Unit of Epidemiology and Medical Statistics, Dept of Diagnostics and Public Health, University of Verona, Verona, Italy
Unit of Epidemiology and Medical Statistics, Dept of Diagnostics and Public Health, University of Verona, Verona, Italy.
Eur Respir J. 2021 Nov 25;58(5). doi: 10.1183/13993003.04656-2020. Print 2021 Nov.
Patients with concomitant features of asthma and chronic obstructive pulmonary disease (COPD) have a heavy disease burden.Using data collected prospectively in the European Community Respiratory Health Survey, we compared the risk factors, clinical history and lung function trajectories from early adulthood to late sixties of middle-aged subjects with asthma+COPD (n=179), past (n=263) or current (n=808) asthma alone, COPD alone (n=111) or none of these (n=3477).Interview data and pre-bronchodilator forced expiratory volume in 1 s (FEV) and forced vital capacity (FVC) were obtained during three clinical examinations in 1991-1993, 1999-2002 and 2010-2013. Disease status was classified in 2010-2013, when the subjects were aged 40-68 years, according to the presence of fixed airflow obstruction (post-bronchodilator FEV/FVC below the lower limit of normal), a lifetime history of asthma and cumulative exposure to tobacco or occupational inhalants. Previous lung function trajectories, clinical characteristics and risk factors of these phenotypes were estimated.Subjects with asthma+COPD reported maternal smoking (28.2%) and respiratory infections in childhood (19.1%) more frequently than subjects with COPD alone (20.9% and 14.0%, respectively). Subjects with asthma+COPD had an impairment of lung function at age 20 years that tracked over adulthood, and more than half of them had asthma onset in childhood. Subjects with COPD alone had the highest lifelong exposure to tobacco smoking and occupational inhalants, and they showed accelerated lung function decline during adult life.The coexistence between asthma and COPD seems to have its origins earlier in life compared to COPD alone. These findings suggest that prevention of this severe condition, which is typical at older ages, should start in childhood.
患有哮喘和慢性阻塞性肺疾病（COPD）并存特征的患者疾病负担沉重。我们使用前瞻性收集的欧洲社区呼吸健康调查数据，比较了中年患者（年龄 40-68 岁）的风险因素、临床病史和肺功能轨迹，这些患者患有哮喘+COPD（n=179）、既往（n=263）或当前（n=808）哮喘、COPD 单独（n=111）或均无这些疾病（n=3477）。在 1991-1993 年、1999-2002 年和 2010-2013 年的三次临床检查中获得了问卷调查数据以及支气管扩张剂前用力呼气 1 秒量（FEV）和用力肺活量（FVC）。根据支气管扩张剂后 FEV/FVC（低于正常下限）固定气流阻塞、终生哮喘史和烟草或职业性吸入剂累积暴露情况，在 2010-2013 年对疾病状态进行了分类。这些表型的既往肺功能轨迹、临床特征和危险因素。哮喘+COPD 患者报告母亲吸烟（28.2%）和儿童时期呼吸道感染（19.1%）的比例高于 COPD 患者（分别为 20.9%和 14.0%）。哮喘+COPD 患者在 20 岁时肺功能受损，且该损害一直持续到成年期，其中超过一半的患者在儿童时期就出现哮喘。COPD 患者终生暴露于烟草和职业性吸入剂的程度最高，并且在成年期肺功能下降速度最快。与单独 COPD 相比，哮喘和 COPD 同时存在的情况似乎在生命早期就已经存在。这些发现表明，应在儿童时期就开始预防这种在老年时更为典型的严重疾病。
