真实世界中哮喘-COPD 重叠综合征（ACOS）的共病，表现及影响
2017/07/24
背景：哮喘－COPD重叠综合征(Asthma-COPD overlap syndrome,ACOS)已经作为一种独特的临床综合征而被识别；然而，在日常临床工作中，其特征仍不清楚。本研究旨在真实世界人群中，研究ACOS的流行病学特征，以及其共病情况及对住院风险的影响。
方法：本研究的数据采集自西班牙巴利阿里群岛的马略卡COPD和哮喘真实世界的回顾性队列研究，包括了初级治疗、住院治疗以及用药数据等。同时患有由医生确诊的哮喘和COPD的患者被定义为ACOS，并与仅患有COPD的人群比较。亚组分析中还应用了更严格的诊断标准(GINA-GOLD)。共病情况对住院率的影响通过多元logistic回归进行了比较。
结果：共有5093例ACOS患者(患病率为5.55人/1000居民)与22778例COPD患者(30.40人/1000居民)比较。ACOS较COPD有更高的女性比例(53.4%和30.8%)， 更年轻(64和65.8岁)，不吸烟的比例高 (分别为41.4%和22.1%) (均为P＜0.001)。校正后分析，过敏性鼻炎(OR:1.81，95%CI:1.63-2.00)、 焦虑(OR:1.18，95%CI:1.10-1.27)、胃食管反流病 (OR :1.18，95%CI:1.04-1.33)以及骨质疏松症 (OR:1.14，95%CI:1.04-1.26)在ACOS中都较COPD更常见；相反，慢性肾病(OR：0.79，95%CI:0.66-0.95)和缺血性心脏病(OR:0.88，95%CI:0.79-0.98)在COPD中更常见，心血管疾病在ACOS患者中与住院率关联最大。
结论：ACOS在一般人群中较为常见，与单纯COPD患者相比，ACOS在更大程度上影响了吸烟暴露少的女性患者。ACOS患者同时罹患心血管系统疾病是住院风险增高最重要的危险因素。
Comorbidome, pattern and impact of asthma-COPD overlap syndrome (ACOS) in real-life
Job F.M. van Boven, PharmD, PhD, Miguel Román-Rodríguez, MD, Joseph F.
Palmer, MD, Núria Toledo Pons, MD, Borja G. Cosío, MD, PhD, Joan B. Soriano, MD,PhD
CHEST.2015.12.002.
BACKGROUND: Asthma-COPD overlap syndrome (ACOS) has been described and acknowledged as a distinct clinical entity; however, its characteristics in daily clinical practice are largely unknown. The aim of this study was to identify the prevalence of ACOS in the real-life population, its pattern of comorbidities, and its impact on hospitalization risk.
METHODS: Data for this retrospective cohort study were extracted from the Majorca Real-Life Investigation in COPD and Asthma cohort, including primary care, hospitalization, and pharmacy data from the Balearic Islands, Spain. Patients who had received a physician-confirmed diagnosis of both asthma and COPD were identified as having ACOS and compared with a COPD-only population. In subanalyses, more stringent diagnostic criteria (Global Initiative for Asthma-Global Initiative for Chronic Obstructive Lung Disease) were applied. The pattern and impact of comorbidities on all-cause hospitalization were compared by multivariate logistic regression.
RESULTS: In total, 5,093 patients with ACOS (prevalence, 5.55 per 1,000 inhabitants) were compared with 22,778 patients with COPD (30.40 per 1,000 inhabitants). Patients with ACOS were more frequently female (53.4%) than were patients with COPD (30.8%), younger (ACOS, 64.0 years; COPD, 65.8 years), and differed by nonsmoking status (ACOS, 41.4%; COPD, 22.1%) (all, P < .001). In adjusted analyses, allergic rhinitis (OR, 1.81; 95% CI, 1.63-2.00), anxiety (OR, 1.18; 95% CI, 1.10-1.27), gastroesophageal reflux disease (OR, 1.18; 95% CI, 1.04-1.33), and osteoporosis (OR, 1.14; 95% CI, 1.04-1.26) were more frequent in ACOS than COPD. In contrast, chronic kidney disease (OR, 0.79; 95% CI, 0.66-0.95) and ischemic heart disease (OR, 0.88; 95% CI, 0.79-0.98) were less frequent. In patients with ACOS, cardiovascular diseases showed the strongest association with hospitalization.
CONCLUSIONS: ACOS is prevalent in the general population, and it affects to a large extent females with less smoking exposure compared with patients with COPD only. Cardiovascular comorbidities in particular contribute most to overall hospitalization risk of patients with ACOS.
