Baarnes Camilla Boslev, Andersen Zorana Jovanovic, Tjønneland Anne, Ulrik Charlotte Suppli
Department of Pulmonary Medicine, Hvidovre Hospital, Hvidovre.
Center for Epidemiology and Screening, Department of Public Health, University of Copenhagen.
Int J Chron Obstruct Pulmon Dis. 2017 Feb 10;12:571-579. doi: 10.2147/COPD.S123167. eCollection 2017.
Incidence and prognosis for severe asthma-COPD overlap is poorly characterized. We investigated incidence and long-term outcome for patients with asthma-COPD overlap compared to asthma and COPD alone.
A total of 57,053 adults (aged 50-64 years) enrolled in the Danish Diet, Cancer, and Health cohort (1993-1997) were followed in the National Patients Registry for admissions for asthma (DJ45-46) and COPD (DJ40-44) and vital status. Asthma-COPD overlap was defined as at least one hospital admission for asthma and one for COPD (different time points), and incident asthma-COPD overlap as at least one of the diagnoses occurring after enrollment into the Diet, Cancer, and Health cohort.
A total of 1,845 (3.2%) and 4,037 (7.1%) participants had admissions for asthma and COPD, respectively, with 662 (1.2%) participants with asthma-COPD overlap. Incidence rate of asthma-COPD overlap per 1,000 person-years was higher in women (0.73) than in men (0.54) (<0.02). Mortality rate was higher in asthma-COPD overlap (25.9 per 1,000 person-years) compared with COPD (23.1, <0.05) and asthma (7.9, <0.001) alone. Compared to COPD alone, mortality was higher in women with asthma-COPD overlap (19.6 and 25.5, respectively; <0.01), and the excess mortality rate for asthma-COPD overlap patients was most prominent for younger age groups (12.9 compared to 7.2 and 4.6 for COPD and asthma alone, respectively; <0.01).
This large population-based study revealed a higher incidence of severe asthma-COPD overlap in women compared to men, and furthermore that all-cause mortality is higher in women and younger subjects with asthma-COPD overlap compared with those with asthma or COPD alone.
重度哮喘-慢性阻塞性肺疾病重叠综合征的发病率和预后特征尚不明确。我们调查了哮喘-慢性阻塞性肺疾病重叠综合征患者相较于单纯哮喘和单纯慢性阻塞性肺疾病患者的发病率及长期预后情况。
丹麦饮食、癌症与健康队列研究（1993 - 1997年）纳入的57053名成年人（年龄50 - 64岁）在国家患者登记处接受随访，记录哮喘（DJ45 - 46）和慢性阻塞性肺疾病（DJ40 - 44）的入院情况及生命状态。哮喘-慢性阻塞性肺疾病重叠综合征定义为至少有一次哮喘住院记录和一次慢性阻塞性肺疾病住院记录（不同时间点），新发哮喘-慢性阻塞性肺疾病重叠综合征定义为在纳入饮食、癌症与健康队列研究后出现至少其中一种诊断。
分别有1845名（3.2%）和4037名（7.1%）参与者因哮喘和慢性阻塞性肺疾病入院，其中662名（1.2%）参与者患有哮喘-慢性阻塞性肺疾病重叠综合征。哮喘-慢性阻塞性肺疾病重叠综合征的发病率为每1000人年0.73例，女性高于男性（0.54例）（<0.02）。哮喘-慢性阻塞性肺疾病重叠综合征患者的死亡率（每1000人年25.9例）高于单纯慢性阻塞性肺疾病患者（23.1例，<0.05）和单纯哮喘患者（7.9例，<0.001）。与单纯慢性阻塞性肺疾病相比，患有哮喘-慢性阻塞性肺疾病重叠综合征的女性死亡率更高（分别为19.6例和25.5例；<0.01），且哮喘-慢性阻塞性肺疾病重叠综合征患者的超额死亡率在较年轻年龄组最为显著（分别为12.9例，而单纯慢性阻塞性肺疾病和单纯哮喘患者分别为7.2例和4.6例；<0.01）。
这项基于大规模人群的研究表明，女性重度哮喘-慢性阻塞性肺疾病重叠综合征的发病率高于男性，此外，患有哮喘-慢性阻塞性肺疾病重叠综合征的女性和较年轻患者的全因死亡率高于单纯哮喘或单纯慢性阻塞性肺疾病患者。
