Rootmensen Geert, van Keimpema Anton, Zwinderman Aeilko, Sterk Peter
a Department of Pulmonology , Academic Medical Centre , Amsterdam , the Netherlands.
b Department of Pulmonology , Waterland ziekenhuis , Purmerend , the Netherlands.
J Asthma. 2016 Dec;53(10):1026-32. doi: 10.3109/02770903.2016.1174258. Epub 2016 Jul 1.
Historically, obstructive airway diseases such as asthma and COPD are classified as different diseases. Although the definitions are clearly described, classification of patients into these traditional, clinical disease entity can be difficult. Recent evidence that there are complex, overlapping phenotypes of obstructive lung disease. Our aim was to capture clinical phenotypes of obstructive diseases through the use of cluster analysis in a representative patient population at a common Dutch pulmonary outpatient clinic. Clinical physiological and cellular/ molecular markers were used in the analysis.
To carry out the cluster analysis, an imputed dataset was created from a random sample of 191 adult patients chosen from a pulmonary outpatient clinic. The selection criteria from the sample included patients with a doctor's diagnosis for asthma or COPD. Detailed assessment of patient pulmonary function, blood eosinophil counts, allergic sensitisation and smoking history was collected.
We observed four distinct clusters with different clinical characteristics of obstructive lung diseases. Cluster 1: patients with a history of extensive cigarette smoking, airway obstruction without signs of emphysema; cluster 2: patients with features of the emphysematous type of COPD; cluster 3: patients with characteristics of allergic asthma; cluster 4: patients with features suggesting an overlap syndrome of atopic asthma and COPD.
Four phenotypes of obstructive lung disease were identified amongst patients clinically labelled as asthma or COPD. These findings emphasize the concept that there are different phenotypes of obstructive lung diseases, including overlapping and complementary disease entities. These phenotypes of chronic airways disease can serve to tailor disease management.
从历史上看，哮喘和慢性阻塞性肺疾病（COPD）等阻塞性气道疾病被归类为不同的疾病。尽管定义已明确描述，但将患者分类到这些传统的临床疾病实体中可能会很困难。最近有证据表明，阻塞性肺病存在复杂且重叠的表型。我们的目的是通过在荷兰一家普通肺部门诊的代表性患者群体中使用聚类分析来捕捉阻塞性疾病的临床表型。分析中使用了临床生理和细胞/分子标志物。
为了进行聚类分析，从一家肺部门诊随机抽取的191名成年患者中创建了一个估算数据集。样本的选择标准包括医生诊断为哮喘或COPD的患者。收集了患者肺功能、血液嗜酸性粒细胞计数、过敏致敏和吸烟史的详细评估信息。
我们观察到阻塞性肺病具有不同临床特征的四个不同聚类。聚类1：有大量吸烟史、气道阻塞但无肺气肿迹象的患者；聚类2：具有肺气肿型COPD特征的患者；聚类3：具有过敏性哮喘特征的患者；聚类4：具有提示特应性哮喘和COPD重叠综合征特征的患者。
在临床诊断为哮喘或COPD的患者中识别出了阻塞性肺病的四种表型。这些发现强调了阻塞性肺病存在不同表型的概念，包括重叠和互补的疾病实体。这些慢性气道疾病的表型可用于指导疾病管理。
