不同ACO定义下哮喘-慢阻肺重叠队列的共病模式

文献信息

中文摘要

背景： 哮喘-慢阻肺重叠已被广泛认识，但其特征尚未完全明确。对于由各种ACO定义所描述的临床表现而言，情况尤其如此。本研究的目的是探讨由不同标准定义的ACO患者的共病模式。方法：数据来自一项在哮喘和COPD混合患者人群中开展的多中心横断面研究。根据五种不同的ACO定义（GINA/GOLD/30%、西班牙标准、COPD+哮喘<40、Gibson标准、临床医生诊断），将患者分为五组、参考ACO组，以及一组未诊断为ACO的阻塞性肺疾病患者。为展示各组之间的差异，我们比较了所有ACO组与非ACO组之间共病的患病率。记录所有患者的年龄、气流阻塞严重程度和吸烟史数据。结果：最终分析纳入1609例患者。与未诊断为ACO的患者相比，属于ACO组的患者共病负担更高、肺功能更差，且吸烟史包年数更多。共病在ACO组中的患病率显著更高。与非ACO组相比，GINA/GOLD/30%组中有九种疾病更常见，COPD+哮喘<40组和临床医生诊断组中各有七种，Gibson标准组中有五种，西班牙标准组中有两种。ACO组中最常见的共病是高血压、冠状动脉疾病、GERD、肌肉骨骼疾病、糖尿病和慢性鼻窦炎。在由更精确哮喘标准定义的ACO组中，慢性鼻窦炎更为常见。结论：临床实践中使用的ACO定义差异很大，所描述的人群也不同。ACO人群在共病、肺功能、吸烟史和年龄方面存在差异。慢性鼻窦炎是一种在由更精确哮喘标准定义的ACO组中更常发生的共病。ACO患者的临床结局与其他阻塞性气道疾病患者不同。

英文摘要

Background: The asthma-COPD overlap is widely recognized, but its characteristics are not fully understood. This is largely true for the clinical presentation characterized by various ACO definitions. The purpose of this study was to investigate the pattern of comorbidities among patients with ACO, defined by various criteria. Methods: The data came from the multicenter cross-sectional study conducted in a mixed population of patients with asthma and COPD. Patients were classified into five groups according to five different definitions of ACO (GINA/GOLD/30%, Spanish criteria, COPD + asthma < 40, Gibson's criteria, clinician's diagnosis), reference ACO groups, and a group of patients with obstructive pulmonary diseases who were not diagnosed with ACO. To demonstrate the differences between groups, we compared the prevalence of comorbidities between all ACO and non-ACO groups. Data on age, severity of airflow obstruction, and smoking history were recorded for all patients. Results: For the final analysis, 1609 patients were included. Patients belonging to the ACO groups had a higher burden of comorbidities, poorer lung function, and a higher number of pack-years of smoking history compared to patients without an ACO diagnosis. Comorbidities were significantly more prevalent in ACO groups. Compared to the non-ACO group, nine diseases were more common in the GINA/GOLD/30% group, seven in both the COPD + asthma < 40 group and the clinician's diagnosis group, five in the Gibson's criteria group, and two in the Spanish criteria group. The most common comorbidities in the ACO groups were hypertension, coronary artery disease, GERD, musculoskeletal disorders, diabetes, and chronic sinusitis. Chronic sinusitis was more frequent in ACO groups defined by more precise asthma criteria. Conclusions: The definitions of ACO used in clinical practice vary widely and describe different populations. ACO populations vary in terms of comorbidities, lung function, smoking history, and age. Chronic sinusitis is a comorbidity that occurs more frequently in ACO groups defined by more precise asthma criteria. Patients with ACO differ in their clinical outcomes from those with other obstructive airway diseases.