老年患者慢性阻塞性肺疾病和哮喘临床分析

目的探讨老年人群中慢性阻塞性肺疾病（COPD）和哮喘的临床特征,以提高两种疾病并存的诊治水平。方法收集2010年10月至2011年3月在广州呼吸疾病研究所呼吸门诊初步诊断为哮喘或COPD的老年患者。分析单纯哮喘、COPD合并哮喘和单纯COPD三组患者的自然病史、临床特点、肺功能指标、胸部CT、诱导痰细胞学和治疗反应的差别。结果在102例患者中,单纯COPD 48例（47.1%）,哮喘合并COPD 36例（35.3%）,单纯哮喘18例（17.6%）。单纯COPD患者病程最长,多有吸烟史,91.7%以咳嗽为首发症状,接近80%的患者肺功能损害为重度及以上,痰中性粒细胞百分比高达（78.3±5.1）%,糖皮质激素治疗反应较差。COPD合并哮喘患者约半数有吸烟史,63.9%以咳嗽为首发症状,36.1%以喘息为首发症状,约60%患者肺功能损害达重度及以上,糖皮质激素治疗效果较好。单纯哮喘患者83.3%以喘息为首发症状,肺功能损害程度低,痰嗜酸粒细胞百分比达（13.5±3.1）%,激素治疗效果最好。结论 COPD和哮喘同样是阻塞性气道炎症性疾病,但两者的自然病史、危险因素、肺功能受损程度、气道炎症特点、糖皮质激素治疗效果存在显著差别。临床中有必要有针对性地选用药物和治疗方案,以提高疗效。

Clinical Analysis of Chronic Obstructive Pulmonary Disease and Asthma in Elderly Patients

Objective To investigate the clinical manifestations of two common obstructive airway inflammatory diseases [chronic obstructive pulmonary disease(COPD) and asthma] in elderly patients for proper diagnosis and treatment of COPD complicated with asthma.Methods 102 elderly patients diagnosed with either COPD or asthma,who visited the Guangzhou Institute of Respiratory Disease from October 2010 to March 2011,were recruited for the study.Comparisons of clinical manifestation,pulmonary function tests(PFTs),chest CT and sputum cytological tests were carried out between the patients with asthma-only,COPD-only,and COPD complicated with asthma.Results Of all 102 patients,18 were diagnosed as asthma-only(17.6%),36 as COPD complicated with asthma(35.3%),and 48 as COPD-only(47.1%).The patients with COPD-only had longer history of present illness in which most had a history of exposure to cigarette smoking.91.7% complained of cough as the first symptom,80% showed severe impairment in PFTs.Among these patients,sputum neutrophilic granulocytes were(78.3±5.1)%,which was significantly higher than the other two groups(P<0.05).Glucocorticosteroid treatment was less effective in these patients.In the patients with COPD complicated with asthma,half were smokers,and cough was the first symptom in 63.9% subjects and wheezing was the first symptom in rest.About 60% had severely impaired PFTs,and these patients responded to glucocorticosteroid better than the COPD-only patients.In the asthma-only group,most complained of wheezing as the first symptom and had better PFTs.However,sputum eosinophilic granulocyte was as high as(13.5±3.1)%.They responded to glucocorticosteroid effectively.Conclusions COPD and asthma were both obstructive airway inflammatory diseases,but pulmonary function and responses to glucocorticosteroid therapy were different.It is necessary to understand the severity and mechanism of airway function impairment in order to improve the proper diagnosis and treatment of asthma and COPD in elderly.