Savran Osman, Bønnelykke Klaus, Ulrik Charlotte Suppli
Respiratory Research Unit Hvidovre, Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark.
Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
J Asthma Allergy. 2024 Dec 14;17:1291-1300. doi: 10.2147/JAA.S474417. eCollection 2024.
Asthma in early life has been linked to subsequent development of COPD and according to GOLD 2023 COPD may be divided into distinct subtypes. We aimed to investigate factors associated with the GOLD classification COPD-A (asthma in childhood) and COPD-C (tobacco exposure) in a cohort of adults with a history of severe childhood asthma.
In a cohort of Danish adults with a history of severe childhood asthma and a previous 4-month stay during childhood at the asthma care facility in Kongsberg, Norway, we divided participants in a long-term follow-up examination into COPD-A and COPD-C, defined as post-bronchodilator FEV/FVC < 0.7, and never-smoker or ever-smoker, respectively, and no airflow limitation. Characteristics between groups were analysed.
The study cohort comprised 232 adults with a history of severe childhood asthma, of whom 30 (13%) and 23 (10%), respectively, were classified as COPD-A and COPD-C. Compared to those with no airflow limitation, individuals with COPD-A and COPD-C more often had had at least one exacerbation (filled prescription of oral corticosteroid) in the past 12 months (risk ratio [RR] 1.83 and 2.65, respectively). The COPD-C group had a significantly higher Medical Research Council dyspnoea score (p<0.01) and significantly higher blood eosinophil count (p<0.01) than those with no airflow limitation. Compared to the COPD-C group, the COPD-A group had higher fractional exhaled nitric oxide (mean 29 [SD 28]) and FEV%pred (mean 75 [SD 20]). Finally, when comparing participants with COPD-A to both COPD-C and participants without airflow limitation, the proportion of participants with osteoporosis (17%) and depression (10%) was more than twice as high.
Our study revealed a high prevalence and unique features of the two COPD subtypes COPD-A and COPD-C in a cohort of adults with a history of severe childhood asthma.
儿童期哮喘与慢性阻塞性肺疾病（COPD）的后续发展有关，根据《慢性阻塞性肺疾病全球倡议》（GOLD）2023版，COPD可分为不同亚型。我们旨在调查在一群有儿童期重度哮喘病史的成年人中，与GOLD分类中的COPD - A（儿童期哮喘）和COPD - C（接触烟草）相关的因素。
在一群有儿童期重度哮喘病史且童年时期曾在挪威孔斯贝格哮喘护理机构住院4个月的丹麦成年人中，我们将长期随访检查的参与者分为COPD - A组和COPD - C组，分别定义为支气管扩张剂后FEV/FVC < 0.7，且从不吸烟者或曾经吸烟者，且无气流受限。分析了两组之间的特征。
该研究队列包括232名有儿童期重度哮喘病史的成年人，其中分别有30名（13%）和23名（10%）被分类为COPD - A和COPD - C。与无气流受限者相比，COPD - A组和COPD - C组个体在过去12个月中更常至少有一次加重（口服糖皮质激素的处方记录）（风险比[RR]分别为1.83和2.65）。COPD - C组的医学研究委员会呼吸困难评分（p<0.01）和血液嗜酸性粒细胞计数（p<0.01）显著高于无气流受限者。与COPD - C组相比，COPD - A组呼出一氧化氮分数更高（平均29[标准差28]），FEV%预计值更高（平均75[标准差20]）。最后，当将COPD - A组参与者与COPD - C组以及无气流受限的参与者进行比较时，骨质疏松症（17%）和抑郁症（10%）参与者比例高出两倍多。
我们的研究揭示了在一群有儿童期重度哮喘病史的成年人中，COPD的两种亚型COPD - A和COPD - C的高患病率及独特特征。
