Asthma-like Features and Clinical Course of Chronic Obstructive Pulmonary Disease An Analysis from the Hokkaido COPD Cohort Study
Asthma-like Features and Clinical Course of Chronic Obstructive Pulmonary Disease An Analysis from the Hokkaido COPD Cohort Study
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DOI：
10.1164/rccm.201602-0353oc
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发表时间：
2016-12-01
影响因子：
24.7
通讯作者：
Nishimura, Masaharu
中科院分区：
文献类型：
--
作者：
Suzuki, Masaru;Makita, Hironi;Nishimura, Masaharu
基本原理：一些慢性阻塞性肺疾病（COPD）患者具有哮喘样特征，如显著的支气管扩张剂可逆性、血嗜酸性粒细胞增多和/或特应性，即使他们在临床上未被诊断为患有哮喘。然而，与COPD重叠的哮喘样特征的临床意义仍不清楚。Objectives：本研究的目的是评估哮喘样特征对COPD患者临床病程的影响，COPD患者接受了充分的治疗并随访了10 years.Methods：共有268例COPD患者被呼吸科专家临床认为没有哮喘。本研究中的哮喘样特征包括支气管扩张剂可逆性（Δ FEV 1，>= 12%和>= 200 ml）、血嗜酸性粒细胞增多（>= 300个细胞/μ l）和特应性（任何吸入抗原的特异性IgE阳性）。支气管扩张剂后FEV 1和COPD急性加重的年度变化进行了监测，在第一个5年，死亡率在整个10年的study. Measures和主要结果：57例（21%）支气管扩张剂可逆性，52（19%）有血嗜酸性粒细胞增多症，67（25%）有特应性。血嗜酸性粒细胞增多症受试者使用支气管扩张剂后FEV 1年下降速度显著较慢;支气管扩张剂可逆性和特应性不影响使用支气管扩张剂后FEV 1年下降速度，且哮喘样特征均与COPD急性加重的发生无关。即使受试者有两个或两个以上的哮喘样特征，他们表现出类似于一个或零哮喘样特征的受试者，以及较低的10年死亡率（P = 0.02）的年度后支气管扩张剂FEV 1下降和恶化率（P = 0.02）。结论：在接受适当治疗的COPD患者中，哮喘样特征的存在与更好的临床病程相关。
Rationale: Some patients with chronic obstructive pulmonary disease (COPD) have asthma-like features, such as significant bronchodilator reversibility, blood eosinophilia, and/or atopy, even if they are not clinically diagnosed as having asthma. However, the clinical significance of asthma-like features overlapping with COPD remains unclear.Objectives: The aim of this study was to assess the effect of asthma like features on the clinical course of patients with COPD who were adequately treated and followed-up over 10 years.Methods: A total of 268 patients with COPD who had been clinically considered as not having asthma by respiratory specialists were included in this study. The asthma-like features included in this study were bronchodilator reversibility (Delta FEV1, >= 12% and >= 200 ml), blood eosinophilia (>= 300 cells/mu l), and atopy (positive specific IgE for any inhaled antigen). The annual changes in post-bronchodilator FEV1 and COPD exacerbations were monitored during the first 5 years, and mortality was followed during the entire 10 years of the study.Measurements and Main Results: Fifty-seven subjects (21%) had bronchodilator reversibility, 52 (19%) had blood eosinophilia, and 67 (25%) had atopy. Subjects with blood eosinophilia had significantly slower annual post-bronchodilator FEV1 decline; bronchodilator reversibility and atopy did not affect the annual post-bronchodilator FEV1 decline, and none of the asthma-like features was associated with development of COPD exacerbation. Even if subjects had two or more asthma-like features, they displayed annual post-bronchodilator FEV1 declines and exacerbation rates similar to those of subjects with one or zero asthma-like features, as well as a lower 10-year mortality rate (P = 0.02).Conclusions: The presence of asthma-like features was associated with better clinical course in patients with COPD receiving appropriate treatment.