1、呼吸内科呼吸内科 材料来源Main teaching points重叠综合征是同时具有哮喘和慢重叠综合征是同时具有哮喘和慢阻肺特点的气流受限性疾病阻肺特点的气流受限性疾病除了吸入激素和支气管扩张药物外，除了吸入激素和支气管扩张药物外，有必要明确和排除可避免的危险因素，有必要明确和排除可避免的危险因素，比如吸烟。比如吸烟。肺功能快速下降的重叠综合征肺功能快速下降的重叠综合征病人多见于哮喘合并吸烟的患病人多见于哮喘合并吸烟的患者者引言ACOSPhenotype of COPD?asthmaACOSCOPDPrevalence of ACOSDifferent criteria different
2、outcomeBurden of ACOSAndersen H.High hospital burden in overlap syndrome of asthma and COPD.Clin.Respir.J.2013;7:3426.Fattahi F.Atopy is a risk factor for respiratory symptoms in COPD patients:results from the EUROSCOP study.Respir.Res.2013;14:10.Chung JW,Kong KA,Lee JH,Lee SJ,Ryu YJ,Chang JH.Charac
3、teristicsand self-rated health of overlap syndrome.Int.J.Chron.Obstruct.Pulmon.Dis.2014;9:795804.PATHOPHYSIOLOGY OF ACOS 基因基因GENE 病 理 和 气 道 功 能病 理 和 气 道 功 能 S T R U C T U R A L CHANGES 临床表现临床表现MANIFESTATIONGeneTh2 inflamationCigarette smoking can alter airway inflammation in asthma from being eosino
4、philic toneutrophilic with increased CD8+cells,thus becomingsimilar to that seen in COPD.Step-wise approach to diagnosing ACOSAsthma ACOS childhood asthma with persistent wheeze from the first years of life into adulthood Longstanding asthma without taking ICS adult-onset asthma severe or difficult-
5、to-treat asthmaCOPD ACOSAvaliable features对慢阻肺患者如果在40岁以前被医生诊断过哮喘，该病人推荐诊断ACOS Recall bias Lack of lung function testing typical symptoms and respond to ICSthorough interviewEosACOSSpirometryGINA and GOLD.Diagnosis of diseases of chronic airflow limitation:asthma,COPD and asthma-COPD overlap syndrome(
6、ACOS)(updated 2015).Available from URL:http:/www.ginasthma.org/.Accessed:13 April 2015.Sputum Eosinophil CountsManagement Individualized management ICS may be considered in patients with ACOS with significant sputum eosinophilia(eosinophil count 3%).DisabilityFuture ACOS Studies First,which genes ar
7、e the genetic risk factors for developing ACOS?the second question is what are the molecular pathways of ACOS?Third,what is the natural course or prognosis of ACOS?Conclusions ACOS may be an interim term applicable to patients in whom it is difficult to distinguish between asthma and COPD.An alternative approach to chronic obstructive airway disease is to describe rather than to categorize the disease.
