Atik Özge, Merve Tepetam Fatma, Özden Şeyma, Ezgi Ak Ayşe
Department of Immunology and Allergy, University of Health Sciences Süreyyapasa Chest Disease and Chest Surgery Training and Research Hospital, Istanbul, Türkiye.
Department of Chest Disease, University of Health Sciences Süreyyapasa Chest Disease and Chest Surgery Training and Research Hospital, Istanbul, Türkiye.
Postepy Dermatol Alergol. 2025 Jun 12;42(3):283-290. doi: 10.5114/ada.2025.152082. eCollection 2025 Jun.
Asthma-chronic obstructive pulmonary disease overlap (ACO) patients are categorized as those with persistent airflow limitation and features of asthma and chronic obstructive pulmonary disease (COPD).
This study aimed to identify ACO subgroups based on atopy, bronchodilator response (BDR), and eosinophil count.
From 2021 to 2024, we conducted a retrospective study on patients with asthma and/or COPD who underwent BDR testing. An ACO diagnosis required persistent airflow limitation, a history of asthma before the age of 40 or significant BDR, and at least one minor criterion. Patients were grouped by atopy status, BDR presence, and eosinophil count. We compared demographic, laboratory, spirometry, and medication data across subgroups.
The study included 109 ACO patients with a mean age of 49.5 ±10.7 years. Atopic ACO patients showed a higher increase in FEV after inhalation of 400 µg of salbutamol or the equivalent (ΔFEVBDR) and higher total IgE levels than non-atopic patients (200 ml vs. 100 ml, = 0.034; 211 IU/ml vs. 60 IU/ml, = 0.002). Eosinophil counts were higher in the BDR-positive group (360/µl vs. 195/µl, = 0.047). High eosinophilic ACO patients also had elevated IgE levels (323 IU/ml vs. 80 IU/ml, = 0.001). BDR-positive and eosinophilic groups demonstrated better spirometric results. Atopic ACO patients used more leukotriene receptor antagonists, while BDR-negative ACO patients used antimuscarinics.
Higher ΔFEVBDR in atopic ACO indicates they may respond better to bronchodilators. Elevated eosinophil counts in BDR-positive patients support their classification and suggest less severe disease progression.
哮喘-慢性阻塞性肺疾病重叠综合征（ACO）患者被归类为具有持续性气流受限以及哮喘和慢性阻塞性肺疾病（COPD）特征的患者。
本研究旨在根据特应性、支气管扩张剂反应（BDR）和嗜酸性粒细胞计数确定ACO亚组。
2021年至2024年，我们对接受BDR检测的哮喘和/或COPD患者进行了一项回顾性研究。ACO诊断需要持续性气流受限、40岁之前有哮喘病史或显著的BDR，以及至少一项次要标准。患者按特应性状态、BDR情况和嗜酸性粒细胞计数进行分组。我们比较了各亚组的人口统计学、实验室检查、肺功能和用药数据。
该研究纳入了109例ACO患者，平均年龄为49.5±10.7岁。与非特应性患者相比，特应性ACO患者吸入400μg沙丁胺醇或等效药物后FEV增加量（ΔFEVBDR）更高，总IgE水平也更高（200ml对100ml，P = 0.034；211IU/ml对60IU/ml，P = 0.002）。BDR阳性组的嗜酸性粒细胞计数更高（360/μl对195/μl，P = 0.047）。高嗜酸性粒细胞ACO患者的IgE水平也升高（323IU/ml对80IU/ml，P = 0.001）。BDR阳性和嗜酸性粒细胞组的肺功能结果更好。特应性ACO患者使用更多的白三烯受体拮抗剂，而BDR阴性ACO患者使用抗胆碱能药物。
特应性ACO患者中较高的ΔFEVBDR表明他们可能对支气管扩张剂反应更好。BDR阳性患者嗜酸性粒细胞计数升高支持了他们的分类，并提示疾病进展较轻。
