Kumar Kapil, Gupta Prem Parkash, Verma Arvind Kumar, Yadav Rohtas
Respiratory Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak.
Pulmonary Medicine, Moti Lal Nehru Medical College, Prayagraj.
Monaldi Arch Chest Dis. 2022 Sep 2;93(2). doi: 10.4081/monaldi.2022.2323.
Given the paucity of research on asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) and the high prevalence of co-morbidities and healthcare utilization associated with it, the current study looked at the prevalence of ACO and its clinico-radiological phenotype in patients with chronic airflow obstruction. The study was conducted at a tertiary care hospital in North India. Patients over 40 with COPD or asthma were screened for inclusion in the ACO, asthma, and COPD groups. The ACO and COPD groups were further investigated. The clinical characteristics, lung functions, health-related quality of life, and radiological features of both groups were investigated and compared. ACO was discovered in 16.3% of patients with chronic airflow obstruction (asthma and COPD). The most commonly observed symptoms at presentation in the evaluated ACO patients (n=77) were shortness of breath, wheezing, cough, and expectoration (mean age at presentation: 57.9; mean duration of illness: 8.62 years). Exacerbation rates in ACO patients were significantly higher than in COPD patients (p<0.001). The ACO group had a significantly greater mean change in FEV1 post-bronchodilator in millilitres (ml) and percentage (379.61 ml and 37.72%) than the COPD group (p<0.001). The proportion of patients with emphysema was lower in the ACO group than in the COPD group (p<0.001). The ACO and COPD groups did not differ significantly in major airway wall thickness (p=0.3), but the COPD group had a significantly higher proportion of patients with vascular attenuation and distortion (p<0.001). Patients with COPD had a higher degree of hyperinflation, according to high resolution computed tomography (HRCT) indices. This study found that patients with ACO have a distinct phenotype in terms of clinical presentation and HRCT features. More research on the radiological features of ACO is required to identify the anatomical abnormalities involved in the disease's pathogenesis and to validate the radiological features of ACO.
鉴于对哮喘-慢性阻塞性肺疾病（COPD）重叠综合征（ACO）的研究匮乏，以及与之相关的共病高患病率和医疗资源利用情况，本研究观察了慢性气流受限患者中ACO的患病率及其临床-放射学表型。该研究在印度北部的一家三级医疗中心进行。对40岁以上的COPD或哮喘患者进行筛查，以纳入ACO、哮喘和COPD组。对ACO组和COPD组进行了进一步调查。研究并比较了两组的临床特征、肺功能、健康相关生活质量和放射学特征。在慢性气流受限患者（哮喘和COPD）中，16.3%被发现患有ACO。在评估的ACO患者（n = 77）中，最常见的症状是气短、喘息、咳嗽和咳痰（就诊时平均年龄：57.9岁；平均病程：8.62年）。ACO患者的急性加重率显著高于COPD患者（p < 0.001）。ACO组支气管扩张剂后第一秒用力呼气容积（FEV1）的平均变化量（毫升）和百分比（379.61毫升和37.72%）显著大于COPD组（p < 0.001）。ACO组肺气肿患者的比例低于COPD组（p < 0.001）。ACO组和COPD组在主气道壁厚度方面无显著差异（p = 0.3），但COPD组血管变细和扭曲的患者比例显著更高（p < 0.001）。根据高分辨率计算机断层扫描（HRCT）指标，COPD患者的肺过度充气程度更高。本研究发现，ACO患者在临床表现和HRCT特征方面具有独特的表型。需要对ACO的放射学特征进行更多研究，以确定疾病发病机制中涉及的解剖学异常，并验证ACO的放射学特征。
