Jo Yong Suk, Lee Jinwoo, Yoon Ho Il, Kim Deog Kyeom, Yoo Chul-Gyu, Lee Chang-Hoon
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Ann Allergy Asthma Immunol. 2017 Jun;118(6):696-703.e1. doi: 10.1016/j.anai.2017.04.010.
A unified definition of asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) is not available, which makes it difficult to evaluate the prevalence and clinical features of patients with ACOS.
To investigate the prevalence and clinical characteristics of ACOS according to the updated widely accepted diagnostic criteria.
Participants were enrolled from a prospective cohort study conducted between April 2013 and November 2016 in South Korea. We adopted 4 criteria of ACOS: modified Spanish, American Thoracic Society (ATS) Roundtable criteria, the Latin American Project for the Investigation of Obstructive Lung Disease (PLATINO), and the Global Initiative for Asthma/Global Initiative for Chronic Obstructive Lung Disease (GINA/GOLD) criteria. The prevalence, clinical characteristics, and exacerbations of ACOS were investigated.
Among 301 patients with chronic obstructive pulmonary disease, 31.3%, 11.9%, 48.3%, and 46.15% were diagnosed with ACOS according to the modified Spanish, ATS Roundtable criteria, PLATINO, and GINA/GOLD criteria, respectively. Compared with other criteria, patients with ACOS diagnosed according to the modified Spanish criteria had better exercise capacity and lung function at baseline but higher risk of moderate to severe (adjusted hazard ratio, 1.97; 95% confidence interval, 1.14-3.41; P = .01) and total (adjusted odds ratio, 2.10; 95% confidence interval, 1.33-3.31; P < .01) exacerbations during at least a 1-year follow-up period than patients without ACOS.
The prevalence of ACOS varied according to the diagnostic criteria. Among the different criteria, the modified Spanish criteria could identify patients with more asthmatic features and higher risk of exacerbation.
ClinicalTrials.gov Identifier: NCT02527486.
目前尚无哮喘-慢性阻塞性肺疾病重叠综合征（ACOS）的统一定义，这使得评估ACOS患者的患病率和临床特征变得困难。
根据最新的广泛接受的诊断标准，调查ACOS的患病率和临床特征。
研究对象来自于2013年4月至2016年11月在韩国进行的一项前瞻性队列研究。我们采用了4种ACOS诊断标准：改良西班牙标准、美国胸科学会（ATS）圆桌会议标准、拉丁美洲阻塞性肺疾病调查项目（PLATINO）标准以及全球哮喘防治创议/慢性阻塞性肺疾病全球倡议（GINA/GOLD）标准。对ACOS的患病率、临床特征和急性加重情况进行了调查。
在301例慢性阻塞性肺疾病患者中，根据改良西班牙标准、ATS圆桌会议标准、PLATINO标准和GINA/GOLD标准诊断为ACOS的患者分别占31.3%、11.9%、48.3%和46.15%。与其他标准相比，根据改良西班牙标准诊断为ACOS的患者在基线时运动能力和肺功能较好，但在至少1年的随访期内，中重度（调整后风险比，1.97；95%置信区间，1.14-3.41；P = 0.01）和总体（调整后优势比，2.10；95%置信区间，1.33-3.31；P < 0.01）急性加重的风险高于非ACOS患者。
ACOS的患病率因诊断标准而异。在不同标准中，改良西班牙标准能够识别出具有更多哮喘特征且急性加重风险更高的患者。
ClinicalTrials.gov标识符：NCT02527486。
