中国 40 岁以上伴气流受限的哮喘-COPD 重叠患者的现状：一项多中心、横断面、非干预性研究。
Current situation of asthma-COPD overlap in Chinese patients older than 40 years with airflow limitation: a multicenter, cross-sectional, non-interventional study.
机构信息
Department of Respiratory Medicine, The First Hospital of China Medical University, Shenyang, 110001, China.
State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
出版信息
Ther Adv Respir Dis. 2020 Jan-Dec;14:1753466620961699. doi: 10.1177/1753466620961699.
BACKGROUND AND AIMS
Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) is poorly recognized in China. Our study determined the distribution of ACO and its clinical characteristics among patients (aged ⩾40 years) with airflow limitation at Chinese tertiary hospitals.
METHODS
This cross-sectional, non-interventional study (NCT02600221), conducted between December 2015 and October 2016 in 20 Tier-3 Chinese hospitals, included patients aged ⩾40 years with post-bronchodilator (BD) FEV/FVC <0.7. The primary variable was distribution of ACO in adults with post-BD forced expiratory volume /forced vital capacity (FEV/FVC) <0.7 based on Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2015 and 2017 reports. Other variables included determination of characteristics of ACO and its clinical recognition rate.
RESULTS
In 2003 patients (mean age 62.30 ± 9.86 years), distribution of ACO, COPD and asthma were 37.40%, 48.50% and 14.10%, respectively. Proportions of patients with A, B, C and D grouping were 11.70%, 31.00%, 6.90% and 50.30% as per GOLD 2017, whereas they were 15.10%, 51.10%, 3.60% and 30.20% as per GOLD 2015. Similar clinical symptoms were reported in all three groups. A higher percentage of ACO patients presented with dyspnea, wheezing and chest tightness. Compared with the COPD group, a greater proportion of ACO patients reported wheezing (74.6% and 65.40%), while a lower proportion in the ACO group reported cough (79.40% 82.70%) and expectoration (76.50% 81.60%). Blood eosinophil count ⩾0.3 × 10/L was observed in 34.6% of ACO patients. The clinical recognition rate of ACO was 31.4%.
CONCLUSION
Despite ACO affecting two-fifths of the study population, the initial diagnosis rate was low at 6% in China, thus warranting concerted efforts to improve ACO diagnosis.
CLINICALTRIALS.GOV: [ClinicalTrials.gov identifier: NCT02600221] registered 22 October 2015, https://clinicaltrials.gov/ct2/show/NCT02600221
背景和目的
在中国，哮喘-慢性阻塞性肺疾病（COPD）重叠（ACO）未得到充分认识。我们的研究旨在确定中国三级医院气流受限患者（年龄 ⩾40 岁）中 ACO 的分布及其临床特征。
方法
这是一项横断面、非干预性研究（NCT02600221），于 2015 年 12 月至 2016 年 10 月在中国 20 家三级医院进行，纳入年龄 ⩾40 岁、支气管扩张剂后（BD）用力呼气量/用力肺活量（FEV/FVC）<0.7 的患者。主要变量是根据全球慢性阻塞性肺疾病倡议（GOLD）2015 年和 2017 年报告，在支气管扩张剂后 FEV/FVC<0.7 的成人中 ACO 的分布。其他变量包括确定 ACO 的特征及其临床识别率。
结果
在 2003 名患者（平均年龄 62.30±9.86 岁）中，ACO、COPD 和哮喘的分布分别为 37.40%、48.50%和 14.10%。按照 GOLD 2017 年的标准，A、B、C 和 D 组的患者比例分别为 11.70%、31.00%、6.90%和 50.30%，而按照 GOLD 2015 年的标准，A、B、C 和 D 组的患者比例分别为 15.10%、51.10%、3.60%和 30.20%。三组均报告有相似的临床症状。ACO 患者呼吸困难、喘息和胸闷的比例更高。与 COPD 组相比，更多的 ACO 患者报告有喘息（74.6%和 65.40%），而 ACO 组报告咳嗽（79.40%和 82.70%）和咳痰（76.50%和 81.60%）的比例较低。34.6%的 ACO 患者血嗜酸粒细胞计数 ⩾0.3×10/L。ACO 的临床识别率为 31.4%。
结论
尽管 ACO 影响了研究人群的五分之二，但中国的初始诊断率仅为 6%，因此需要共同努力提高 ACO 的诊断率。
临床试验。政府：[临床试验.gov 标识符：NCT02600221]于 2015 年 10 月 22 日注册，https://clinicaltrials.gov/ct2/show/NCT02600221
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