方法：本研究的数据采集自西班牙巴利阿里群岛的马略卡COPD和哮喘真实世界的回顾性队列研究，包括了初级治疗、住院治疗以及用药数据等。同时患有由医生确诊的哮喘和COPD的患者被定义为ACOS，并与仅患有COPD的人群比较。亚组分析中还应用了更严格的诊断标准(GINA-GOLD)。共病情况对住院率的影响通过多元logistic回归进行了比较。
结果：共有5093例ACOS患者(患病率为5.55人/1000居民)与22778例COPD患者(30.40人/1000居民)比较。ACOS较COPD有更高的女性比例(53.4%和30.8%)， 更年轻(64和65.8岁)，不吸烟的比例高 (分别为41.4%和22.1%) (均为P＜0.001)。校正后分析，过敏性鼻炎(OR:1.81，95%CI:1.63-2.00)、 焦虑(OR:1.18，95%CI:1.10-1.27)、胃食管反流病 (OR :1.18，95%CI:1.04-1.33)以及骨质疏松症 (OR:1.14，95%CI:1.04-1.26)在ACOS中都较COPD更常见；相反，慢性肾病(OR：0.79，95%CI:0.66-0.95)和缺血性心脏病(OR:0.88，95%CI:0.79-0.98)在COPD中更常见，心血管疾病在ACOS患者中与住院率关联最大。
结论：ACOS在一般人群中较为常见，与单纯COPD患者相比，ACOS在更大程度上影响了吸烟暴露少的女性患者。ACOS患者同时罹患心血管系统疾病是住院风险增高最重要的危险因素。
(王程仕1 张红萍1 王刚1 四川大学华西医院中西医结合科呼吸病组 610041 摘译)
（CHEST.2015.12.002.）
（CHEST.2015.12.002.）
Comorbidome, pattern and impact of asthma-COPD overlap syndrome (ACOS) in real-life
Job F.M. van Boven, PharmD, PhD, Miguel Román-Rodríguez, MD, Joseph F.
Palmer, MD, Núria Toledo Pons, MD, Borja G. Cosío, MD, PhD, Joan B. Soriano, MD,PhD
CHEST.2015.12.002.
BACKGROUND: Asthma-COPD overlap syndrome (ACOS) has been described and acknowledged as a distinct clinical entity; however, its characteristics in daily clinical practice are largely unknown. The aim of this study was to identify the prevalence of ACOS in the real-life population, its pattern of comorbidities, and its impact on hospitalization risk.
METHODS: Data for this retrospective cohort study were extracted from the Majorca Real-Life Investigation in COPD and Asthma cohort, including primary care, hospitalization, and pharmacy data from the Balearic Islands, Spain. Patients who had received a physician-confirmed diagnosis of both asthma and COPD were identified as having ACOS and compared with a COPD-only population. In subanalyses, more stringent diagnostic criteria (Global Initiative for Asthma-Global Initiative for Chronic Obstructive Lung Disease) were applied. The pattern and impact of comorbidities on all-cause hospitalization were compared by multivariate logistic regression.
RESULTS: In total, 5,093 patients with ACOS (prevalence, 5.55 per 1,000 inhabitants) were compared with 22,778 patients with COPD (30.40 per 1,000 inhabitants). Patients with ACOS were more frequently female (53.4%) than were patients with COPD (30.8%), younger (ACOS, 64.0 years; COPD, 65.8 years), and differed by nonsmoking status (ACOS, 41.4%; COPD, 22.1%) (all, P < .001). In adjusted analyses, allergic rhinitis (OR, 1.81; 95% CI, 1.63-2.00), anxiety (OR, 1.18; 95% CI, 1.10-1.27), gastroesophageal reflux disease (OR, 1.18; 95% CI, 1.04-1.33), and osteoporosis (OR, 1.14; 95% CI, 1.04-1.26) were more frequent in ACOS than COPD. In contrast, chronic kidney disease (OR, 0.79; 95% CI, 0.66-0.95) and ischemic heart disease (OR, 0.88; 95% CI, 0.79-0.98) were less frequent. In patients with ACOS, cardiovascular diseases showed the strongest association with hospitalization.
CONCLUSIONS: ACOS is prevalent in the general population, and it affects to a large extent females with less smoking exposure compared with patients with COPD only. Cardiovascular comorbidities in particular contribute most to overall hospitalization risk of patients with ACOS.
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9个欧洲出生队列研究中分娩方式与学龄期儿童哮喘的关系
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哮喘成人中的合并症：基于苏格兰140万成人群体的横断面研究
