Daniel Jefferson, Gupta Richa, Thangakunam Balamugesh, Christopher Devasahayam Jesudas
Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
Department of Respiratory Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
Heliyon. 2023 Mar 22;9(4):e14711. doi: 10.1016/j.heliyon.2023.e14711. eCollection 2023 Apr.
Patients who have features of both Asthma & COPD are now known as Asthma COPD overlap (ACO). Prevalence of ACO based on the Global Initiative for Asthma (GINA) and Global initiative for obstructive lung disease (GOLD) Syndromic Approach is scarce. In this cross-sectional observational study, we recruited physician-diagnosed-pAsthma, pCOPD & pACO by simple random sampling. Clinical features, spirometry, 6-min walk test, Serum Immunoglobulin E, % blood eosinophils and chest x-rays were reviewed. Syndromic approach was applied, and the diagnosis was reclassified accordingly. In all, 877 patients were included (Male = 445, Female = 432). Physician diagnosis for these were: pAsthma-713, pCOPD-157 and pACO-7. They were reclassified using the Syndromic approach as: sAsthma, sCOPD and sACO. The 713 pAsthmatics were reclassified as follows: sAsthma-684 (95.94%), sCOPD-12 (1.68%) and sACO-17 (2.38%). Of the 157 pCOPD patients, 91 (57.96%) were reclassified as sCOPD, 23 (14.6%) as sACO, and 17 (927.38%) as sAsthma. Of the 7 previously diagnosed pACO patients, only 1 (14.28%) was reclassified as sACO, 5 (71.42%) as sAsthma and 1 (14.28%) as sCOPD. sCOPD patients had more exacerbations (52.88% vs 46.34%, p = 0.479), critical care admissions (16.35% vs 7.32%, p = 0.157) and intubations (17.31% vs 9.76%, p = 0.255) compared to sACO patients, the latter had more events than sAsthma patients: exacerbations 46.34% vs 10.11% (p < 0.001), critical care admissions 7.32% vs 1.64% (p = 0.010) and intubations 9.76% vs 1.5% (p < 0.001). The syndromic approach helped us to identify ACO and also more appropriately classified COPD & Asthma. There was a significant difference between physician diagnosis and diagnosis using Syndromic Approach. It revealed considerable misclassification of several Asthmatic and ACO subjects, who could have been denied inhaled corticosteroids, as they were wrongly categorised as COPD by physician diagnosis.
同时具有哮喘和慢性阻塞性肺疾病（COPD）特征的患者现在被称为哮喘-COPD重叠综合征（ACO）。基于全球哮喘防治创议（GINA）和慢性阻塞性肺疾病全球倡议（GOLD）综合征方法的ACO患病率数据稀缺。在这项横断面观察性研究中，我们通过简单随机抽样招募了经医生诊断的哮喘患者（pAsthma）、COPD患者（pCOPD）和ACO患者。回顾了临床特征、肺功能测定、6分钟步行试验、血清免疫球蛋白E、血液嗜酸性粒细胞百分比和胸部X光片。应用综合征方法，并据此重新分类诊断。总共纳入了877例患者（男性=445例，女性=432例）。医生对这些患者的诊断为：pAsthma-713例，pCOPD-157例，pACO-7例。使用综合征方法将他们重新分类为：sAsthma、sCOPD和sACO。713例pAsthma患者重新分类如下：sAsthma-684例（95.94%），sCOPD-12例（1.68%），sACO-17例（2.38%）。在157例pCOPD患者中，91例（57.96%）重新分类为sCOPD，23例（14.6%）为sACO，17例（17.38%）为sAsthma。在7例先前诊断为pACO的患者中，只有1例（14.28%）重新分类为sACO，5例（71.42%）为sAsthma，1例（14.28%）为sCOPD。与sACO患者相比，sCOPD患者有更多的急性加重（52.88%对46.34%，p=0.479）、重症监护病房入院（16.35%对7.32%，p=0.157）和插管（17.31%对9.76%，p=0.255），后者比sAsthma患者有更多的事件：急性加重46.34%对10.11%（p<0.001）、重症监护病房入院7.32%对1.64%（p=0.010）和插管9.76%对1.5%（p<0.001）。综合征方法帮助我们识别了ACO，并且更恰当地对COPD和哮喘进行了分类。医生诊断和使用综合征方法的诊断之间存在显著差异。它揭示了一些哮喘和ACO患者存在相当大的误诊，这些患者可能因医生诊断错误地归类为COPD而被拒绝使用吸入性糖皮质激素。
