Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow G12 OYN, UK.
Immunol Allergy Clin North Am. 2022 Aug;42(3):615-630. doi: 10.1016/j.iac.2022.03.004. Epub 2022 Jun 30.
Exposure to cigarette smoke has a key role in the development, adverse health outcomes, and impaired response to some therapies among individuals with features of asthma and chronic obstructive pulmonary disease overlap (ACO). To aid the identification of clinical subtypes, the description of ever smokers with features of asthma and COPD should include data on smoking status, cumulative smoking history, and the phenotype of asthma and smoking-related chronic airway disease. Pathogenic mechanisms in smoking-related ACO involve poorly understood, complex interactions between smoking-induced and asthma-induced airway inflammation, corticosteroid insensitivity, and tissue remodeling. Evidence for the clinical effectiveness of interventions for adults with smoking-related ACO is limited. Management currently involves the identification and targeting of treatable traits such as current smoking, type 2 high eosinophilic inflammation, symptomatic airflow obstruction, and extrapulmonary comorbidities.
吸烟暴露在具有哮喘和慢性阻塞性肺疾病重叠特征（ACO）个体的疾病发展、不良健康结局和对某些治疗反应受损中起着关键作用。为了帮助识别临床亚型，具有哮喘和 COPD 特征的既往吸烟者的描述应包括吸烟状况、累计吸烟史以及哮喘和与吸烟相关的慢性气道疾病表型的数据。与吸烟相关的 ACO 中的发病机制涉及吸烟引起的和哮喘引起的气道炎症、皮质类固醇不敏感性和组织重塑之间复杂的相互作用，这些相互作用尚未被充分理解。针对与吸烟相关的 ACO 成年人的干预措施的临床效果证据有限。目前的管理包括确定和针对可治疗的特征，如当前吸烟、2 型高嗜酸性粒细胞炎症、有症状的气流阻塞和肺外合并症。
