The study of the clinical features of the concurrence of an attack of asthma and chronic obstructive pulmonary disease in elderly patients / 中华急诊医学杂志

ABSTRACT

Objective To investigate the clinical features of asthma at attack and chronic obstructive pulmonary disease (COPD) occurred at the same time (ACO),in elderly people for correct diagnosis and treatment of ACO.Methods A total of 102 elderly patients with either COPD or asthma who visited the Beijing Chaoyang Hospital from October 2010 to June 2016 were recruited for the study.Comparisons of clinical characteristics pulmonary function,airway inflammation and systemic inflammation,quality of life,acute aggravation,treatment and health care costs and comorbidity were carried out among the patients with COPD,asthma and ACO.Results ACO may present the features of both asthma and COPD.FEV1 and FEV1 FVC in ACO group (43.38±11.55)vs.(45.58±11.26) were significantly lower than those in asthma group(71.28±12.46) vs.(74.61±16.21) (P＜0.05),but there was no statistical difference between ACO group and COPD group (1.78±10.28)vs.(52.59±8.52)(P＞0.05).DLco in ACO group(61.86±13.53) was significantly lower than that in asthma group (86.28±16.54) (P＜0.05) and higher than that in COPD group(49.27±19.63) (P＜0.05).RV TLC in ACO group(49.85±12.59) was significantly higher than that in asthma group(29.58±1 5.43)(P＜0.05),but there was no statistical difference between ACO group and COPD group(52.65±1 1.58) (P＞＜0.05).Fractional exhaled nitric oxide(FeNO) in ACO group (29.37±10.85)was significantly lower than that in asthma group (40.18±11.86) (P＜0.05) and higher than that in COPD group(10.22±9.28) (P＜0.05).The proportion of patients with increased percentage of eosinophils in ACO group 25％ was significantly lower than that in asthma group 44.44％ (P＜0.05) and higher than that in COPD group 3.70％ (P＜0.05).The similar results were seen in IgE and C-reactive protein(CRP).There was significantly statistical difference in asthma control test(ACT) between ACO group and asthma group.There was significantly statistical difference in COPD assessment test(CAT) and the modified British Medical Research Council questionnaire (mMRC) scores between ACO group and COPD group;There was significantly statistical difference in six-minute walking distance (6MWD) among three groups(all P＜0.05).The number of acute exacerbations in ACO group (2.93±0.92) was significantly higher than that in asthma group(1.76±0.79)and COPD group(2.12±0.88) (F=14.09,P＜0.05).There was no statistical difference in treatment and health care costs among three groups(all P＞0.05).There were no statistically difference in comorbidity among three groups (all P＞0.05).Conclusions The clinical characteristics of ACO patients are different from those of COPD and asthma patients,It is necessary to understand the mechanism of ACO in order to improve the diagnosis and treatment.