Fujino Naoya, Sugiura Hisatoshi
Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan.
Diagnostics (Basel). 2021 May 11;11(5):859. doi: 10.3390/diagnostics11050859.
Asthma and chronic obstructive pulmonary disease (COPD) are now recognized to be able to co-exist as asthma-COPD overlap (ACO). It is clinically relevant to evaluate whether patients with COPD concurrently have components of asthma in primary care. This is because: (i) ACO is a relatively common condition among asthma (over 40 years of age) or COPD irrespective of its diagnosis criteria; (ii) patients with ACO can have higher frequency of exacerbation and more rapid decline in lung function than those with asthma or COPD; and (iii) asthmatic features such as eosinophilic airway inflammation are promising indicators for prediction of inhaled corticosteroid-responsiveness in COPD. The aim of this review to evaluate diagnostic markers for ACO. We searched PubMed for articles related to ACO published until 2020. Articles associated with diagnostic biomarkers were included. We identified a total of 25 studies, some of which have revealed that a combination of biomarkers such as fractional exhaled nitric oxide and serum immunoglobulin E is useful to discern type 2 inflammation in the airways of COPD. Here, we review the current understanding of the clinical characteristics, biomarkers and molecular pathophysiology of ACO in the context of how ACO can be differentiated from COPD.
哮喘和慢性阻塞性肺疾病（COPD）现在被认为能够以哮喘-COPD重叠综合征（ACO）的形式共存。在初级保健中评估COPD患者是否同时存在哮喘成分具有临床意义。这是因为：（i）无论诊断标准如何，ACO在哮喘（40岁以上）或COPD患者中是一种相对常见的病症；（ii）与单纯哮喘或COPD患者相比，ACO患者可能有更高的急性加重频率和更快的肺功能下降；（iii）嗜酸性气道炎症等哮喘特征是预测COPD患者吸入糖皮质激素反应性的有前景的指标。本综述的目的是评估ACO的诊断标志物。我们在PubMed上搜索了截至2020年发表的与ACO相关的文章。纳入了与诊断生物标志物相关的文章。我们共鉴定出25项研究，其中一些研究表明，呼出气一氧化氮分数和血清免疫球蛋白E等生物标志物的组合有助于识别COPD气道中的2型炎症。在此，我们结合如何将ACO与COPD区分开来，综述目前对ACO临床特征、生物标志物和分子病理生理学的认识。
