Clinical Observation Of Clinical Festures Of Asthma-chronic Obstructive Pulmonary Disease Overlap Syndrome

Background:Asthma-chronic obstructive pulmonary disease overlap syndrome is a kind of disease that has the characteristics of bronchial asthma and chronic obstructive pulmonary disease simultaneously.At present,ACOS is only a descriptive diagnosis,and there is no clear and uniform diagnostic standard.Therefore,the missed diagnosis rate is high in clinical work.In clinical practice,we should realize the possibility of ACOS according to the patient's medical history,clinical symptoms and related auxiliary examination,so as to further clarify the diagnosis.Therefore,it is of great significance to make clear the clinical features of ACOS for its diagnosis and further effective treatment.Objective:By comparing the differences of basic characteristics,pulmonary function examination and FeNO between patients with asthma,COPD and ACOS,the clinical features of ACOS patients in various factors are summarized,and the diagnostic awareness is improved in clinical work,thus better individualized guidance for the treatment and evaluation of ACOS patients and the improvement of the prognosis of the patients.Method:375 patients were randomly enrolled in the Department of respiration of our hospital from January 2015 to December 2017,including 41 cases of asthma,192 cases of COPD and 142 cases of ACOS,which accurately recorded the basic information of the patients and the results of lung function examination.Data processing was performed by SPSS21.0 software.1.basic characteristics comparisonThe age of the patients in the COPD group was the largest,while those in the ACOS group and asthma group were significantly different.There was no significant difference in gender composition between the three groups.The BMI value of each group was compared.The BMI value of asthma group was the highest,and the rest group was ACOS group and COPD group.In the allergy history comparison,the patients with the history of allergy in group COPD were significantly less than those in the asthma group and the group ACOS,and the difference between the groups was obvious,but there was no significant difference between the asthma group and the ACOS group.In the comparison of smoking history,COPD group had the most smoking history,while the rest group was ACOS group and asthma group.2.comparison of eosinophils in peripheral blood of the patients in each groupIn the comparison of peripheral blood eosinophil count(eosinophilia,EOS),the patients with asthma were the highest in group ACOS and group COPD,and the difference between each group was significant.3.the pulmonary function characteristics of the patients in each group were compared.In asthma group,FEV1% and FVC% were the highest before inhaling bronchodilator,while those in group ACOS and COPD were significantly different.Before inhaled bronchodilator FEV1/FVC%,patients in asthma group were higher than group ACOS and group CODP,and there was significant difference between group and group,but there was no significant difference between group ACOS and COPD group.In asthma group,FEV1% and FVC% were the highest after inhaling bronchodilator,while those in group ACOS and COPD were significantly different.In group ACOS,FEV1/FVC% was the highest after inhaling bronchodilator,and the rest was asthma group and COPD group.The variation rate of FEV1 in COPD group was lower than that of asthma group and ACOS group before and after inhalation of bronchial diastolic agent.There was significant difference between group and group,but there was no statistical difference between the asthma group and the ACOS group.The PEF% of asthma group was the highest,while the rest group was ACOS group and COPD group.On the comparison of FEF50%,FEF75% and MMEF%,the highest and the rest of asthma group were ACOS group and COPD group respectively.The small airway dysfunction rate of patients in group COPD and ACOS group(FEF50,FEF75%,MMEF% three items two less than 60%)reached 100%,but the patients in simple asthma group reached 87.8%.4.comparison of the FeNO characteristics of the patients in each groupFeNO in asthma group was higher than that in group ACOS and group COPD,and there was significant difference between groups.However,there was no significant difference in FeNO between group ACOS and group COPD.5.Analysis of the risk factors of bronchial asthma combined with COPDThe basic information of P<0.05 in the single factor analysis of bronchial asthma group and ACOS group was analyzed by multiple logistics regression risk factors,suggesting that age and smoking history were independent risk factors for asthma combined with COPD.The greater the age of asthma is,the easier it is to merge COPD.The easier it is to combine COPD with smoking history.6.Analysis of the risk factors of COPD combined with bronchial asthmaThe basic information of P<0.05 in group COPD and group ACOS was analyzed by multiple logistics regression risk factors,suggesting that age,BMI and smoking history were independent risk factors for asthma combined with COPD.Patients with younger age and no smoking history are more likely to have asthma.The greater the COPD of BMI is,the more likely it is to have asthma.7.Correlation analysis between FeNO and peripheral blood eosinophil countsThere is no correlation between FeNO and eosinophils in peripheral blood.Conclusion:1.Age and smoking history are independent risk factors for COPD in bronchial asthma.BMI is an independent risk factor for COPD combined with bronchial asthma.2.Lung function impairment,airway obstruction and reversibility of airflow obstruction in patients with ACOS were all located between bronchial asthma and COPD patients.3.The level of FeNO in group ACOS was between asthma and COPD,suggesting that airway inflammation in ACOS patients also had the characteristics of bronchial asthma and COPD inflammation.4.Combined with the basic characteristics of patients,laboratory examination,pulmonary function test and FeNO,it is helpful for the diagnosis of ACOS and the assessment of the severity of the disease.