哮喘-COPD重叠综合征（ACOS）与“纯”COPD相比：有独特的表型？
2016/10/09
摘要
背景：一些研究表明，哮喘-COPD重叠综合征（ACOS）具有比COPD更坏的结果。这项研究的目标是，进一步探究在现实生活中的慢性阻塞性肺疾病患者队列中的ACOS患者的临床特点和患者的生存状态。
方法:对来自法国的COPD队列"Initiatives BPCO"（N = 998例）的数据进行分析来评估在40岁之前被医生诊断为哮喘的ACOS患者的频率并分析其影响。进行单因素分析来评估ACOS与社会人口学特征、危险因素（吸烟、职业暴露、特应性疾病）、症状（慢性支气管炎，呼吸困难-改进医学研究理事会的规模和基线呼吸困难指数）、生活质量、情绪障碍、加重、合并症、肺功能、治疗、和生存状态之间的关系。
结果：129例患者（13%）被确诊是ACOS。在多变量分析中，ACOS与累积吸烟量呈负相关（比值比OR：0.992；95% CI 0.984-1.000每包-年），与肥胖程度：OR：1.97 [ 1.22-3.16 ]，过敏性疾病史（枯草热：OR：5.50 [ 3.42-9.00 ]和特应性皮炎：OR：3.76 [ 2.14-6.61 ]），和药物的使用（LABA +ICS：OR：1.86 [ 1.27-2.74 ]，抗白三烯OR：4.83 [ 1.63-14.34 ]，茶碱：OR：2.46[ 1.23-4.91 ]和口服皮质类固醇：OR：2.99[ 1.26-7.08 ]）呈正相关。没有发现与呼吸困难、生活质量、病情加重和死亡率有独立的关联。
结论：相比“纯”的COPD患者，ACOS患者表现出较低的累积吸烟量、受肥胖和过敏性疾病的困扰更多，并进行过更多的哮喘治疗。疾病的严重程度（呼吸困难、生活质量、加重、合并症）及预后（死亡）与“纯”的慢性阻塞性肺病患者没有区别。
（苏欣 审校）
Allergy. 2016 Aug 9. doi: 10.1111/all.13004. [Epub ahead of print]
Asthma-COPD overlap syndrome (acos) versus "pure" copd: a distinct phenotype?
Caillaud D1, Chanez P2, Escamilla R3, Burgel PR4, Court-Fortune I5, Nesme-Meyer P6, Deslee G7, Perez T8, Paillasseur JL9, Pinet C10, Jebrak G11,Roche N4.
Author information
Abstract
BACKGROUND:Some studies suggest that ACOS is associated with worse outcomes than COPD. The goal of this study was to further explore the clinical characteristics and survival of patients with ACOS identified in a real-life cohort of COPD patients.
METHODS:Data from the French COPD cohort "Initiatives BPCO" (n=998 patients) were analyzed to assess the frequency of ACOS defined as a physician diagnosis of asthma before the age of 40 years and to analyze its impact. Univariate analyses were performed to assess the relationship between ACOS and sociodemographic characteristics, risk factors (smoking, occupational exposure, atopic diseases), symptoms (chronic bronchitis, dyspnea -modified Medical Research Council scale and baseline dyspnea index-), quality of life, mood disorders, exacerbations, comorbidities, lung function, prescribed treatment, and survival.
RESULTS:ACOS was diagnosed in 129 patients (13%). In multivariate analyses, ACOS was associated negatively with cumulative smoking (Odds Ratio -OR-: 0.992; 95%CI 0.984-1.000 per pack-year) and positively with obesity: OR: 1.97 [1.22-3.16], history of atopic disease (hay fever: OR: 5.50 [3.42-9.00] and atopic dermatitis: OR 3.76 [2.14-6.61]), and drug use (LABA+ ICS: 1.86 [1.27-2.74], anti-leukotriènes 4.83 [1.63-14.34], theophylline: 2.46; [1.23-4.91] and oral corticosteroids: [2.99;.1.26-7.08]). No independent association was found with dyspnea, QoL, exacerbations and mortality.
CONCLUSIONS:Compared to "pure" COPD patients, patients with ACOS exhibit lower cumulative smoking, suffer more from obesity and atopic diseases and use more asthma treatments. Disease severity (dyspnea, QoL, exacerbations, comorbidities) and prognosis (mortality) are not different from "pure" COPD patients. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
KEYWORDS:ACOS ; COPD ; mortality; severity; treatment
Allergy. 2016 Aug 9. doi: 10.1111/all.13004. [Epub ahead of print]
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