Although asthma and chronic obstructive pulmonary disease(COPD) are distinct airway diseases characterized by chronic inflammation, in some cases distinguishing between them is puzzling. For example, chronic smoking l...Although asthma and chronic obstructive pulmonary disease(COPD) are distinct airway diseases characterized by chronic inflammation, in some cases distinguishing between them is puzzling. For example, chronic smoking leads asthmatic inflammation to a differentiated pattern resembling the COPD inflammation, and in some cases to fixed obstruction as in COPD, and on the other hand, few COPD patients may present with airway reversibility. ACOS is the condition sharing features encountered both in asthma and COPD. Asthma-COPD overlap syndrome(ACOS) represents a diagnostic challenge in the clinical practice, since there is lack of specific indicators to distinguish it from asthma or COPD, and moreover, genetic risk factors, underlying pathology and molecular pathways, clinical characteristics, therapeutic interventions, response to treatment and prognosis are poorly described. The management of ACOS is recommended to be individualized and should target on the maximum effectiveness with the least side effects. Combination therapy with ICS/LABA or LAMA, or newly developed specific anti-eosinophil therapies and treatments specifically targeting neutrophils might be of relevance in the management of ACOS, but studies are needed in order to assess the response and prognosis. Based on the current knowledge about ACOS thus far, it would be recommended that we approached chronic obstructive airway disease rather by describing than by classifying the disease; this would allow us to have a picture that better describes the disease and to implement an individualized therapeutic approach, according to the custom phenotype. Nevertheless, more studies are needed in order to clarify several important issues with regard to ACOS, such as the genetic risk factors for developing ACOS, the links between genotype and phenotype, the molecular pathways and underlying mechanisms of ACOS, the identification of possible specific biomarkers for diagnosis and targeted treatment, the optimal therapeutic interventions, and finally, the prognosis of ACOS.展开更多
目的通过开展清咳平喘颗粒治疗慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)(痰热郁肺证)的临床研究,观察其对AECOPD临床症状的改善情况及炎症指标的调节作用,评价清咳平喘颗粒治疗A...目的通过开展清咳平喘颗粒治疗慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)(痰热郁肺证)的临床研究,观察其对AECOPD临床症状的改善情况及炎症指标的调节作用,评价清咳平喘颗粒治疗AECOPD(痰热郁肺证)的有效性和安全性。方法采用前瞻性、随机、平行、对照的临床研究设计,将2022年3月-2023年4月就诊于河北省中医院呼吸科病房的痰热郁肺证AECOPD患者100例,使用随机数字表法分成对照组、试验组各50例。对照组给予常规西医对症治疗,试验组在常规治疗基础上给予清咳平喘颗粒治疗,疗程14 d。观察两组的临床疗效,比较两组患者慢阻肺评估测试(COPD assessment test,CAT)评分、改良版英国医学研究委员会呼吸困难问卷(modified medical research council,mMRC)评分和中医证候量表评分,血气指标、6 min步行试验(6 min walking test,6MWT)距离、血清白细胞介素-6(interleukin-6,IL-6)和降钙素原(procalcitonin,PCT)水平、实际住院天数及不良反应发生情况。结果试验组总有效率(97.92%)高于对照组的93.62%,但差异不具有显著性(P>0.05)。治疗后,两组中医证候积分和CAT、mMRC评分均较治疗前降低(P<0.05),且试验组中医证候积分和CAT、mMRC评分较对照组下降更明显(P<0.05)。治疗后,两组血二氧化碳分压(pCO_(2))较治疗前明显降低,血氧分压(pO_(2))、6MWT较治疗前明显升高(P<0.05);且试验组pCO_(2)、pO_(2)、6MWT较对照组明显改善(P<0.05)。治疗后,两组血清PCT、IL-6水平均较治疗前明显降低(P<0.05);与对照组比较,试验组治疗第1周末血清PCT、IL-6水平差异不明显(P>0.05),治疗第2周末,试验组血清PCT、IL-6水平下降更明显(P<0.05)。两组比较试验组实际住院天数明显短于对照组(P<0.05)。在不良反应方面,观察期间,两组均未发现明显的严重不良反应,安全性良好。结论清咳平喘颗粒可有效改善AECOPD(痰热郁肺证)的临床症状及各项试验指标,且具有较好的安全性,值得在临床进一步研究推广。展开更多
