Asthma - chronic obstructive pulmonary disease overlap syndrome

Abstract

Astma i kronična opstruktivna plućna bolest najčešće su kronične bolesti dišnog sustava u našoj populaciji. Astma se tipično javlja u djetinjstvu i karakterizirana je simptomima bronhalne opstrukcije: zviždanjem, piskanjem i kašljem. Opstrukcija je reverzibilna te simptomi prestaju spontano ili primjenom terapije. KOPB je bolest srednje i starije životne dobi; karakterizirana je većim ili manjim stupnjem ireverzibilne dišne opstrukcije. Progresivnog je tijeka uz razvoj sistemnih komplikacija. U određenog broja bolesnika istovremeno postoje simptomi obje bolesti, tzv. sindrom preklapanja. Sindrom preklapanja karakteriziran je varijabilnim protokom zraka dišnim putovima uz određeni stupanj ireverzibilne bronhalne opstrukcije. Neki od čimbenika rizika za nastajanje bolesti su starenje, hiperreaktivnost bronha, astma u anamnezi, izloženost duhanskom dimu (uključujući i pasivnu) i učestale infekcije dišnog sustava. Dijagnoza sindroma preklapanja postavlja se klinički na temelju anamnestičkih podataka, fizikalnog pregleda, spirometrijskog testiranja prije i nakon primjene bronhodilatatora. Promjene u bronhalnom zidu i plućnom parenhimu te analiza sputuma mogu pomoći pri postavljanju dijagnoze. Liječenje sindroma preklapanja provodi se prema smjernicama za liječenje astme i KOPB-a. Za što bolji pristup ovim bolesnicima nužno je bolje upoznati mehanizme nastajanja, međudjelovanje rizičnih čimbenika, ulogu upalnih medijatora te mogućnosti liječenja. Boljim prepoznavanjem bolesti i boljim liječenjem smanjiti će se morbiditet i mortalitet oboljelih te poboljšati kvaliteta njihovog života.Asthma and chronic obstructive pulmonary disease (COPD) are the most common obstructive airway diseases in our population, characterised with various degrees of airflow limitation, inflammation and tissue remodeling. Asthma is an allergic disease associated with airway hyper-responsiveness that usually develops in childhood. It leads to recurrent episodes of breathlessness, wheezing, chest tightness and coughing. Generally, it has favourable prognosis and responds well to anti-inflammatory treatment. COPD is usually associated with smoking, develops in mid to later life and is characterised with incompletely reversible airflow limitation. It results in a progressive decline in lung function, poorer quality of life and premature death. Many older patients have symptomatic and pathobiological features of both diseases, resulting in an overlap syndrome. Overlap syndrome is defined by the coexistence of increased variability of airflow in a patient with incompletely reversible airway obstruction. Risk factors include increasing age, bronchial hyper-responsiveness, tobacco smoke exposure, asthma and lower respiratory infections. Clinical recognition of the overlap is based on inflammatory features, changes in thickness of bronchial wall, CT scans and spirometry results before and after drug administration. The problem we are facing today is the difficulty to develop precise guidelines to diagnose ACOS, distinguish different subtypes of disease and most importantly, treat these patients more efficiently. Therefore, more studies are needed for better understanding of the disease