Division of Pulmonary Diseases & Critical Care Medicine, Department of Medicine, University of Texas Health at San Antonio, San Antonio, Texas.
Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas.
Ann Allergy Asthma Immunol. 2019 Oct;123(4):335-344. doi: 10.1016/j.anai.2019.07.021. Epub 2019 Jul 31.
To review the latest literature on management approaches to patients with asthma chronic obstructive pulmonary disease (COPD) overlap (ACO).
Studies and reports were identified from the databases of PubMed/Medline and ClinicalTrials.gov from the US National Institutes of Health and the Cochrane Register of Controlled Trials.
Studies on the management of asthma, COPD, and ACO were included in this review.
Patients with asthma COPD overlap tend to have greater morbidity than those with asthma or COPD alone, but the information on the best therapeutic approach to this group of patients is still limited. Current treatment recommendations rely on expert opinions, roundtable discussions, and strategy documents, because most clinical studies in asthma and COPD have excluded patients with ACO. Because of the potential risk described in patients with asthma with the use of long-acting 2 agonist monotherapy, initial therapy for patients with ACO is recommended to include a long-acting bronchodilator in conjunction with inhaled corticosteroids. Long-acting muscarinic antagonists are effective in both asthma and COPD and should be considered in ACO as an add-on treatment. If inhaler therapy is not effective, advanced therapies based on phenotyping and identification of treatable traits may be considered.
Few studies have evaluated prospectively therapies in the ACO population, and future studies need to determine best strategies for the treatment of these patients, focusing on targeting its different phenotypes and its treatable traits.
回顾哮喘-慢性阻塞性肺疾病（COPD）重叠（ACO）患者管理方法的最新文献。
从美国国立卫生研究院的 PubMed/Medline 和 ClinicalTrials.gov 数据库以及 Cochrane 对照试验登记处确定了研究和报告。
本综述纳入了关于哮喘、COPD 和 ACO 管理的研究。
与仅患有哮喘或 COPD 的患者相比，哮喘-COPD 重叠患者的发病率更高，但针对这组患者的最佳治疗方法的信息仍然有限。目前的治疗建议依赖于专家意见、圆桌讨论和策略文件，因为哮喘和 COPD 的大多数临床研究都排除了 ACO 患者。由于长期使用 2 激动剂单药治疗哮喘患者存在潜在风险，建议对 ACO 患者进行初始治疗，包括长效支气管扩张剂联合吸入皮质类固醇。长效抗胆碱能药物在哮喘和 COPD 中均有效，在 ACO 中应作为附加治疗考虑。如果吸入器治疗无效，则可以考虑基于表型和可治疗特征鉴定的先进治疗方法。
很少有研究前瞻性地评估 ACO 人群中的治疗方法，未来的研究需要确定针对这些患者的最佳治疗策略，重点是针对其不同的表型和可治疗特征。
