한빛사 논문
Clarus Leung MD, Don D. Sin MD*
University of British Columbia
*Correspondence to: Dr Don D. Sin, University of British Columbia, Centre for Heart Lung Innovation, St. Paul’s Hospital, 1081 Burrard Street, Vancouver, B.C., V6Z 1Y6, Canada
Abstract
Asthma-COPD overlap (ACO) is a heterogeneous condition that describes patients who have persistent airflow limitation with clinical features that support both asthma and chronic obstructive pulmonary disease (COPD). Although there is no single consensus definition to diagnose this entity, common major criteria include a strong bronchodilator reversibility or bronchial hyperreactivity, a physician diagnosis of asthma, and ≥ 10 pack-year cigarette smoking history. The prevalence of ACO ranges from 0.9-11.1% in the general population depending on the diagnostic definition used. Notably, patients with ACO have greater symptom burden, worse quality of life, and more frequent and severe respiratory exacerbations than those with asthma or COPD. The underlying pathophysiology of ACO has been debated. While emerging evidence supports the role of environmental and inhalational exposures in its pathogenesis among patients with a pre-existing airway disease, biomarker profiling and genetic analyses suggest ACO may be a heterogeneous condition but with definable characteristics. Early life factors including childhood-onset asthma and cigarette smoking may interact to increase the risk of airflow obstruction later in life. For treatment options, the ACO population has been historically excluded from therapeutic trials; therefore strong, evidence-based recommendations are lacking beyond first-line inhaler therapies. Advanced therapies in patients with ACO are selected according to disease phenotypes and based on extrapolated data from asthma and COPD. Research focused on defining biomarkers and evidence-based treatment options for ACO is urgently needed.
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