哮喘联盟

   摘要
   背景：人们对哮喘和COPD重叠的认识日渐增加。本综述阐述了哮喘-COPD重叠的新视野、治疗及存在的知识缺陷。
   方法：对哮喘和COPD进行系统性文献回顾和聚类分析。2009至今发表的涉及哮喘-COPD重叠的患病率、发病率及治疗的文献被纳入综述。
   结果：使用大量不同研究设计和采样方法的研究中的哮喘-COPD重叠被统一识别。在有气道阻塞疾病的患者中哮喘-COPD重叠的患病率约为20%。哮喘-COPD重叠与发病率增加相关，并可能增加死亡率和共患病。证据显示气道炎症存在异质性，包括嗜酸性粒细胞性（成年哮喘患者中）、中性粒细胞性或混合模式（严重哮喘和COPD患者中）。哮喘-COPD重叠存在全身炎症反应，并与COPD类似。有证据显示哮喘-COPD重叠患者中存在不同亚组，但不能通过支气管扩张剂反应性成功识别。指南推荐了一系列评估方法，推荐的治疗方案以针对哮喘为主。对于哮喘-COPD重叠，尚需针对影响结果的关键临床特征、机制及治疗方法的研究。运用多维评估方法鉴别和治疗疾病成分是可行的。
   结论：哮喘-COPD重叠使得气道阻塞性疾病中的显著异质性受到关注。其将被能够识别并管理异质性组分的新方法所取代，例如多元评估和治疗。未来研究需要对这些新的、个性化的方法进行测试。
 

（苏欣 审校）
2015 May 6. pii: thoraxjnl-2014-206740. doi: 10.1136/thoraxjnl-2014-206740. [Epub ahead of print]

 

Asthma-COPD overlap 2015: now we are six.
 

Gibson PG1, McDonald VM1.
Author information
 

Abstract
BACKGROUND:The overlap between asthma and COPD is increasingly recognised. This review examines the new insights, treatment and remaining knowledge gaps for asthma-COPD overlap.
METHOD:A systematic literature review of cluster analyses of asthma and COPD was performed. Articles from 2009 to the present dealing with prevalence, morbidity and treatment of asthma-COPD overlap were identified and reviewed.
RESULTS:Asthma-COPD overlap was consistently recognised in studies using a variety of different study designs and sampling. The prevalence was approximately 20% in patients with obstructive airways diseases.Asthma-COPD overlap was associated with increased morbidity and possibly an increased mortality and comorbidity. There was evidence of a heterogeneous pattern of airway inflammation that included eosinophilic (in adult asthma), neutrophilic or mixed patterns (in severe asthma and COPD). Systemic inflammation was present in asthma-COPD overlap and resembled that of COPD. Within asthma-COPD overlap, there is evidence of different subgroups, and recognition using bronchodilator responsiveness has not been successful. Guidelines generally recommend a serial approach to assessment, with treatment recommendations dominated by an asthma paradigm. Research is needed into key clinical features that impact outcome, mechanisms and treatment approaches in asthma-COPD overlap. Identifying and treating disease components by multidimensional assessment shows promise.
CONCLUSIONS:Asthma-COPD overlap has drawn attention to the significant heterogeneity that exists within obstructive airway diseases. It should be replaced by novel approaches that identify and manage the components of this heterogeneity, such as multidimensional assessment and treatment. Future research is needed to test these novel and personalised approaches.
 

2015 May 6. pii: thoraxjnl-2014-206740. doi: 10.1136/thoraxjnl-2014-206740. [Epub ahead of print]