COPD 和重度哮喘队列中 COPD-哮喘重叠患者的表型。
Phenotype of Asthma-COPD Overlap in COPD and Severe Asthma Cohorts.
机构信息
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
出版信息
J Korean Med Sci. 2022 Aug 1;37(30):e236. doi: 10.3346/jkms.2022.37.e236.
BACKGROUND
Asthma and chronic obstructive pulmonary disease (COPD) are airway diseases with similar clinical manifestations, despite differences in pathophysiology. Asthma-COPD overlap (ACO) is a condition characterized by overlapping clinical features of both diseases. There have been few reports regarding the prevalence of ACO in COPD and severe asthma cohorts. ACO is heterogeneous; patients can be classified on the basis of phenotype differences. This study was performed to analyze the prevalence of ACO in COPD and severe asthma cohorts. In addition, this study compared baseline characteristics among ACO patients according to phenotype.
METHODS
Patients with COPD were prospectively enrolled into the Korean COPD subgroup study (KOCOSS) cohort. Patients with severe asthma were prospectively enrolled into the Korean Severe Asthma Registry (KoSAR). ACO was defined in accordance with the updated Spanish criteria. In the COPD cohort, ACO was defined as bronchodilator response (BDR) ≥ 15% and ≥ 400 mL from baseline or blood eosinophil count (BEC) ≥ 300 cells/μL. In the severe asthma cohort, ACO was defined as age ≥ 35 years, smoking ≥ 10 pack-years, and post-bronchodilator forced expiratory volume in 1 s/forced vital capacity < 0.7. Patients with ACO were divided into four groups according to smoking history (threshold: 20 pack-years) and BEC (threshold: 300 cells/μL).
RESULTS
The prevalence of ACO significantly differed between the COPD and severe asthma cohorts (19.8% [365/1,839] vs. 12.5% [104/832], respectively; < 0.001). The percentage of patients in each group was as follows: group A (light smoker with high BEC) - 9.1%; group B (light smoker with low BEC) - 3.7%; group C (moderate to heavy smoker with high BEC) - 73.8%; and group D (moderate to heavy smoker with low BEC) - 13.4%. Moderate to heavy smoker with high BEC group was oldest, and showed weak BDR response. Age, sex, BDR, comorbidities, and medications significantly differed among the four groups.
CONCLUSION
The prevalence of ACO differed between COPD and severe asthma cohorts. ACO patients can be classified into four phenotype groups, such that each phenotype exhibits distinct characteristics.
背景
哮喘和慢性阻塞性肺疾病（COPD）是具有相似临床表现的气道疾病，尽管它们的病理生理学存在差异。哮喘-COPD 重叠（ACO）是一种以两种疾病的临床特征重叠为特征的疾病。关于 COPD 和重度哮喘队列中 ACO 的患病率，已有报道较少。ACO 具有异质性，可根据表型差异对患者进行分类。本研究旨在分析 COPD 和重度哮喘队列中 ACO 的患病率。此外，本研究还比较了根据表型分类的 ACO 患者的基线特征。
方法
前瞻性纳入 COPD 患者进入韩国 COPD 亚组研究（KOCOSS）队列。前瞻性纳入重度哮喘患者进入韩国重度哮喘登记处（KoSAR）。ACO 根据更新的西班牙标准定义。在 COPD 队列中，ACO 定义为支气管扩张剂反应（BDR）≥15%和≥400mL 自基线或血嗜酸性粒细胞计数（BEC）≥300 细胞/μL。在重度哮喘队列中，ACO 定义为年龄≥35 岁，吸烟≥10 包年，支气管扩张剂后用力呼气量 1 秒/用力肺活量（FEV1/FVC）<0.7。根据吸烟史（阈值：20 包年）和 BEC（阈值：300 细胞/μL），将 ACO 患者分为四组。
结果
ACO 在 COPD 和重度哮喘队列中的患病率差异有统计学意义（19.8%[365/1839]与 12.5%[104/832]；<0.001）。各亚组的患者比例如下：A 组（轻度吸烟者且高 BEC）9.1%；B 组（轻度吸烟者且低 BEC）3.7%；C 组（中重度吸烟者且高 BEC）73.8%；D 组（中重度吸烟者且低 BEC）13.4%。中重度吸烟者且高 BEC 组年龄最大，BDR 反应较弱。年龄、性别、BDR、合并症和药物在四组之间有显著差异。
结论
ACO 在 COPD 和重度哮喘队列中的患病率不同。ACO 患者可分为四组表型，各表型具有不同的特征。
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