哮喘-慢性阻塞性肺疾病重叠综合征（ACOS）在美国的特征和发病率
2016/04/11
摘要
背景：哮喘-慢性阻塞性肺疾病重叠综合征(ACOS)是指患者既出现固定型气道阻塞 （COPD的症状），同时又表现出多种典型的哮喘症状。目前ACOS与其共患疾病的特征并未阐明。
目的：因为ACOS倾向于更频繁的急性加重，在美国，我们假设与COPD、哮喘和对照组人群相比，ACOS具有更高共患疾病率。
方法：我们在行为风险因素监测系统(BRFSS)调查> 35岁(n = 90851) 的研究对象，检测了自我报告的人口统计学资料、吸烟状态、共患疾病、住院或急诊(ED)探视经历，比较ACOS与COPD，哮喘和对照组之间的差别。在调整了人口因素和吸烟状况后，我们使用Logistic回归分析算出优势比(OR)和可信区间(CI) ，比较ACOS 和COPD共患疾病及对住院治疗/看急诊的影响。
主要结果：美国ACOS患病率为3.2%，单独COPD患病率为6.0%，两者都随年龄增加。受访者中ACOS患者年龄 (64.0±11.7岁)比COPD患者 (67.1±11.8岁)年轻，比哮喘(59.0±13.1岁)年长，(P<0.0001)。ACOS 和COPD共患疾病率高于哮喘组和对照组。ACOS组相比其它组有较高的BMI，较低的收入和较低的受教育程度。与COPD组相比，ACOS组更可能至少有一个共患疾病(90.2%比84%，P<0.0001)，更高的住院治疗或看急诊次数 (22.0%比13.2%,P<0.0001)，更少的锻炼(50.0%比58.6%，P=0.0024)和更多的残疾(70.8% vs 58.6%， P<0.0001)。
结论：与单纯COPD的患者相比，有哮喘和COPD双重诊断的患者相对更年轻，有更多的差异性。与单独的COPD相比，ACOS在自我报告的共患疾病、残疾、住院治疗或急诊次数有更高的负担。
（南方医科大学南方医院 彭显如 赵海金）
Ann Am Thorac Soc. 2016 Mar 14. [Epub ahead of print]
Characteristics and Prevalence of Asthma/Chronic Obstructive Pulmonary Disease Overlap in the United States.
Kumbhare S, Pleasants R, Ohar JA, Strange C.
Abstract
RATIONALE:The Asthma-COPD overlap syndrome (ACOS) occurs in patients with fixed airways obstruction that defines COPD and with symptoms more typical of asthma. ACOS prevalence and the co-morbidities associated with this syndrome have been inadequately characterized.
OBJECTIVES:Because this population is prone to more frequent exacerbations, we hypothesized that co-morbidities associated with ACOS are higher compared to those with COPD, asthma and control populations in the United States.
METHODS:We examined the self-reported demographics, smoking status, co-morbidities, and hospitalization or emergency department (ED) visitation experience among study respondents aged >35 years (n=90,851) in the Behavioral Risk Factor Surveillance System (BRFSS) survey and compared participants with ACOS to COPD, asthma, and control groups. We used logistic regression to compare ACOS and COPD populations to model the impact of co-morbid conditions and hospitalization/ED visits after adjusting for demographic factors and smoking status to generate odds ratios (OR) and confidence intervals (CI).
MEASUREMENTS AND MAIN RESULTS:The US prevalence of ACOS was 3.2% and COPD alone was 6.0% and both increased with age. Respondents with ACOS were younger (64.0 ± 11.7 years) than respondents with COPD (67.1 ± 11.8 years) and older compared to respondents with asthma (59.0 ± 13.1 years) (P<0.0001). The prevalence of co-morbidities was higher in the group with ACOS and COPD compared to asthma or control groups. The ACOS group had a higher BMI, lower income, and lower education than other groups. The ACOS group was more likely to have at least one co-morbidity (90.2% vs 84%, P<0.0001), more hospitalization or ED visits (22.0% vs 13.2%, p<0.0001), less exercise (50.0% vs 58.6%, p=0.0024) and more disability (70.8% vs 58.6%, p<0.0001) compared to the COPD group.
CONCLUSIONS:The patients with a dual diagnosis of asthma and COPD are younger and with more disparities compared to those diagnosed with COPD alone. ACOS has a higher burden of self-reported co-morbidity, disability, and hospitalization or ED visitation than COPD alone.
Ann Am Thorac Soc. 2016 Mar 14. [Epub ahead of print]
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