ACOS – самостоятельная нозологическая форма? Клиническая картина и диагностика ACOS

На данный момент изучение синдрома перекреста бронхиальной астмы (БА) и хронической обструктивной болезни легких (ХОБЛ) – asthma-COPD overlap syndrome (ACOS) находится на начальном этапе, при этом исследования в области этиологии, фенотипов и персонализированной терапии данного заболевания отсутствуют. Актуальность данной работы обусловлена не только недостаточной изученностью данного патологического состояния, но и все более очевидными серьезностью, распространенностью и недостаточной курабельностью ACOS. Целью исследования явилось определение особенностей воспаления и возможности этиологической диагностики больных ACOS. Материалы и методы. В рамках исследования (n = 175) у лиц с БА (n = 78), ХОБЛ (n = 38), ACOS (n = 39) и практически здоровых (n = 20) проводилось общее клиническое и лабораторное обследование, определялись уровни α1-антитрипсина (ААТ), иммуноглобулинов (Ig)-G и IgE к 4 бактериальным антигенам (Streptococcus pneumoniae, Haemophilus influenzae, Neisseria perflava и Staphylococcus aureus), а также показатели функции внешнего дыхания (ФВД). Результаты. Определены особенности не только клинического течения ACOS по сравнению с таковым при БА, ХОБЛ и у здоровых лиц, но и воспаления у больных БА, ACOS и ХОБЛ с учетом корреляционных связей между маркером воспаления ААТ и показателями ФВД. Для этиологической диагностики у больных ACOS оценены возможности использования титров специализированных IgG и IgE к бактериальным антигенам. Заключение. Наличие у больных ACOS достоверной отрицательной связи ААТ с показателями ФВД и высоких уровней IgG к бактериальным антигенам и отсутствие этих связей у больных БА и ХОБЛ позволяет считать ACOS самостоятельной, отличной от БА и ХОБЛ, связанной с микробным воспалением и маркируемой ААТ нозологической формой.

1. Guerra S. Overlap of asthma and chronic obstructive pulmonary disease. Curr. Opin. Pulm. Med. 2005; 11 (1): 7-3. https://doi.org/10.1016/j.annepidem.2005.04.008.

2. Gibson P.G., Simpson J.L. The overlap syndrome of asthma and COPD: what are its features and how important is it? Thorax. 2009; 64 (8): 728-735. https://doi.org/10.1136/thx.2008.108027.

3. Diagnosis of diseases of chronic airflow limitation: asthma, COPD and asthma-COPD overlap syndrome (ACOS). Available at: https://ginasthma.org/wp-content/uploads/2016/01/ACOS_2015.pdf

4. Barnes P.J. Against the Dutch hypothesis: asthma and chronic obstructive pulmonary disease are distinct diseases. Am. J. Respir. Crit. Care Med. 2006; 174 (3): 240-244. https://doi.org/10.1164/rccm.2604008.

5. Yayan J., Rasche K. Asthma and COPD: similarities and differences in the pathophysiology, diagnosis and therapy. Adv. Exp. Med. Biol. 2016; (910): 31-38. https://doi.org/10.1007/5584_2015_206.

6. Global Initiative for Asthma. Global strategy for asthma management and prevention. Updated 2015. Available at: https://ginasthma.org

7. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. Updated 2015. Available at: https://goldcopd.org

8. Postma D.S., Rabe K.F. The asthma-COPD overlap syndrome. N. Engl. J. Med. 2015; 373 (13): 1241-1249. https://doi.org/10.1056/NEJMra1411863.

9. Bobolea I., Perez de Llano L.A. Asthma-COPD overlap syndrome (ACOS): Current understanding and future perspectives. Open access peer-reviewed chapter. 2016. https://doi.org/10.5772/62412.

10. Cosentino J., Zhao H., Hardin M. et al. Analysis of asthma-COPD overlap syndrome when defined on the basis of bronchodilator response and degree of emphysema. Ann. Am. Thorac. Soc. 2016; 13 (9): 1483-1489. https://doi.org/10.1513/AnnalsATS.201511-761OC.

11. Cazzola M., Rogliani P. Do we really need asthma-chronic obstructive pulmonary disease overlap syndrome? J. Allergy Clin. Immonol. 2016; 138 (4): 977-983. https://doi.org/10.1016/j.jaci.2016.04.028.

