Blurred lines. Eosinophilic COPD: ACOS or COPD phenotype?
Blurred lines. Eosinophilic COPD: ACOS or COPD phenotype?
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DOI：
10.1016/j.rppnen.2016.01.006
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发表时间：
2016-09-01
影响因子：
--
通讯作者：
Loureiro, C. C.
中科院分区：
文献类型：
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作者：
Loureiro, C. C.
由于哮喘和COPD都是炎症性慢性阻塞性气道疾病，有几种临床表现容易引起混淆，如：嗜酸性粒细胞性哮喘伴固定性阻塞，是一种危险因素，可能进展为COPD;嗜酸性粒细胞性COPD; COPD伴部分可逆性梗阻，无哮喘成分，以及嗜酸性粒细胞性哮喘-COPD重叠综合征（ACOS）虽然在这些疾病的两个极端，病理免疫学过程明显不同，但在一些患者中存在重叠，并且哮喘和COPD之间的病理生理学边界融合。目前的指南显然不足以对阻塞性患者进行分类，考虑到这两种疾病之间的二元分离并不完全清楚，我们应该抵制将患者标记为ACOS的诱惑，并考虑新的气道疾病分类法。无论涉及何种疾病，在阻塞性患者的算法方法中应考虑嗜酸性粒细胞：在COPD中，与哮喘一样，它们与潜在的病理过程相关;它们具有预后价值，并与治疗反应相关。因此，嗜酸性粒细胞应被视为有用的生物标志物，并纳入多维诊断和治疗方法，铭记慢性阻塞性气道疾病的表型，免疫病理学和功能的复杂性。(C)2016年，葡萄牙石油公司。出版社：Elsevier Espana，S.L.U.
Because asthma and COPD are both inflammatory chronic obstructive airway diseases, there are several clinical expressions which can cause confusion, such as: eosinophilic asthma with fixed obstruction, which is a risk factor and might progress to COPD; eosinophilic COPD; COPD with partial reversible obstruction with no asthmatic component and also eosinophilic asthma-COPD overlap syndrome (ACOS).While at the two extremes of these disorders the pathoimmunological processes are clearly different, in some patients there is overlap and the pathophysiological border between asthma and COPD is fused (or diffuse).The current guidelines are clearly insufficient for classification of the obstructive patients and, taking into account that binary separation between the two diseases is not completely clear, we should resist the temptation to label patients as ACOS and consider new airway disease taxonomy. Regardless of the condition concerned, eosinophils should be considered in the algorithm approach to obstructive patients: in COPD, as in asthma, they are related to the underlying pathological process; they have prognostic value and are related to therapeutic response. Therefore, eosinophils should be valued as useful biomarkers and included in a multidimensional diagnostic and therapeutic approach, bearing in mind the phenotypic, immunopathological and functional complexity of chronic obstructive airway disease. (C) 2016 Sociedade Portuguesa de Pneumologia. Published by Elsevier Espana, S.L.U.