Nadeau Myriam, Boulay Marie-Ève, Milot Joanne, Lepage Johane, Bilodeau Lara, Maltais François, Boulet Louis-Philippe
Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada.
Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada.
Respir Med. 2017 Apr;125:82-88. doi: 10.1016/j.rmed.2017.03.005. Epub 2017 Mar 6.
Asthma with incomplete reversibility of airway obstruction (IRAO) may often be associated to smoking-induced changes. Nevertheless, a high proportion of patients showing IRAO have never smoked. These patients with IRAO often share features of patients with chronic obstructive pulmonary disease (COPD). Although IRAO is still a poorly defined condition, it has been associated with a higher morbidity and mortality than asthma with complete reversibility of airway obstruction (CRAO) or even COPD alone. A high prevalence of comorbidities could contribute to the reported poorer clinical outcome in IRAO, in comparison to CRAO or COPD alone.
To determine the prevalence of past and current comorbidities in IRAO patients compared to patients with CRAO or COPD.
This was a retrospective, cross-sectional study. Demographic data, clinical characteristics and 36 predetermined comorbidities documented from self-report and chart review, were recorded from smoking-associated IRAO (S-IRAO), non-smoking IRAO (NS-IRAO), CRAO and COPD patients.
A total of 199 patients were included in the final analysis (111F/88M, mean (±SD) age of 63 ± 10 years). The CRAO group had more comorbidities than the three other groups, but this difference was significant only with the NS-IRAO group (P = 0.04). For most comorbidities, the prevalence of comorbidities in both IRAO sub-groups was intermediate between CRAO and COPD, with significant differences between S-IRAO and NS-IRAO only for hypertension (P = 0.03), nasal polyps (P = 0.002) and pneumonia (P = 0.04). Typical asthma-associated comorbidities tended to be more prevalent in NS-IRAO patients and COPD-associated comorbidities in S-IRAO patients.
In this study, the prevalence of comorbidities was not superior in patients with IRAO, compared to those with CRAO or COPD alone. The prevalence of comorbidities in the two main types of IRAO patients reflects exposure to cigarette smoke and asthma-related mechanisms.
气道阻塞不完全可逆（IRAO）的哮喘常与吸烟引起的变化有关。然而，很大一部分表现为IRAO的患者从未吸烟。这些IRAO患者常具有慢性阻塞性肺疾病（COPD）患者的特征。尽管IRAO仍是一种定义不明确的疾病，但与气道阻塞完全可逆（CRAO）的哮喘甚至单独的COPD相比，它与更高的发病率和死亡率相关。与CRAO或单独的COPD相比，共病的高患病率可能导致IRAO患者报告的临床结局较差。
确定与CRAO或COPD患者相比，IRAO患者过去和当前共病的患病率。
这是一项回顾性横断面研究。从吸烟相关的IRAO（S-IRAO）、非吸烟IRAO（NS-IRAO）、CRAO和COPD患者中记录人口统计学数据、临床特征以及通过自我报告和病历审查记录的36种预先确定的共病情况。
共有199例患者纳入最终分析（111例女性/88例男性，平均（±标准差）年龄63±10岁）。CRAO组的共病比其他三组更多，但仅与NS-IRAO组差异有统计学意义（P = 0.04）。对于大多数共病，两个IRAO亚组的共病患病率介于CRAO和COPD之间，仅高血压（P = 0.03）、鼻息肉（P = 0.002）和肺炎（P = 0.04）在S-IRAO和NS-IRAO之间存在显著差异。典型的哮喘相关共病在NS-IRAO患者中往往更普遍，而COPD相关共病在S-IRAO患者中更普遍。
在本研究中，与单独的CRAO或COPD患者相比，IRAO患者的共病患病率并不更高。两种主要类型的IRAO患者的共病患病率反映了接触香烟烟雾和哮喘相关机制的情况。
