. Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis (SC) Brasil.
. Núcleo de Pesquisa em Asma e Inflamação das Vias Aéreas, Universidade Federal de Santa Catarina, Florianópolis (SC) Brasil.
J Bras Pneumol. 2020 Nov 6;47(1):e20200033. doi: 10.36416/1806-3756/e20200033. eCollection 2020.
To evaluate the frequency of asthma-COPD overlap (ACO) in patients with COPD and to compare, from a clinical, laboratory, and functional point of view, patients with and without ACO, according to different diagnostic criteria.
The participants underwent evaluation by a pulmonologist, together with spirometry and blood tests. All of the patients were instructed to record their PEF twice a day. The diagnosis of ACO was based on the Proyecto Latinoamericano de Investigación en Obstrucción Pulmonar (PLATINO, Latin American Project for the Investigation of Obstructive Lung Disease) criteria, the American Thoracic Society (ATS) Roundtable criteria, and the Spanish criteria. We investigated patient histories of exacerbations and hospitalizations, after which we applied the COPD Assessment Test and the modified Medical Research Council scale, to classify risk and symptoms in accordance with the GOLD criteria.
Of the 51 COPD patients, 14 (27.5%), 8 (12.2%), and 18 (40.0) were diagnosed with ACO on the basis of the PLATINO, ATS Roundtable, and Spanish criteria, respectively. The values for pre-bronchodilator FVC, post-bronchodilator FVC, and pre-bronchodilator FEV1 were significantly lower among the patients with ACO than among those with COPD only (1.9 ± 0.4 L vs. 2.4 ± 0.7 L, 2.1 ± 0.5 L vs. 2.5 ± 0.8 L, and 1.0 ± 0.3 L vs. 1.3 ± 0.5 L, respectively). When the Spanish criteria were applied, IgE levels were significantly higher among the patients with ACO than among those with COPD only (363.7 ± 525.9 kU/L vs. 58.2 ± 81.6 kU/L). A history of asthma was more common among the patients with ACO (p < 0.001 for all criteria).
In our sample, patients with ACO were more likely to report previous episodes of asthma and had worse lung function than did those with COPD only. The ATS Roundtable criteria appear to be the most judicious, although concordance was greatest between the PLATINO and the Spanish criteria.
评估慢性阻塞性肺疾病（COPD）患者中哮喘-COPD 重叠（ACO）的频率，并从临床、实验室和功能角度比较根据不同诊断标准，患有和不患有 ACO 的患者。
参与者由一位肺病专家进行评估，同时进行肺量计检查和血液检查。所有患者均被指示每天记录两次最大呼气流速（PEF）。ACO 的诊断基于拉丁美洲阻塞性肺疾病研究项目（PLATINO）标准、美国胸科学会（ATS）圆桌会议标准和西班牙标准。我们调查了患者的加重和住院病史，之后根据 GOLD 标准应用 COPD 评估测试和改良的医学研究委员会量表对风险和症状进行分类。
在 51 名 COPD 患者中，根据 PLATINO、ATS 圆桌会议和西班牙标准，分别有 14 名（27.5%）、8 名（12.2%）和 18 名（40.0%）患者被诊断为 ACO。与仅 COPD 患者相比，ACO 患者的支气管扩张前 FVC、支气管扩张后 FVC 和支气管扩张前 FEV1 值明显较低（1.9 ± 0.4 L 比 2.4 ± 0.7 L、2.1 ± 0.5 L 比 2.5 ± 0.8 L 和 1.0 ± 0.3 L 比 1.3 ± 0.5 L）。应用西班牙标准时，ACO 患者的 IgE 水平明显高于仅 COPD 患者（363.7 ± 525.9 kU/L 比 58.2 ± 81.6 kU/L）。ACO 患者的哮喘病史更为常见（所有标准均为 p < 0.001）。
在我们的样本中，ACO 患者比仅 COPD 患者更有可能报告以前的哮喘发作，并且肺功能更差。ATS 圆桌会议标准似乎最明智，尽管 PLATINO 和西班牙标准之间的一致性最高。