文摘Although asthma and chronic obstructive pulmonary disease(COPD) are distinct airway diseases characterized by chronic inflammation, in some cases distinguishing between them is puzzling. For example, chronic smoking leads asthmatic inflammation to a differentiated pattern resembling the COPD inflammation, and in some cases to fixed obstruction as in COPD, and on the other hand, few COPD patients may present with airway reversibility. ACOS is the condition sharing features encountered both in asthma and COPD. Asthma-COPD overlap syndrome(ACOS) represents a diagnostic challenge in the clinical practice, since there is lack of specific indicators to distinguish it from asthma or COPD, and moreover, genetic risk factors, underlying pathology and molecular pathways, clinical characteristics, therapeutic interventions, response to treatment and prognosis are poorly described. The management of ACOS is recommended to be individualized and should target on the maximum effectiveness with the least side effects. Combination therapy with ICS/LABA or LAMA, or newly developed specific anti-eosinophil therapies and treatments specifically targeting neutrophils might be of relevance in the management of ACOS, but studies are needed in order to assess the response and prognosis. Based on the current knowledge about ACOS thus far, it would be recommended that we approached chronic obstructive airway disease rather by describing than by classifying the disease; this would allow us to have a picture that better describes the disease and to implement an individualized therapeutic approach, according to the custom phenotype. Nevertheless, more studies are needed in order to clarify several important issues with regard to ACOS, such as the genetic risk factors for developing ACOS, the links between genotype and phenotype, the molecular pathways and underlying mechanisms of ACOS, the identification of possible specific biomarkers for diagnosis and targeted treatment, the optimal therapeutic interventions, and finally, the prognosis of ACOS.
文摘目的通过开展清咳平喘颗粒治疗慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)(痰热郁肺证)的临床研究,观察其对AECOPD临床症状的改善情况及炎症指标的调节作用,评价清咳平喘颗粒治疗AECOPD(痰热郁肺证)的有效性和安全性。方法采用前瞻性、随机、平行、对照的临床研究设计,将2022年3月-2023年4月就诊于河北省中医院呼吸科病房的痰热郁肺证AECOPD患者100例,使用随机数字表法分成对照组、试验组各50例。对照组给予常规西医对症治疗,试验组在常规治疗基础上给予清咳平喘颗粒治疗,疗程14 d。观察两组的临床疗效,比较两组患者慢阻肺评估测试(COPD assessment test,CAT)评分、改良版英国医学研究委员会呼吸困难问卷(modified medical research council,mMRC)评分和中医证候量表评分,血气指标、6 min步行试验(6 min walking test,6MWT)距离、血清白细胞介素-6(interleukin-6,IL-6)和降钙素原(procalcitonin,PCT)水平、实际住院天数及不良反应发生情况。结果试验组总有效率(97.92%)高于对照组的93.62%,但差异不具有显著性(P>0.05)。治疗后,两组中医证候积分和CAT、mMRC评分均较治疗前降低(P<0.05),且试验组中医证候积分和CAT、mMRC评分较对照组下降更明显(P<0.05)。治疗后,两组血二氧化碳分压(pCO_(2))较治疗前明显降低,血氧分压(pO_(2))、6MWT较治疗前明显升高(P<0.05);且试验组pCO_(2)、pO_(2)、6MWT较对照组明显改善(P<0.05)。治疗后,两组血清PCT、IL-6水平均较治疗前明显降低(P<0.05);与对照组比较,试验组治疗第1周末血清PCT、IL-6水平差异不明显(P>0.05),治疗第2周末,试验组血清PCT、IL-6水平下降更明显(P<0.05)。两组比较试验组实际住院天数明显短于对照组(P<0.05)。在不良反应方面,观察期间,两组均未发现明显的严重不良反应,安全性良好。结论清咳平喘颗粒可有效改善AECOPD(痰热郁肺证)的临床症状及各项试验指标,且具有较好的安全性,值得在临床进一步研究推广。