12. National Asthma Council (Australia). Australian Asthma Management Handbook. 2014. Available at: https://www.nationalasthma.org.au

13. Guidelines for the Diagnosis and Treatment of COPD. 3rd Edition. Available at: http://www.jrs.or.jp/uploads/uploads/files/photos/765.pdf

14. Soler-Cataluna J.J., Cosio B., Izquiero J.L. et al. Consensus document on the overlap phenotype COPD-asthma in COPD. Arch. Bronconeumol. 2012; 48 (9): 331-337. https://doi.org/10.1016/j.arbres.2011.12.009.

15. Koblizek V., Chlumsky J., Zindr V. et al. Chronic Obstructive Pulmonary Disease: official diagnosis and treatment guidelines of the Czech Pneumological and Phthisiological Society, a novel phenotypic approach to COPD with patient-oriented care. Biomed. Pap. Med. Fac. Univ. Palacky. Olomouc. Czech. Repub. 2013; 157 (2): 187-201. https://doi.org/10.5507/bp.2013.039.

16. Rhee C.K. Phenotype of asthma-chronic obstructive pulmonary disease overlap syndrome. Korean J. Intern Med. 2015; 30 (4): 443-449. https://doi.org/10.3904/kjim.2015.30.4.443.

17. Iwamoto H., Goac J., Koskela J. et al. Differences in plasma and sputum biomarkers between COPD and COPD-asthma overlap. Eur. Respir. J. 2014; 43 (2): 421-429. https://doi.org/10.1183/09031936.00024313.

18. Gibson P.G., McDonald V.M. Asthma-COPD overlap2015: now we are six. Thorax. 2015; 70 (7): 683-691. https://doi.org/10.1136/thoraxjnl-2014-206740.

19. Alshabanat A., Zafari Z., Albanyan O. et al. Asthma and COPD overlap syndrome (ACOS): a systematic review and meta analysis. PLoS One. 2015; 10 (9): e0136065. https://doi.org/10.1371/journal.pone.0136065.

20. Mirabelli M.C., Beavers S.F., Chatterjee A.B. Active asthma and the prevalence of physician-diagnosed COPD. Lung. 2014; 192 (5): 693-700. https://doi.org/10.1007/s00408-014-9609-2.

21. de Marco R, Pesce G., Marcon A. et al. The coexistence of asthma and chronic obstructive pulmonary disease (COPD): prevalence and risk factors in young, middle-aged and elderly people from the general population. PLoS One. 2013; 8 (5): e62985. https://doi.org/10.1371/journal.pone.0062985.

22. Miravitlles M., Huerta A., Fernandez-Villar J.A. et al. Generic utilities in chronic obstructive pulmonary disease patients stratified according to different staging systems. Health Qual. Life Outcomes. 2014; (12): 20. https://doi.org/10.1186/1477-7525-12-20.

23. Kauppi P., Kupiainen H., Laitinen T. et al. Overlap syndrome of asthma and COPD predicts low quality of life. J. Asthma. 2011; 48 (3): 279-285. https://doi.org/10.3109/02770903.2011.555576.

24. Fu J.J., Gibson P.G., Simpson J.L., McDonald V.M. Longitudinal changes in clinical outcoms in older patient with asthma, COPD and asthma-COPD overlap syndrome. Respiration. 2014; 87 (1): 63-74. https://doi.org/10.1159/000352053.

25. Milanese M., DiMarco F., Corsico A.G. et al. Asthma control in elderly asthmatics. An Italian observational study. Respir. Med. 2014; 108 (8): 1091-1099. https://doi.org/10.1016/j.rmed.2014.05.016.

26. Marsh S.E., Travels J., Weatherall M. et al. Proportional classifications of COPD phenotypes. Thorax. 2008; 63 (9): 761-767. https://doi.org/10.1136/thx.2007.089193.

27. Menezes A.M., Montes de Oca M., Perez-Padilla R. et al. Increased risk of exacerbation and hospitalization in subjects with an overlap phenotype: COPD-asthma. Chest. 2014; 145 (2): 297-304. https://doi.org/10.1378/chest.13-0622.

28. Chung W.S., Lin C.L., Kao C.H. Comparison of acute respiratory events between asthma-COPD overlap syndrome and COPD patients. A population-based cohort study. Medicine (Baltimore). 2015; 94 (17): e755. https://doi.org/10.1097/MD.0000000000000755.

29. Barrecheguren M., Esquinas C., Muravitlles M. The asthma-COPD overlap syndrome: a now entity? COPD Res. Pract. 2015; 1: 8. https://doi.org/10.1186/s40749-015-0012-z.

