Clinical Characteristics Of The Asthma–COPD Overlap Syndrome

BackgroundAsthma-Chronic Obstractive pulmonary Disease Overlap sydrom is characterized by asthma and chronic obstructive pulmonary disease.Its pathogenesis and pathophysiology are not yet clear.Lung damage may be associated with chronic inflammation of airway,airway hyperresponsiveness,airway remodeling and airway structural damage and other comprehensive factors.ACOS patients usually have poor symptoms,tend to suffer repeated acute exacerbations?rapid progression and severe decline in lung function.Most of the previous study focused on children and young,non-smoking patients with asthma alone or on the elderly and smoking COPD patients alone,ACOS patients are usually eliminated as a confounding factor,the research on ACOS is not fully complete,the results are not unified and lack the direct evidence of medical basis,its treatment and management are based on expert consensus and guidelines of asthma and COPD.ObjectiveOur study is to analyse the basic information?nutritional status?inflammation index ? Lung function and acute exacerbation of asthma-chronic obstructive pulmonary syndrome and to improve diagnosis consciouseness of ACOS patients and level of treatment among Clinicians.Methods1.A total of 117 patients with chronic obstructive pulmonary disease were enrolled in the Department of Respiratory Medicine,Third Affiliated Hospital of Guangzhou Medical University from 2016.10-2017.4;they were divided into ACOS group and COPD group according to the Spanish guidelines.Including 15 cases in ACOS group,102 cases in COPD group;The diagnostic criteria include three major and three minor standards.Meet two main criteria or a major standard plus two secondary standards;Three major standards:(1)Significant bronchial diastolicresponse(FEV1 increased> 15% and more than 400 mL)after inhalation of bronchodilator;(2)increased sputum eosinophilia(> 2.5%);(3)History of asthma before the age of 40;Three minor standards.(1)the total IgE level increased(>150ug / L);(2)the history of personal allergies;(3)bronchial diastolic response more than 2 times(FEV1 increased> 12%,and more than 200 ml above baseline after inhalation of bronchodilator).2.The clinical data of the patients in two groups were prospectively analyzed and compared;Record and compare the general information of the patients in two groups including gender,age,BMI,smoking history,allergy history,past medical history,history bronchodilator reversibility test parameters before and after the test of all cases and Laboratory test results including Blood routine examination(WBC?NEU?NEU%?Plt?ESO?ESO%?HGB),PCT?CRP?ESR?DDI?FIB?NT-BNP?pulmonary function(FEV1 percentage of expected value?FEVl/FVC?FEV1)?FeNO,arterial blood gas analysis(PaO2?PaCO2)?blood coagulation function(FIB?DDI)?total IgE?Sputum cells?Exhaled nitric oxide.Record the number of acute exacerbations of COPD patients in the past year.3.Follow up these patients by telephone once a month since they were discharged from hospital,The last follow-up date was April 12,record the number of acute exacerbations and their survival status.Results1.basic data of ACOS :ACOS patients accounts for 12.8% in COPD patients.ACOS patients aged 73.3±10.1,COPD patients aged 76.5±8.7,ACOS patients slightly younger than COPD patients,but the difference was not statistically significant.The proportion of allergic history in ACOS group was higher than COPD group,the difference was statistically significant.The smoking index of ACOS group was 320±636 and the smoking index of COPD group was 851±795,the difference was statistically significant.The percentage of ACOS smoking history was significantly lower than that of COPD(P=0).The common concomitant diseases in two group were hypertension,bronchiectasis,heart failure,although the incidence of complications in both groups was no significant difference,apart from coronary heart disease,upper gastrointestinal bleeding,renal insufficiency,the Incidence rate of ACOS group with pneumonia,hypertension,OSAS,bronchiectasis,diabetes,heartfailure,liver disease,pleural effusion,cerebrovascular disease was higher than COPD group.There was no significant difference in the proportion of respiratory failure and respiratory failure types.2.nutritional status ACOS patients had a body mass index of 23.9±4.9kg/m2 and COPD of 20.9±4.0kg/m2,the difference was statistically significant,but the proportion of overweight or underweight was not statistically significant(P>0.05).Albumin in ACOS group was 39.1±3.3g/L,COPD group was 36.7±3.9g/L,the difference was statistically significant(P=0.026),and the ratio of albumin lower than normal range in ACOS group was lower than COPD group,the difference was statistically significant.3 inflammation index There was no significant differences between the two group in blood samples including whiteblood cells,neutrophils,percentage of neutrophils,esosinophils,percentage of esosinophils,platelets,procalcitonin and erythrocyte sedimentation rate..The concentration of NT-BNP was377±634pg/ml,the COPD was 2062±4082pg/ml,The difference was statistically significant.The concentration of C-reactive protein in ACOS group was20.1±28.8mg/L,and the concentration of C-reactive protein in ACOS patients was lower than that in patients with COPD group,COPD group was 48.6±5.5mg/L,,the difference was statistically significant.The concentration of ESR in ACOS group was22.7±15.3 mm/H,and the concentration of ESR in ACOS patients was lower than that in patients with COPD group,COPD group was 34.6±2.7mm/H,the difference was statistically significant.The ratio of increased fibrinogen in ACOS group was33.3% and COPD was 64.7%,the difference was statistically significant,but there was no significant difference between the two groups in the concentration.There was no difference in sputum cell ratio and the level of total IgE between ACOS group and COPD group,the level of exhaled nitric oxide in ACOS patients is 75.4±5.6ppb and COPD patients was 27.5±1.9ppb,The level of FeNO in ACOS group was significantly higher than that of COPD.4.Pulmonary function: FEV1 percentage of expected value ? FEV1/FVC,FEV1 in ACOS group were higher than in COPD patients,but only the difference of FEV1 percentage of expected value was statistically significant.5.acute exacerbations and hospital days,mortality of ACOSThe number of acute exacerbations in the past year was more than COPDpatients(2.5±2.2 VS 1.2±1.5,P=0.007),ACOS patients stayed longer in hospital during hospitalization,both of the difference were statistically significant(9.7±2.7VS 7.8±2.2,P=0.004).There was no significant difference in mortality between ACOS patients and COPD patients.Conclusion:1.ACOS patients accounts for 12.8% in COPD patients.There is no differcence between two groups in age,Compared with COPD,the proportion of smoking and smoking level is lower in ACOS.The rate of allergic history in ACOS group is higher than COPD group,The concomitant diseases are significantly differrent between the two groups.2.BMI index in ACOS patients tend to be higher than COPD group,the concentration of albumin in ACOS patients was higher than COPD patients,the nutritional status is better than COPD.3.The white blood cell?eosinophils in two groups showed no difference,but C-reactive protein ESR and NT-BNP in ACOS group was lower than COPD patients.There is no difference in sputum cell ratio and the level of total IgE between ACOS group and COPD group,The level of FeNO in ACOS group is significantly higher than that of COPD4.FEV1 percentage of expected value is significantly higher in ACOS group than in COPD group.5The number of acute exacerbations in ACOS group is more than COPD patients,ACOS patients stay longer in hospital during hospitalization.