哮喘联盟

   摘要
   哮喘和COPD都是异构性肺部疾病，包括许多不同的表型。经典的哮喘和COPD表型由于反应了表型谱的极端类型所以很容易被辨别。因此，儿童哮喘和吸烟者中的COPD有自己的表型表达，并伴有重要的不同的潜在病理生理机制。对于老年人，哮喘和COPD更难区分，大多数但并不是所有哮喘患者会存在支气管扩张剂应答，同时，大多数但并不是所有COPD患者存在持续性气道阻，虽然即使高达50%的患者报道对FEV1评估的支气管扩张剂有一定反应。无论哮喘和COPD，大气道和小气道都可以出现气道阻塞，但与COPD相比，小气道阻塞更易在哮喘中发生，且严重哮喘和老年哮喘患者较COPD更易发生小气道阻塞。虽然哮喘和COPD的潜在炎症和重塑过程中的极端表型存在不同，但即使稳定COPD的嗜酸性粒细胞炎症和长期严重哮喘的中性粒细胞炎症也有重叠的表型。
 

（刘国梁 审校）
Clin Chest Med. 2014 Mar;35(1):143-156. doi: 10.1016/j.ccm.2013.09.010. Epub 2013 Dec 12.

 

Asthma and Chronic Obstructive Pulmonary Disease: Similarities and Differences.
 

Postma DS1, Reddel HK2, Ten Hacken NH3, van den Berge M3.
 

Abstract
Asthma and COPD are both heterogeneous lung diseases including many different phenotypes. The classical asthma and COPD phenotypes are easy to discern because they reflect extremes of a phenotypical spectrum. Thus asthma in childhood and COPD in smokers have their own phenotypic expression with underlying pathophysiological mechanisms that differ importantly.In older adults, asthma and COPD are more difficult to differentiate and there exists a bronchodilator response in most but not all patients with asthma and persistent airway obstruction in most but not all patients with COPD where even up to 50% have been reported to have some bronchodilator response as assessed with FEV1. Airway obstruction is generated in the large and small airways both in asthma and COPD, and this small airway obstruction is located more proximally in asthma, yet is found more distally in severe and older individuals with asthma, comparable to COPD. Though the underlying inflammation and remodelling processes in asthma and COPD are different in their extreme phenotypes, there are overlap phenotypes with eosinophilic inflammation even in stable COPD and neutrophilic inflammation in longstanding and severe asthma.
 

Clin Chest Med. 2014 Mar;35(1):143-156. doi: 10.1016/j.ccm.2013.09.010. Epub 2013 Dec 12.