Zhongguo quanke yixue (Apr 2024)
Clinical Characteristics of Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Asthma-chronic Obstructive Pulmonary Disease Overlap Patients with Different Low Attenuation Area Grades
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease. Asthma-COPD overlap (ACO) has clinical features both related to asthma and COPD. Some patients are unable to cooperate with pulmonary function tests, so it is difficult to determine the degree of airflow limitation. Objective To compare the clinical characteristics of different low attenuation area (LAA) grades in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and asthma-chronic obstructive pulmonary disease overlap (ACO), and analyze the correlation between forced expiratory volume in 1 second as a percentage of predicted value (FEV1%pred) and LAA grades, so as to provide a reference index for patients who are unable to receive pulmonary function tests. Methods The clinical data of AECOPD and ACO patients hospitalized in the Department of Pulmonary and Critical Care Medicine of the Second Hospital of Hebei Medical University from March 2020 to May 2022 were collected. The participants were divided into the four groups including the emphysema AECOPD group (150 cases), bronchitis AECOPD group (84 cases), emphysema ACO group (47 cases) and bronchitis ACO group (59 cases) according to the LAA grade, LAA≥2 as emphysema groups, LAA<2 as bronchitis groups. The clinical characteristics of the AECOPD and ACO groups and the patients with different LAA grades within the group were compared. Multiple linear regression analysis was used to analyze the influencing factors of FEV1%pred in ACO and AECOPD patients. Results Compared with the bronchitis AECOPD group, BMI, PaO2/FiO2 and FEV1%pred of the bronchitis AECOPD group were lower, and the amount of cigarette smoking, proportions of males and smokers were higher (P<0.05). In the bronchitis AECOPD group, BMI, FEV1%pred, PaO2/FiO2, and albumin (ALB) were lower in patients with LAA grade 1 than those with LAA grade 0 (P<0.05) ; Neutrophil/lymphocyte ratio (NLR), high-sensitivity C-reactive protein (hs-CRP), fibrinogen degradation product (FDP) and interleukin-6 (IL-6) were higher (P<0.05). In the emphysema AECOPD group, compared with patients with LAA grade 4, patients with LAA grade 3 were elder, with higher BMI and FEV1%pred (P<0.05), patients with LAA grade 2 had higher BMI and FEV1%pred, and shorter hospital stay (P<0.05) ; NLR, hs-CRP, and FEV1%pred in patients with LAA grade 3 were higher than those with LAA grade 2 (P<0.05). Compared with the bronchitis ACO group, the emphysema ACO group had higher amount of cigarette smoking, proportions of males and smokers, and lower BMI and FEV1%pred (P<0.05). In the bronchitis ACO patients, patients with LAA grade 0 had higher proportion and total amount of systemic steroids and lower FEV1%pred than those with LAA grade 1 (P<0.05). In the emphysema ACO patients, FEV1%pred was lower in patients with LAA grade 4 than those with LAA grade 3 and LAA grade 2, and FEV1%pred in patients with LAA grade 3 was lower than patients with LAA grade 2. Multiple linear regression analysis showed that LAA grades were negatively correlated with FEV1%pred in AECOPD and ACO patients. Conclusion In AECOPD and ACO patients, different LAA grades are manifested as various clinical characteristics. ACO patients with LAA grade 1 were less sensitive to corticosteroids than those with LAA grade 0. There is a negative correlation between LAA grades and FEV1%pred. LAA grades can provide a reference for evaluating the degree of airflow limitation in AECOPD and ACO patients who are unable to receive pulmonary function tests.
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