van den Berge Maarten, Aalbers René
Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Department of Pulmonary Diseases, Martini Hospital, Groningen, the Netherlands.
J Asthma Allergy. 2016 Feb 10;9:27-35. doi: 10.2147/JAA.S78900. eCollection 2016.
It is increasingly recognized that both asthma and chronic obstructive pulmonary disease (COPD) are heterogeneous diseases with a large inter-individual variability with respect to their clinical expression, disease progression, and responsiveness to the available treatments. The introduction of asthma-COPD overlap syndrome (ACOS) may lead to a better clinical characterization and improved treatment of patients with obstructive airways disease. However, it is still in its early phase and several improvements will have to be made. First, a clear definition of ACOS and preferably also its sub-phenotypes, eg, asthma-ACOS and COPD-ACOS, is urgently needed. That would also allow researchers to design clinical studies in well-defined patients. The latter is important since the interpretation of clinical studies performed so far is hampered by the use of many different definitions of ACOS. Second, future studies are needed to investigate the role of state-of-the-art techniques such as computed tomography, genetics, and genomics in the phenotyping of patients with obstructive airways disease, ie, asthma, COPD, and ACOS. Third, longitudinal studies are now needed to better define the clinical implications of ACOS with respect to the long-term outcome and treatment of ACOS and its sub-phenotypes compared to only asthma or COPD.
人们越来越认识到，哮喘和慢性阻塞性肺疾病（COPD）都是异质性疾病，在临床表现、疾病进展以及对现有治疗的反应性方面存在很大的个体差异。哮喘-COPD重叠综合征（ACOS）的提出可能会使阻塞性气道疾病患者得到更好的临床特征描述和治疗改善。然而，它仍处于早期阶段，还需要做出一些改进。首先，迫切需要对ACOS给出明确的定义，最好还能定义其亚表型，例如哮喘-ACOS和COPD-ACOS。这也将使研究人员能够在明确界定的患者中设计临床研究。后者很重要，因为迄今为止进行的临床研究的解释受到ACOS多种不同定义的阻碍。其次，需要开展未来研究，以调查诸如计算机断层扫描、遗传学和基因组学等前沿技术在阻塞性气道疾病患者（即哮喘、COPD和ACOS）表型分析中的作用。第三，现在需要进行纵向研究，以更好地确定ACOS相对于仅哮喘或COPD在ACOS及其亚表型的长期结局和治疗方面的临床意义。
