Lee Jong Min, Kim Youlim, Choi Joon Young, Ra Seung Won, Kim Deog Kyeom, Kim Tae-Hyung, Yoon Hyung Kyu, Yoo Kwang Ha, Jung Ki-Suck, Rhee Chin Kook
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seocho-gu, Seoul, 06591, Republic of Korea.
Division of Pulmonary and Allergy, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.
BMC Pulm Med. 2025 May 23;25(1):260. doi: 10.1186/s12890-025-03731-9.
The 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) document proposed the COPD-A subtype as a condition of COPD with asthma. We examined the characteristics of COPD-A patients and analyzed them according to smoking history and inhaled corticosteroid (ICS) use.
Patients in the COPD cohort with a history of asthma were included. The patients were divided into two groups according to their smoking history (< 10 vs. ≥10 pack-years) and their clinical characteristics were compared. The association between patients' ICS use and the occurrence for exacerbations during 1 year follow-up period was analyzed.
Of the 970 patients included in the analysis, the group with a smoking history less than 10 pack-years (n = 158) had a significantly higher BMI, FEV (%), FEV/FVC (%), DLco, ESR, and prevalence of osteoporosis. Among 560 patients who were followed up for 1 year, the patients with ICS (n = 274) had a higher exacerbation rate than without ICS (n = 286) (54% vs. 44.1%, p = 0.018). However, in multivariable analysis, ICS use was not significantly associated with exacerbation. In subgroup analysis of patients with blood eosinophil count ≥ 300 cells/µl, ICS use showed a trend to reduce the risk for exacerbation (IRR = 0.907, p = 0.708). In patients with blood eosinophil count < 300 cells/µl, ICS use significantly increased the risk for exacerbation (IRR = 1.547, p = 0.005).
COPD-A patients with a smoking history of less than 10 pack-years had better pulmonary function test results, BMI, ESR, and prevalence of osteoporosis. The use of ICS did not decrease exacerbations in COPD-A.
2023年慢性阻塞性肺疾病全球倡议（GOLD）文件提出将慢性阻塞性肺疾病合并哮喘（COPD-A）作为慢性阻塞性肺疾病的一种情况。我们研究了COPD-A患者的特征，并根据吸烟史和吸入性糖皮质激素（ICS）的使用情况对其进行分析。
纳入慢性阻塞性肺疾病队列中有哮喘病史的患者。根据吸烟史（<10与≥10包年）将患者分为两组，并比较他们的临床特征。分析患者ICS使用情况与1年随访期内急性加重发生情况之间的关联。
在纳入分析的970例患者中，吸烟史少于10包年的组（n = 158）的体重指数、第1秒用力呼气容积（FEV）（%）、FEV/用力肺活量（FVC）（%）、一氧化碳弥散量（DLco）、红细胞沉降率（ESR）和骨质疏松症患病率显著更高。在560例接受1年随访的患者中，使用ICS的患者（n = 274）的急性加重率高于未使用ICS的患者（n = 286）（54%对44.1%，p = 0.018）。然而，在多变量分析中，ICS的使用与急性加重无显著关联。在血嗜酸性粒细胞计数≥300个/微升的患者亚组分析中，ICS的使用显示出降低急性加重风险的趋势（发病率比值比[IRR]=0.907，p = 0.708）。在血嗜酸性粒细胞计数<300个/微升的患者中，ICS的使用显著增加了急性加重风险（IRR = 1.547，p = 0.005）。
吸烟史少于10包年的COPD-A患者的肺功能测试结果、体重指数、红细胞沉降率和骨质疏松症患病率更好。ICS的使用并未降低COPD-A的急性加重次数。
