Lin Ling, Cheng Wei, Song Qing, Li Tao, Liu Cong, Zhang Ping, Zeng Yuqin, Deng Dingding, Yu Zhiping, Chen Yan, Chen Ping
Department of Respiratory and Critical Care Medicine, Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, 410011, Hunan, China.
Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China.
BMC Pulm Med. 2025 Jul 2;25(1):294. doi: 10.1186/s12890-025-03767-x.
Many studies explored the features of Chronic obstructive pulmonary disease (COPD) with asthma-like features. We aimed to compare the exacerbation and mortality during one-year follow-up among COPD patients with asthma-like features with different inhalation therapies in the Chinese population (compare Without-inhaled corticosteroids(ICS)and With-ICS inhalation therapy, and then ICS + long-acting β-2-agonist(LABA) and ICS + LABA + long-acting muscarinic antagonists (LAMA).
This real-world observational study was conducted in the RealDTC cohort (ChiCTR-POC-17010431, Trial Regisrtation Date: 2017.01.14). COPD patients with asthma-like features in China from July 1, 2017, to June 31 2022 were recruited into the study and followed-up for 12 months. The Without-ICS inhalation therapy cohort included patients with LAMA or LABA + LAMA therapy, the With-ICS inhalation therapy cohort included patients with ICS + LABA or ICS + LABA + LAMA therapy.
Of the 2735 eligible participants, the With-ICS inhalation therapy cohort was less likely to experience moderate-to-severe exacerbation and severe exacerbation during follow-up than the Without-ICS inhalation therapy cohort after PSM in multivariate analysis, but not death. The ICS + LABA + LAMA group had a lower risk of moderate-to-severe and frequent exacerbations than the ICS + LABA group after PSM. In addition, patients with CAT ≥ 10, or with previous exacerbation history, or with GOLD II and GOLD III + IV grade, receiving ICS + LABA + LAMA had a decreased risk of exacerbation compared to ICS + LABA.
COPD patients with asthma-like features with With-ICS inhalation therapy based on bronchodilators were less likely to experience future exacerbations than those Without-ICS inhalation therapy, but not death. In addition, ICS + LABA + LAMA therapy decreased the risk of exacerbation compared to ICS + LABA therapy during follow-up, especially in patients with CAT ≥ 10, or with previous exacerbation history, or with GOLD II and GOLD III + IV grade.
许多研究探讨了具有哮喘样特征的慢性阻塞性肺疾病（COPD）的特点。我们旨在比较中国人群中接受不同吸入疗法的具有哮喘样特征的COPD患者在一年随访期间的急性加重情况和死亡率（比较不使用吸入性糖皮质激素（ICS）和使用ICS吸入疗法，然后比较ICS联合长效β2受体激动剂（LABA）和ICS联合LABA加长效毒蕈碱拮抗剂（LAMA））。
这项真实世界观察性研究在RealDTC队列中进行（ChiCTR-POC-17010431，试验注册日期：2017年1月14日）。纳入2017年7月1日至2022年6月31日在中国的具有哮喘样特征的COPD患者并进行12个月的随访。不使用ICS吸入疗法队列包括接受LAMA或LABA+LAMA治疗的患者，使用ICS吸入疗法队列包括接受ICS+LABA或ICS+LABA+LAMA治疗的患者。
在2735名符合条件的参与者中，多因素分析中倾向得分匹配（PSM）后，使用ICS吸入疗法队列在随访期间发生中重度急性加重和重度急性加重的可能性低于不使用ICS吸入疗法队列，但在死亡率方面无差异。PSM后，ICS+LABA+LAMA组发生中重度和频繁急性加重的风险低于ICS+LABA组。此外，与ICS+LABA相比，CAT≥10或有既往急性加重史或GOLD II级和GOLD III+IV级的患者接受ICS+LABA+LAMA治疗后急性加重风险降低。
基于支气管扩张剂使用ICS吸入疗法的具有哮喘样特征的COPD患者未来发生急性加重的可能性低于不使用ICS吸入疗法的患者，但在死亡率方面无差异。此外，与ICS+LABA疗法相比，随访期间ICS+LABA+LAMA疗法降低了急性加重风险，尤其是在CAT≥10或有既往急性加重史或GOLD II级和GOLD III+IV级的患者中。
