Department of Pulmonology, Semmelweis University, 1/C, Diós árok, Budapest, 1125, Hungary.
Chiesi Hungary Ltd., Dunavirág u. 2, Budapest, 1138, Hungary.
Lung. 2018 Oct;196(5):591-599. doi: 10.1007/s00408-018-0141-7. Epub 2018 Jul 14.
Comorbidities associated with chronic obstructive pulmonary disease (COPD) affect quality of life and increase mortality. Asthma-COPD overlap (ACO) may express a different profile of comorbidities compared to COPD alone. It is unclear how recent changes in GOLD recommendations affect the profile of comorbidities in COPD and ACO.
Eight hundred and thirty-four patients with COPD were recruited from 67 Hungarian secondary care outpatient clinics, 469 of them had ACO. Comorbidities were defined by respiratory specialists based on medical history, patient report, and medications. COPD grades were defined according to the old 2016 and the new 2017 GOLD document. Comorbidities were compared along COPD ABCD groups determined by the old and new GOLD.
66 and 72% of the COPD patients in groups C and D (GOLD 2016) were recategorized to groups A and B (GOLD 2017), respectively. There was no difference in the prevalence of disorders along the 2016 GOLD categories except for osteoporosis in ACO (p = 0.01). When the patients were categorized according to the 2017 GOLD criteria, the prevalence of osteoporosis (p = 0.01) was different among the four groups in all COPD patients. Subgroup analysis of non-ACO COPD patients revealed inter-group differences for cardiac arrhythmia (p < 0.01). No alteration was seen in the prevalence of coronary artery disease, hypertension, diabetes, or the total number of comorbidities.
A significant number of patients are recategorized according to the GOLD 2017 criteria. This change only marginally affects the profile of comorbidities; still this needs to be considered when assessing the patients in daily practice.
与慢性阻塞性肺疾病（COPD）相关的合并症会影响生活质量并增加死亡率。哮喘-COPD 重叠（ACO）与单纯 COPD 相比，可能表现出不同的合并症特征。目前尚不清楚 GOLD 指南的最新变化如何影响 COPD 和 ACO 患者的合并症特征。
834 例 COPD 患者来自匈牙利 67 家二级保健门诊，其中 469 例患有 ACO。合并症由呼吸科专家根据病史、患者报告和药物来定义。根据旧的 2016 年和新的 2017 年 GOLD 文件定义 COPD 分级。根据旧和新的 GOLD 标准，比较 COPD ABCD 组的合并症。
在旧的 GOLD 2016 中 C 和 D 组（GOLD 2016）的 66%和 72%的 COPD 患者分别被重新分类为 A 和 B 组（GOLD 2017）。除 ACO 中的骨质疏松症（p=0.01）外，2016 年 GOLD 分类中的各种疾病的患病率没有差异。当根据 2017 年 GOLD 标准对患者进行分类时，在所有 COPD 患者中，骨质疏松症（p=0.01）在四个组之间的患病率不同。非 ACO COPD 患者的亚组分析显示心律失常（p<0.01）存在组间差异。冠心病、高血压、糖尿病或合并症总数的患病率没有变化。
根据 GOLD 2017 标准，大量患者被重新分类。这种变化仅对合并症特征产生轻微影响；但在日常实践中评估患者时需要考虑到这一点。
