Kim Sang Heon, Moon Ji Yong, Lee Jae Hyun, Ban Ga Young, Kim Sujeong, Kim Mi Ae, Kim Joo Hee, Kim Min Hye, Park Chan Sun, Park So Young, Kwon Hyouk Soo, Kwon Jae Woo, Jung Jae Woo, Kang Hye Ryun, Park Jong Sook, Kim Tae Bum, Park Heung Woo, Cho You Sook, Yoo Kwang Ha, Oh Yeon Mok, Lee Byung Jae, Jang An Soo, Cho Sang Heon, Park Hae Sim, Park Choon Sik, Yoon Ho Joo
Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Allergy Asthma Immunol Res. 2018 May;10(3):225-235. doi: 10.4168/aair.2018.10.3.225.
Severe asthma and asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) are difficult to control and are often associated with poor clinical outcomes. However, much is not understood regarding the diagnosis and treatment of severe asthma and ACOS. To evaluate the current perceptions of severe asthma and COPD among asthma and COPD specialists, we designed an e-mail and internet-based questionnaire survey.
Subjects were selected based on clinical specialty from among the members of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Academy of Tuberculosis and Respiratory Diseases. Of 432 subjects who received an e-mail invitation to the survey, 95 subjects, including 58 allergists and 37 pulmonologists, responded and submitted their answers online.
The specialists estimated that the percentage of severe cases among total asthma patients in their practice was 13.9%±11.0%. Asthma aggravation by stepping down treatment was the most common subtype, followed by frequent exacerbation, uncontrolled asthma despite higher treatment steps, and serious exacerbation. ACOS was estimated to account for 20.7% of asthma, 38.0% of severe asthma, and 30.1% of COPD cases. A history of smoking, persistently low forced expiratory volume in 1 second (FEV1), and low FEV1 variation were most frequently classified as the major criteria for the diagnosis of ACOS among asthma patients. Among COPD patients, the highly selected major criteria for ACOS were high FEV1 variation, positive bronchodilator response, a personal history of allergies and positive airway hyperresponsiveness. Allergists and pulmonologists showed different assessments and opinions on asthma phenotyping, percentage, and diagnostic criteria for ACOS.
Specialists had diverse perceptions and clinical practices regarding severe asthma and ACOS patients. This heterogeneity must be considered in future studies and strategy development for severe asthma and ACOS.
重度哮喘和哮喘-慢性阻塞性肺疾病（COPD）重叠综合征（ACOS）难以控制，且常与不良临床结局相关。然而，关于重度哮喘和ACOS的诊断及治疗仍有许多未知之处。为评估哮喘和COPD专家对重度哮喘和COPD的当前认知，我们设计了一项基于电子邮件和互联网的问卷调查。
根据临床专业从韩国哮喘、过敏与临床免疫学会以及韩国结核病与呼吸疾病学会的成员中选取研究对象。在432名收到电子邮件邀请参与调查的对象中，95名对象做出回应并在线提交了答案，其中包括58名过敏症专科医生和37名肺科医生。
专家们估计，在他们诊治的哮喘患者中，重度病例的比例为13.9%±11.0%。因逐步减少治疗而导致哮喘加重是最常见的亚型，其次是频繁发作、尽管治疗级别较高但哮喘仍未得到控制以及严重发作。ACOS估计占哮喘病例的20.7%、重度哮喘病例的38.0%以及COPD病例的30.1%。吸烟史、持续较低的第一秒用力呼气量（FEV1）以及较低的FEV1变异性是哮喘患者中最常被列为ACOS诊断主要标准的因素。在COPD患者中，ACOS高度选定的主要标准是FEV1变异性高、支气管扩张剂反应阳性、个人过敏史以及气道高反应性阳性。过敏症专科医生和肺科医生对哮喘表型、ACOS的比例及诊断标准表现出不同的评估和看法。
专家们对重度哮喘和ACOS患者有不同的认知和临床实践。在未来针对重度哮喘和ACOS的研究及策略制定中，必须考虑到这种异质性。
