慢性阻塞性肺疾病合并支气管哮喘的认识变迁

Changes in understanding of COPD combined with asthma

慢性阻塞性肺疾病(COPD)是一种以持续呼吸道症状和气流受限为特征,常见的、可预防和可治疗的疾病;而哮喘是一种以慢性气道炎症为特征,临床上表现为反复发作的喘息、气急、胸闷、咳嗽等症状,常在夜间和(或)清晨发作、加剧,同时伴有可变的气流受限的异质性疾病。在临床上常常发现一些患者具有以上2种疾病的特征,难以区分,而且这类患者较COPD、哮喘患者会有更频繁的急性发作以及更差的预后,因此引起临床重视,同时也引出了许多临床问题,COPD合并哮喘究竟是一种疾病还是两种疾病的重叠?应该如何诊断以及治疗?文章将梳理历史上对于COPD合并支气管哮喘认识变迁的重要事件,并介绍指南对于COPD合并支气管哮喘的诊断和治疗。

COPD is a common preventable and treatable disease,characterized by persistent airflow limitation that is usually progressive and associated with enhanced chronic inflammatory responses in the airways and the lungs to noxious particles or gases.Exacerbations and comorbidities contribute to the overall severity in individual patients.Asthma is a heterogeneous disease,usually characterized by chronic airway inflammation.It is defined by the history of respiratory symptoms such as wheeze,shortness of breath,chest tightness and cough that vary over time and in intensity,together with variable expiratory airflow limitation.It is often found clinically that some patients have the characteristics of the above two diseases,which is difficult to distinguish,and these patients have more frequent acute attacks and worse prognosis than patients with chronic obstructive pulmonary disease and asthma,so they have attracted special clinical attention and many clinical questions are raised:is this a disease or an overlap of two diseases?How should it be diagnosed and treated?This article will sort out the important events in the history of understanding changes in COPD with asthma,and introduce the guidelines for the diagnosis and treatment of COPD with bronchial asthma.