| Objective:To analyse the clinical features and the effectiveness of inhaled corticosteroid and bronchodilator therapy of patients with asthma-COPD overlay syndrome(ACOS) and their comparisons with asthma and COPD.Methods:1. (1)Twenty-seven patients with ACOS were enrolled in the prospective study. Only moderate to severe persistent asthma or COPD patients divided into group C or D according to combined COPD assessment were enrolled. (2)We analyzed the general information. (3)We analyzed the clinical manifestation, ACT, mMRC, CAT, HAD, the number of acute exacerbations form last year. (4)We analyzed the peripheral eosnophils%, pulmonary function test(FEV1%、FEV1/FVC、FEF50～75% MMEF%、RV/TLC、DLco%), Fractional exhaled Nitric Oxide(FeNO), and arterial blood gas analysis.2. (1) Twenty-seven patients with defined ACOS、thirty patients with asthma and twenty-eight patients with COPD were enrolled. Only moderate to severe persistent asthma or COPD patients divided into group C or D according to combined COPD assessment were enrolled. (2)The comparisons of ACT, CAT, mMRC, the number of acute exacerbations, pulmonary function test, FeNO, PaO2 and eosnophils% among three groups.3. (1) Three months therapies of Budesonide and Formoterol Fumarate Powder for Inhalation(ICS+LABA) and Tiotropium Bromide Powder for Inhalation(LAMA) were given to ACOS patients and COPD patients, while only ICS+LABA were given to asthma patients. (2)The comparisons of ACT, CAT, mMRC, the number of acute exacerbations, pulmonary function test, FeNO, PaO2, eosnophils% among three groups, and so was these data between pre-treatment and post-treatment.Results:1. (1) These ACOS patients included 11 males and 16 females(1:1.45), with an mean age of (55.3±8.1). Smokers were 66.7%. Concomitant diseases included allergic rhinitis(48.1%), allergic conjunctivitis(48.1%), gastroesophageal reflux(29.6%). Family history of astham was presented in 9(33.3%) patients. (2)Clinical manifestation included cough(92.6%), wheeze(88.9%), sputum production(88.9%), dyspnea(77.8%), chest tightness(70.4%), wheezing rale of lung(51.9%). ACT score was (16.1+3.5), CAT score was (28.2±4.1), mMRC scale was (2.8±0.8). HAD showed depression in 33.3% patients, anxiety in 29.6% patients, and the presence of depression and anxiety in 14.8% patients. The number of acute exacerbations was (2.8±0.7). (3)A11 the ACOS patients had pulmonary ventilation dysfunction, small airway dysfunction and diffusive dysfunction. Pulmonary emphysema was presented in 19(70.4%) patients. Type-Ⅱ respiratory failure was presented in 4(14.8%) patients. Increased FeNO was presented in 19(70.4%) patients. Increased eosnophils% was presented in 7(25.9%) patients.2. (1)There was no statistical difference of ACT, CAT, mMRC scores among three groups(p>0.05). (2)The number of acute exacerbations in ACOS group(2.8±0.7) was significantly higher than asthma group(1.9±0.8) and COPD group(2.4±0.3)(P<0.05). (3)FEV1% in ACOS group(40.3±8.4)% was significantly lower than asthma group (54.9±10.2)%(P<0.05), but there were no statistical difference between ACOS group and COPD group(40.9±7.8)%(P>0.05). Post bronchodilator FEV1/FVC in ACOS group (53.1±13.6)% was significantly lower than asthma group(70.5±10.6)%(P<0.05), but there were no statistical difference between ACOS group and COPD group (51.2±12.9)%(P>0.05). There was more patients had small airway dysfunction in ACOS group(100.0%) than asthma group(76.7%)(P<0.05), but there was no statistical difference between ACOS group and COPD group(92.9%)(P>0.05). RV/TLC in ACOS group(44.7±8.2)% was significantly higher than asthma group(32.6±7.1)%(P<0.05), but there was no statistical difference between ACOS group and COPD group(46.3±5.1)%(P>0.05). DLco% in ACOS group(63.9±14.2)% was significantly lower than asthma group(86.4±15.9)% and higher than COPD group(53.7± 18.9)%(P<0.05). PaO2 in ACOS group(69.5±9.4)mmHg was significantly lower than asthma group(78.3±8.9)mmHg(P<0.05), but there was no statistical difference between ACOS group and COPD group(67.5±10.3)mmHg (P>0.05). (4)Median FeNO in ACOS group(33.9ppb) was significantly lower than asthma group(82.6ppb) and higher than COPD group(20.5ppb)(P<0.05). The proportion of patients had increased eosnophils% in ACOS group(25.9%) was significantly lower than asthma group(56.7%)(P<0.05), but there was no statistical difference between ACOS group and COPD group(7.1%)(P>0.05).3. (1)The post-treatment ACT score in ACOS group(19.7±3.1) had significantly improved than that in pre-treatment, but the improvement degree was significantly lower than asthma group(P<0.05). The post-treatment CAT score and mMRC scale in ACOS group(20.2±4.3)(2.1±0.8) had significantly improved and the improvement degree was significantly higher than COPD group(P<0.05). (2)The post-treatment FEV1% in ACOS group(63.9±13.0)% had significantly improved and the improvement degree was significantly lower than asthma group but higher than COPD group(P<0.05). The post-treatment FEV1/FVC in ACOS group(60.1±8.6)% had significantly improved and the improvement degree was significantly lower than asthma group(P<0.05). (3)The post-treatment PaO2 in ACOS group(78.4±10.6) had significantly improved and the improvement degree was significantly lower than asthma group(P<0.05), but there was no statistical difference between ACOS group and COPD group(P>0.05). (4)The post-treatment FeNO in ACOS group(24.4ppb) had significantly decreased and degree of decrease was lower than astham group(P<0.05).Conclusion:1. ACOS patients’mean age is (55.3±8.1). Smokers are 66.7%. ACOS patients have both the clinical features of asthma and COPD. All the ACOS patients enrolled have pulmonary ventilation disorder, small airway dysfunction and diffusive dysfunction. Increased FeNO was presented in 19(70.4%) patients. Increased eosnophils% was presented in 7(25.9%) patients.2. Pulmonary ventilation function, diffusive function, PaO2, FeNO and the proportion of patients with increased eosnophils% in ACOS group are lower than that in asthma group while the number of acute exacerbations, small airway function, and RV/TLC are higher than asthma group. The number of acute exacerbation, diffusive function and FeNO are higher than COPD group.3. After 3 months therapies with ICS+LABA+LAMA, the post-treatment ACT, FEV1%, FEV1/FVC, PaO2 and FeNO in ACOS group have significantly improved but the improvement degree is significantly lower than asthma group. The post-treatment CAT, mMRC and FEV1% in ACOS group has significantly improved and the improvement degree is significantly higher than COPD group. |
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