哮喘COPD重叠综合征：一种接近阻塞性肺疾病真实世界亚型的方法吗？
2016/11/09
摘要
背景：虽然一些具有阻塞性肺疾病的患者（OLD）有哮喘和慢性阻塞性肺疾病（COPD）两种疾病的特点，术语：哮喘-COPD重叠综合征（ACOS）是最近才提出来的。然而，我国的临床特点、发病机制、预后和ACOS的患者管理与我们的认知还有差距。
目的：回顾文献来确定ACOS的临床特点、病理机制、临床结果、目前的治疗方法与单独的哮喘或单独的COPD的区别到何种程度。
方法：从PUBMED进行搜索，来回顾人口、临床特征、合并症、肺部影像特征、预后、病理机制，和目前的治疗方法在ACOS患者和单独哮喘或单独的COPD患者之间的差别。
结果：用于诊断ACOS的标准有很大的不同。总的来说，ACOS的患者比单独的哮喘患者或者单独的COPD患者有更高的症状负担（特别是呼吸困难）、更差的生活质量评分、更频繁和严重的急性加重。然而，对患者预后的报道相互矛盾。影像学研究表明，ACOS主要是气道疾病。ACOS被认为与在COPD患者的气道的Th2型免疫反应和在哮喘患者气道的Th1型免疫反应有关。对于ACOS患者目前的治疗选择包括可吸入糖皮质激素和支气管扩张剂。然而，还未采用随机临床试验来优化ACOS病人的管理。
结论:ACOS患者的临床特征现在已经明确，但还需要进一步的研究对ACOS的发病机制和优化对这些患者的治疗提供新的见解。
（杨冬 审校）
Curr Pharm Des. 2016 Sep 6. [Epub ahead of print]
Asthma COPD Overlap Syndrome: An Approach to A Real -World Endotype in Obstructive Lung Disease?
Laucho-Contreras ME1, de Oca MM, Owen CA.
Author information
Abstract
BACKGROUND:Although some patients with obstructive lung disease (OLD) have features of both asthma and chronic obstructive pulmonary disease (COPD), the term "asthma-COPD overlap syndrome (ACOS)" was coined only relatively recently. However, there are gaps in our knowledge of the clinical features, pathogenesis, prognosis, and management of ACOS patients.
OBJECTIVES:To review the literature on ACOS to determine the extent to which the clinical features, pathologic mechanisms, clinical outcomes, and current therapeutic approaches for ACOS differ from those in patients with asthma alone or COPD alone.
METHODS:PUBMED searches were conducted to review the demographic and clinical features, comorbidities, lung imaging characteristics, prognoses, pathologic mechanisms, and current therapeutic approaches for patients with ACOS versus asthma alone or COPD alone.
RESULTS:Criteria that are used to diagnose ACOS vary considerably. Overall, ACOS patients have higher symptom burdens (especially dyspnea), poorer quality of life scores, and more frequent and severe exacerbations than patients with COPD alone or asthma alone. However, there are conflicting reports on the prognosis of ACOS patients. Imaging studies indicate that ACOS is predominantly an airway disease. ACOS has been linked to the presence of Th2-type immune responses in COPD airways and Th1-type immune responses in asthmatic airways. Current therapeutic options for ACOS patients include inhaled corticosteroids and bronchodilators. However, randomized clinical trials have not yet been conducted to optimize the management of ACOS patients.
CONCLUSION:ACOS patients have clinical features that are now well defined, but additional studies are needed to provide novel insights into ACOS pathogenesis, and to optimize the treatment of these patients.
Curr Pharm Des. 2016 Sep 6. [Epub ahead of print]
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重症难治性哮喘患者的支气管热成形术的效果：临床和组织病理学的相关性
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在美国的孩子中，哮喘、花粉症和食物过敏与护理人员报告的言语障碍有关
