哮喘-慢阻肺重叠在中低等收入国家的流行病学及危险因素
2018/10/23
摘要
背景：哮喘-COPD重叠（ACO）代表支气管气道高反应性和慢性气流受限的汇合，并已被描述为导致比单一疾病过程更差的肺功能和生活质量疾病。
目的：我们的目的是描述在六个低收入和中等收入国家（LMICs）的成年人中ACO的患病率和危险因素。
方法：我们在12个环境中，从四个基于人群的研究中，对11923名年龄在35～92岁的参与者进行了横断面数据的汇编。我们把COPD定义为支气管扩张后FEV1/FVC低于正常下限，哮喘定义为喘息或12个月内用药或自我报告的内科诊断，ACO定义为两者兼有。
结果：ACO的患病率为3.8%（自秘鲁普诺农村的0%至孟加拉共和国Matlab的7.8%）。与非阻塞性个体相比，家庭暴露于生物燃料烟雾(OR=1.48；95%CI 0.98-2.23)、吸烟(OR=1.28/10包年；1.22-1.34)和具有小学或更少教育(OR=1.35；1.07-1.70)时患ACO的几率更高。ACO与重度呼吸阻塞（FEV1%预测<50%；31.5%ACO vs 10.9%单独COPD或3.5%单独哮喘）和严重肺功能缺损[与哮喘患者相比（-1.61z FEV1评分；-1.48，-1.75）或仅患COPD相比（0.94z评分；-0.78，-1.10）]相关。
结论：ACO在中低等收入国家中可能比在高收入环境中报道的更普遍和更严重。暴露于生物燃料烟雾可能是一个被忽视的危险因素，并且我们赞成ACO的诊断标准，包括低收入和中等收入国家常见的环境暴露因素。
Epidemiology and Risk Factors of Asthma-COPD Overlap in Low- and Middle-Income Countries.
Morgan BW, Grigsby MR, Siddharthan T, Chowdhury M, Rubinstein A, Gutierrez L, Irazola V, Miranda JJ, Bernabe-Ortiz A, Alam D, Wise RA, Checkley W.
Abstract
BACKGROUND: Asthma-COPD Overlap (ACO) represents the confluence of bronchial airway hyper reactivity and chronic airflow limitation and has been described as leading to worse lung function and quality of life than found with either singular disease process.
OBJECTIVE: We aimed to describe the prevalence and risk factors for ACO among adults across six low- and middle-income countries (LMICs).
METHODS: We compiled cross-sectional data for 11,923 participants aged 35-92 years from four population-based studies in 12 settings. We defined COPD as post-bronchodilator FEV1/FVC below the lower limit of normal, asthma as wheeze or medication use in 12 months or self-reported physician diagnosis, and ACO as having both.
RESULTS: The prevalence of ACO was 3.8% (0% in rural Puno, Peru to 7.8% in Matlab, Bangladesh). The odds of having ACO were higher with household exposure to biomass fuel smoke (OR=1.48; 95% CI 0.98-2.23), smoking (OR=1.28 per 10 pack-years; 1.22-1.34), and having primary or less education (OR=1.35; 1.07-1.70) compared to non-obstructed individuals. ACO was associated with severe breathing obstruction (FEV1 % predicted <50; 31.5% of ACO vs. 10.9% of COPD alone or 3.5% of asthma alone) and severe spirometric deficits compared to participants with asthma (-1.61 z scores FEV1; -1.48, -1.75) or COPD alone (-0.94 z scores; -0.78, -1.10).
CONCLUSION: ACO may be as prevalent and more severe in LMICs than has been reported in high-income settings. Exposure to biomass fuel smoke may be an overlooked risk factor and we favor diagnostic criteria for ACO that include environmental exposures common to LMICs.
