支气管哮喘慢性阻塞性肺疾病重叠最新研究进展

The recent advances of asthma-chronic obstructive pulmonary disease overlap

支气管哮喘(简称哮喘)及慢性阻塞性肺疾病(简称慢阻肺)重叠(ACO)是近年来的热点话题,尽管国际上尚无准确的ACO的定义,但学者们发现同时拥有哮喘和慢阻肺症状的患者较单纯的哮喘或慢阻肺患者预后更差,医疗负担更重。因此,如何更好地了解并管理这部分患者是目前临床上亟需攻克的难题。为了加强对这类患者的认识,2014年全球慢性阻塞性肺疾病防治倡议(GOLD)和全球支气管哮喘防治倡议(GINA)首次将其命名为哮喘慢阻肺重叠综合征(ACOS)。为防止其被误认为一种独立的疾病,在后续的GINA指南中(2017)将其修正为哮喘慢阻肺重叠(ACO)。尽管近年来关于ACO的研究显著增多,但尚有很多争议之处,其主要体现在:⑴无准确清晰的标准;⑵无公认的治疗指南。本文就近年来ACO的研究进展及治疗策略展开综述。

Asthma and chronic obstructive pulmonary disease overlap( ACO) is a hot topic in recent years. Although the precise definition of ACO is still controversial,scholars have found that the patients with overlapping features of asthma and COPD have a worse prognosis and increased medical cost than those with asthma or COPD alone. Thus,there is a big challenge to have a better understanding and to manage these patients in clinical practice. To strengthen awareness of this type of patients,the Global initiative for Chronic Obstructive Lung Disease( GOLD) and Global initiative for asthma( GINA) in 2014 named them as " Asthma Chronic Obstructive Lung Overlap Syndrome"( ACOS),which was further revised to the Asthma Chronic Obstructive Lung Overlap( ACO) in the follow-up GINA guidelines( 2017). In the updated version,it emphasized that ACO was not a separate disease. However,although the research on ACO has increased significantly in recent years,there are still many controversies,which includes the definition,diagnostic criteria and treatment therapies. In this review,we provide the recent advances in the diagnosis and an overview of available treatment for of ACO.