30. Corlateanu A., Covantev S., Matyioudakis A.G. et al. Asthma-Chronic obstructive pulmonary disease overlap syndrome (ACOS): current evidence and future research directions. COPD Res. Pract. 2017; 3: 6. https://doi.org/10.1186/s40749-017-0025-x.

31. Kumbhare S., Pleasats R., Ohar J.A., Strange C. Characteristics and prevalence of asthma/COPD overlap in the United States. Proc. Am. Thorac. Soc. 2016; 13 (6): 803-810. https://doi.org/10.1513/AnnalsATS.201508-554OC.

32. Hazawa N. Clinical approaches towards asthma and chronic obstructive pulmonary disease based on the heterogeneity of disease pathogenesis. Clin. Exp. Allergy. 2016; 46 (5): 678-687. https://doi.org/10.1111/cea.12731.

33. Bateman E.D., Reddel H.K., van Zyl-Smit R.N., Agusti A. The asthma-COPD overlap syndrome: towards a revised taxonomy of chronic airways diseases? Lancet Respir. Med. 2015; 3 (9): 719-728. https://doi.org/10.1016/S2213-2600(15)00254-4.

34. Федосеев Г.Б., Трофимов В.И., Негруца К.В. и др. Что такое overlap синдром (ACOS), диагностика и лечение. Российский аллергологический журнал. 2018; 15 (2): 17-28.

35. Nakawah M.O., Hawkins C., Barbandi F. Asthma, chronic obstructive pulmonary disease (COPD), and the overlap syndrome. J. Am. Board. Fam. Med. 2013; 26 (4): 470-477. https://doi.org/10.3122/jabfm.2013.04.120256.

36. Soler X., Ramvsdel J.W. A asthma and COPD a continuum of the same disease? J. Allergy Clin. Immunol. Pract. 2015; 3 (4): 489-495. https://doi.org/10.1016/j.jaip.2015.05.030.

37. Orie N.G. The Dutch hypothesis. Chest. 2000; 117 (5, Suppl. 1.): 299S. https://doi.org/10.1016/S0012-3692(15)51044-1.

38. Sin D.D. Asthma-COPD overlap syndrome: What we know and what we don't. Tuberc. Respir. Dis. (Seoul). 2017; 80 (1): 11-20. https://doi.org/10.4046/trd.2017.80.1.11.

39. Konstantellou E., Papaioannou A.I., loukides S. et al. Persistent airflow obstruction in patients with asthma: characteristics of a distinct clinical phenotype. Respir. Med. 2015; 109 (11): 1404-1409. https://doi.org/10.1016/j.rmed.2015.09.009.

40. Ghebre M.A., Bafadrel M., Desal D. et al. Biological clustering supports both «Dutch» and «British» hypotheses of asthma and chronic obstructive pulmonary disease. J. Allergy Clin. Immunol. 2015; 135 (1): 63-72. https://doi.org/10.1016/j.jaci.2014.06.035.

41. Kostikas K., Clemens A., Patalano F. The asthma-COPD overlap syndrome: do we really need another syndrome in the already complex matrix of airway disease? Int. J. Chron. Obstruct. Pulmon. Dis. 2016; 11: 1297-1306. https://doi.org/10.2147/COPD.S107307.

42. Hardin M., Cho M., McDonald M.L. et al. The cliniсal and genetic features of COPD-asthma overlap syndrome. Eur. Respir. J. 2014; 44 (2): 341-350. https://doi.org/10.1183/09031936.00216013.

43. Gonzales-Aguirre J.E., Mercado-Longorio R. Asthma-COPD overlap syndrome: A work in progress. Pulm. Crit. Care. Med. 2017; 2 (2): 1-2. https://doi.org/10.15761/PCCM.1000132.

44. Sin D.D., Miravitlless M., Mannino D.M. et al. What is asthma-COPD overlap syndrome? Towards a consensus definition from a round table discussion. Eur. Respir. J. 2016; 48 (3): 664-673. https://doi.org/10.1183/13993003.00436-2016.

45. Пузырев, В.П., Огородова Л.М. Генетика бронхолегочных заболеваний. М.: Атмосфера; 2010.

46. Shapiro S.D. Proteinases in chronic obstructive pulmonary disease. Biochem. Soc. Trans. 2002; 30 (2): 98-102. https://doi.org/10.1042/bst0300098.