背景：哮喘-COPD重叠（ACO）代表支气管气道高反应性和慢性气流受限的汇合，并已被描述为导致比单一疾病过程更差的肺功能和生活质量疾病。
目的：我们的目的是描述在六个低收入和中等收入国家（LMICs）的成年人中ACO的患病率和危险因素。
方法：我们在12个环境中，从四个基于人群的研究中，对11923名年龄在35～92岁的参与者进行了横断面数据的汇编。我们把COPD定义为支气管扩张后FEV1/FVC低于正常下限，哮喘定义为喘息或12个月内用药或自我报告的内科诊断，ACO定义为两者兼有。
结果：ACO的患病率为3.8%（自秘鲁普诺农村的0%至孟加拉共和国Matlab的7.8%）。与非阻塞性个体相比，家庭暴露于生物燃料烟雾(OR=1.48；95%CI 0.98-2.23)、吸烟(OR=1.28/10包年；1.22-1.34)和具有小学或更少教育(OR=1.35；1.07-1.70)时患ACO的几率更高。ACO与重度呼吸阻塞（FEV1%预测<50%；31.5%ACO vs 10.9%单独COPD或3.5%单独哮喘）和严重肺功能缺损[与哮喘患者相比（-1.61z FEV1评分；-1.48，-1.75）或仅患COPD相比（0.94z评分；-0.78，-1.10）]相关。
结论：ACO在中低等收入国家中可能比在高收入环境中报道的更普遍和更严重。暴露于生物燃料烟雾可能是一个被忽视的危险因素，并且我们赞成ACO的诊断标准，包括低收入和中等收入国家常见的环境暴露因素。
(中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校)
(J Allergy Clin Immunol. 2018 Oct 3. pii: S0091-6749(18)31362-9. doi: 10.1016/j.jaci.2018.06.052. [Epub ahead of print])
(J Allergy Clin Immunol. 2018 Oct 3. pii: S0091-6749(18)31362-9. doi: 10.1016/j.jaci.2018.06.052. [Epub ahead of print])
Epidemiology and Risk Factors of Asthma-COPD Overlap in Low- and Middle-Income Countries.
Morgan BW, Grigsby MR, Siddharthan T, Chowdhury M, Rubinstein A, Gutierrez L, Irazola V, Miranda JJ, Bernabe-Ortiz A, Alam D, Wise RA, Checkley W.
Abstract
BACKGROUND: Asthma-COPD Overlap (ACO) represents the confluence of bronchial airway hyper reactivity and chronic airflow limitation and has been described as leading to worse lung function and quality of life than found with either singular disease process.
OBJECTIVE: We aimed to describe the prevalence and risk factors for ACO among adults across six low- and middle-income countries (LMICs).
METHODS: We compiled cross-sectional data for 11,923 participants aged 35-92 years from four population-based studies in 12 settings. We defined COPD as post-bronchodilator FEV1/FVC below the lower limit of normal, asthma as wheeze or medication use in 12 months or self-reported physician diagnosis, and ACO as having both.
RESULTS: The prevalence of ACO was 3.8% (0% in rural Puno, Peru to 7.8% in Matlab, Bangladesh). The odds of having ACO were higher with household exposure to biomass fuel smoke (OR=1.48; 95% CI 0.98-2.23), smoking (OR=1.28 per 10 pack-years; 1.22-1.34), and having primary or less education (OR=1.35; 1.07-1.70) compared to non-obstructed individuals. ACO was associated with severe breathing obstruction (FEV1 % predicted <50; 31.5% of ACO vs. 10.9% of COPD alone or 3.5% of asthma alone) and severe spirometric deficits compared to participants with asthma (-1.61 z scores FEV1; -1.48, -1.75) or COPD alone (-0.94 z scores; -0.78, -1.10).
CONCLUSION: ACO may be as prevalent and more severe in LMICs than has been reported in high-income settings. Exposure to biomass fuel smoke may be an overlooked risk factor and we favor diagnostic criteria for ACO that include environmental exposures common to LMICs.
上一篇：
活化白细胞粘附分子刺激过敏性哮喘的T细胞应答
下一篇：
Th2型生物标志物在重症哮喘中的分离；主要由FeNO作为恶化的预测因子，骨膜蛋白作为肺功能降低的预测因子
