Kumar Avi, Kunal Shekhar, Shah Ashok
Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi 110 007, India.
Asia Pac Allergy. 2017 Oct;7(4):199-205. doi: 10.5415/apallergy.2017.7.4.199. Epub 2017 Oct 23.
Chronic obstructive pulmonary disease (COPD) is now recognized as a systemic disorder with many comorbidities. Atopy in patients with COPD and upper airways symptoms has not been characterized.
We investigated the occurrence and impact of aeroallergen sensitisation in patients with COPD and upper airways symptoms.
All 41 subjects with COPD diagnosed as per Global Initiative for Chronic Obstructive Lung Disease guidelines, underwent spirometry with reversibility, computed tomography of the paranasal sinuses (CT-PNS), skin prick test (SPT) against common aeroallergens and responded to St. George's Respiratory Questionnaire (SGRQ) and Sino Nasal Outcome Test - 22 (SNOT-22) questionnaires. Upper airways symptoms were assessed as per the Allergic Rhinitis and its Impact on Asthma guidelines.
As documented earlier, 27 of the 41 patients (65.9%) with COPD had upper airways symptoms. Of these 27 patients, 11 had SPT positivity against at least one aeroallergen (group 1). One patient had monosensitisation to pollens of grass while polysensitisation was seen in 10/11 patients commonly to weeds, trees, and insects. Fungal sensitisation to was seen in 3 of 11 patients (27.2%). In group 1, all 11 patients (100%) had radiological sinusitis as compared to 8 of 16 (50%) in group 2. The mean CT-PNS scores were significantly higher in group 1 as compared to group 2. Similarly, the SNOT-22 scores were significantly higher in group 1 as compared to group 2. However, there was no difference in SGRQ scores between the 2 groups. In group 1, there was a significant correlation between CT-PNS and SNOT-22 scores.
Patients with COPD, associated upper airways symptoms and a positive SPT had a significantly higher frequency of radiological sinusitis on CT-PNS. They even had worse quality of life as compared to those with a negative SPT. The study suggested that atopic patients with COPD and upper airways involvement were more symptomatic. It is therefore possible that upper airways symptoms, if left untreated, would result in less than desirable control of the disease.
慢性阻塞性肺疾病（COPD）现被认为是一种伴有多种合并症的全身性疾病。COPD患者合并上呼吸道症状时的特应性情况尚未得到明确描述。
我们调查了COPD合并上呼吸道症状患者中吸入性过敏原致敏的发生情况及其影响。
所有41例根据慢性阻塞性肺疾病全球倡议指南诊断为COPD的受试者，均接受了可逆性肺量计检查、鼻窦计算机断层扫描（CT-PNS）、针对常见吸入性过敏原的皮肤点刺试验（SPT），并填写圣乔治呼吸问卷（SGRQ）和鼻鼻窦结局测试-22（SNOT-22）问卷。根据变应性鼻炎及其对哮喘的影响指南对上呼吸道症状进行评估。
如先前文献记载，41例COPD患者中有27例（65.9%）有上呼吸道症状。在这27例患者中，11例对至少一种吸入性过敏原皮肤点刺试验呈阳性（第1组）。1例患者对草花粉单致敏，而11例中的10例患者常见对杂草、树木和昆虫多致敏。1例患者对真菌致敏。在第1组中，所有11例患者（100%）有鼻窦放射学炎症，而第2组16例中有8例（50%）有。第1组的平均CT-PNS评分显著高于第2组。同样，第组的SNOT-22评分显著高于第2组。然而，两组间SGRQ评分无差异。在第1组中，CT-PNS评分与SNOT-22评分之间存在显著相关性。
COPD合并上呼吸道症状且皮肤点刺试验呈阳性患者的CT-PNS上鼻窦放射学炎症发生率显著更高。与皮肤点刺试验阴性患者相比，他们的生活质量甚至更差。该研究表明，COPD合并上呼吸道受累的特应性患者症状更明显。因此，如果上呼吸道症状未得到治疗，可能导致疾病控制不理想。
