Respiratory Research Unit, Pulmonary Institute, Shaare Zedek Medical Center, Jerusalem, Israel.
Rokach Pulmonary Institute, Clalit Health Services, Jerusalem, Israel.
Respiration. 2020;99(1):35-42. doi: 10.1159/000503328. Epub 2019 Nov 6.
Many studies have described asthma-COPD overlap (ACO) among patients diagnosed with asthma or chronic obstructive pulmonary disease (COPD), but less so in broad populations of patients with chronic airway obstruction.
This study aimed to (i) examine the prevalence of ACO, asthma, and COPD phenotypes among subjects referred for pulmonary function testing (PFT), who had airway obstruction in spirometry (forced expiratory volume in 1 s [FEV1]/forced vital capacity [FVC] <0.7); and (ii) delineate the therapeutic approach of each group.
Cross-sectional study of patients who were referred for PFT at the Rokach Institute, in Jerusalem. Working definitions were as follows: (a) COPD: post-bronchodilator (BD) FEV1/FVC <0.70; (b) asthma: physician-diagnosed asthma before age 40 and/or minimum post-BD increase in FEV1 or FVC of 12% and 200 mL; and (c) ACO: the combination of the 2. Demographics, smoking habits, episodes of exacerbation, health-related quality of life (HRQL), and respiratory medication utilization were analyzed.
Of 3,669 referrals from January 1 to April 30, 2017, 1,220 had airway obstruction of which 215 were included. Of these, 82 (38.1%) had ACO, 49 (22.8%) asthma, and 84 (39.1%) COPD. ACO subjects tended to (a) be predominantly female; (b) be older than asthmatics, (c) be smokers; (d) have worse HRQL in the activity domain; and (d) have more exacerbations. Treatment of ACO and COPD patients differed from that of asthmatics, but not from each other, in the proportion of subjects on maintenance treatment, use of LABA, LAMA, and ICS, alone or in combination, and in the number of inhaler devices used by patients.
ACO represented >1/3 of patients referred for PFT. Despite a clearly identifiable phenotype, ACO patients received treatment similar to COPD patients, suggesting poor ACO identification. Our data emphasize the need to raise the awareness of ACO among clinicians, in order to guide better recognition and appropriate treatment in individual patients.
许多研究已经描述了哮喘-COPD 重叠（ACO）在被诊断为哮喘或慢性阻塞性肺疾病（COPD）的患者中，但在患有慢性气道阻塞的广泛患者群体中则较少见。
本研究旨在：（i）检查接受肺功能检查（PFT）的患者中存在的 ACO、哮喘和 COPD 表型的患病率，这些患者在肺量测定中存在气道阻塞（1 秒用力呼气量[FEV1] /用力肺活量[FVC] <0.7）；（ii）描述每个组的治疗方法。
在耶路撒冷的罗卡奇研究所进行的患者的横断面研究。以下是工作定义：（a）COPD：支气管扩张剂后（BD）FEV1/FVC <0.70；（b）哮喘：40 岁之前医生诊断的哮喘，和/或 BD 后 FEV1 或 FVC 的最小增加量为 12%和 200 mL；（c）ACO：这两种情况的组合。分析了人口统计学、吸烟习惯、加重发作次数、健康相关生活质量（HRQL）和呼吸药物使用情况。
在 2017 年 1 月 1 日至 4 月 30 日期间，3669 份转诊中有 1220 份存在气道阻塞，其中 215 份纳入了研究。其中，82 名（38.1%）患有 ACO，49 名（22.8%）患有哮喘，84 名（39.1%）患有 COPD。ACO 患者倾向于：（a）主要为女性；（b）比哮喘患者年龄大；（c）吸烟；（d）在活动方面的 HRQL 较差；和（d）发作次数更多。ACO 和 COPD 患者的治疗与哮喘患者不同，但彼此之间的维持治疗、使用长效β2 激动剂（LABA）、长效抗胆碱能药物（LAMA）和吸入皮质激素（ICS）的比例、单独或联合使用的吸入器设备的数量以及因哮喘加重而住院的比例无差异。
ACO 占接受 PFT 检查的患者的 1/3 以上。尽管有明确可识别的表型，但 ACO 患者接受的治疗与 COPD 患者相似，这表明 ACO 的识别较差。我们的数据强调需要提高临床医生对 ACO 的认识，以便更好地识别和为个体患者提供适当的治疗。
Zotero 插件