哮喘，慢性阻塞性肺病（COPD）和重叠综合征
2013/09/12
摘要
哮喘和慢性阻塞性肺病（COPD）是一般人群中非常普遍的慢性疾病。两者以不同的慢性气道炎症和气道阻塞为特征。在两种情况下，慢性炎症均会影响从中心到外周气道的整个呼吸道，但由于参与的炎症细胞不同、产生的介质不同，因此两者对治疗的反应也不同。气道阻塞在哮喘中是典型的间歇性的、可逆的，而在COPD中是进展性的、大多不可逆的。然而，这两种不同疾病之间存在大量病理性和功能性重叠，特别是对于可能存在这两种疾病成分（哮喘-COPD重叠综合征）的老年人。当前指南推荐的哮喘和COPD定义存在局限，因为定义并未阐明临床实践中遇到的所有阻塞性气道疾病。按单独个体分别定义哮喘和COPD忽略了相当大比例具有重叠特点的病人，这种定义方法主要是基于专家意见而非基于最好的当前证据。阻塞性气道疾病存在不同表型或成分，因此，需要给予个体化、优化治疗以达到最佳疗效并尽量减少患者不良反应。尽管每个疾病都有其特异的干预措施，但阻塞性气道疾病的治疗目标相似，主要需求是控制症状、优化健康水平以及预防疾病发作。
（刘国梁 审校）
J Am Board Fam Med. 2013 Jul-Aug;26(4):470-7. doi: 10.3122/jabfm. 2013.04. 120256.
Asthma, Chronic Obstructive Pulmonary Disease (COPD), and the Overlap Syndrome.
Nakawah MO, Hawkins C, Barbandi F.
Abstract
Asthma and chronic obstructive pulmonary disease (COPD) are highly prevalent chronic diseases in the general population. Both are characterized by heterogeneous chronic airway inflammation and airway obstruction. In both conditions, chronic inflammation affects the whole respiratory tract, from central to peripheral airways, with different inflammatory cells recruited, different mediators produced, and thus differing responses to therapy. Airway obstruction is typically intermittent and reversible in asthma but is progressive and largely irreversible in COPD. However, there is a considerable pathologic and functional overlap between these 2 heterogeneous disorders, particularly among the elderly, who may have components of both diseases (asthma-COPD overlap syndrome). The definitions for asthma and COPD recommended by current guidelines are useful but limited because they do not illustrate the full spectrum of obstructive airway diseases that is encountered in clinical practice. Defining asthma and COPD as separate entities neglects a considerable proportion of patients with overlapping features and is largely based on expert opinion rather than on the best current evidence. The presence of different phenotypes or components of obstructive airway diseases, therefore, needs to be addressed to individualize and optimize treatment to achieve the best effect with the fewest side effects for the patient. Although specific interventions vary by disease, the treatment goals of obstructive airway diseases are similar and driven primarily by the need to control symptoms, optimize health status, and prevent exacerbations.
J Am Board Fam Med. 2013 Jul-Aug;26(4):470-7. doi: 10.3122/jabfm. 2013.04. 120256.
