.26）在重叠综合征中比 COPD 更为常见。相反，慢性肾脏病（OR，0.79；95%CI，0.66-0.95）和缺血性心脏病（OR，0.88；95%CI，0.79-0.98）则较为少见。在重叠综合征患者中，心血管疾病与住院治疗的相关性最强。
结论
重叠综合征在一般人群中较为常见，与仅患有 COPD 的患者相比，其主要影响女性，且吸烟暴露程度较低。特别是心血管合并症对重叠综合征患者的整体住院风险贡献最大。
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