Clinical Observation Of Clinical Features And Drug Efficacy Of Asthma-chronic Obstructive Pulmonary Syndrome

Objective:To investigate the levels of pulmonary function and FeNO,serum total IgE,allergen positive rate in patients with ACOS and the difference with asthma and chronic obstructive pulmonary disease.To compare the degree of airway inflammation and airway obstruction in ACOS patients,and to analysis the diagnostic significance of pulmonary function,FeNO,serum total IgE,allergen in patients with ACOS.To study the efficacy of inhalation therapy for ACOS and the difference in efficacy with patients of asthma and chronic obstructive pulmonary disease by using Tian Qing Su Le(Tiotropium Bromide Powder for Inhalation)combined with Symbicort(Budesonide and Formoterol Fumarate Powder for Inhalation).To provide new ideas for clinicians in the diagnosis and treatment of ACOS.Methods:In this study,60 patients with ACOS were collected in the Department of Respiratory Medicine in the Norman Bethune First Hospital of Jilin University from February 2015 to July 2016,as ACOS group,the average age(71.3±5.2)years old,of which 30 males and 30 females.Diagnostic criteria are defined in accordance with the definitions and recommended five diagnostic procedures of ACOS byGINA 2014 guidelines.Meanwhile,according to the diagnosis of asthma and COPD guidelines randomly selected asthmatic patients hospitalized over the same period 65 cases,COPD 60 cases,non-respiratory disease and no serious other systemic diseases of physical examination in our hospital 60 patients.Detailed records of the patient’s gender,age,height,weight,smoking history and other information.The four groups of patients with pulmonary function,FeNO,serum total IgE,allergen determination,then record the results accurately.All data were processed by SPSS19.0,measurement data based on whether or not to accord with normal distribution using single factor analysis of variance or Rank sum test(Kruskal-Wallis H test),count data using χ2 test analysis whether the differences between the groups were statistically significant.From ACOS group,asthma group,chronic obstructive pulmonary disease group respectively select FEV1%Pred,FEV1/FVC were no significant difference in patients to regroup,named ACOS treatment group,asthma treatment group,chronic obstructive pulmonary disease treatment group,patients in each group were given basic treatment during hospitalization(including anti-inflammation,reduce phlegm and relieving asthma),after discharge were given the Tian Qing Su Le combined with Symbicort inhaled treatment,follow up for 6 months,to observe the improvement of FEV1%Pred,FEV1/FVC in patients,paired t-test and variance analysis were used to calculate the difference between the groups before and aftertreatment and the difference between groups.Result:(1)The level of FEV1%Pred and FEV1/FVC in ACOS group was significantly lower than those in asthma group and the control group,the difference was statistically significant(P<0.05),but higher than COPD group,The difference was not statistically significant(P>0.05).(2)The level of improvement rate of FEV1 in ACOS group after bronchial dilation test was significantly higher than that in COPD group and the control group,the difference was statistically significant(P<0.05),but lower than asthma group,The difference was not statistically significant(P>0.05).(3)The level of FeNO in ACOS group was significantly higher than that in COPD group and the control group,the difference was statistically significant(P<0.05),but lower than asthma group,The difference was not statistically significant(P>0.05).(4)The level of serum total IgE in ACOS group was significantly higher than that in COPD group and the control group,but lower than asthma group,the difference was statistically significant(P<0.05).(5)The positive rate of allergen in ACOS group was significantly higher than that in COPD group and the control group,the difference was statistically significant(P<0.05),but lower than asthma group,the difference was not statistically significant(P>0.05).(6)ACOS treatment group,asthma treatment group,COPD treatment group of patients after three months,six months of treatment,FEV1%Pred,FEV1/FVC were increased,compared with before treatment,the difference was significant(P<0.05).(7)In the treatment groups,The levels of FEV1% Pred,FEV1/FVC improved from high to low were:asthma treatment group,ACOS treatment group,COPD group,there were significant differences among the groups(P<0.05).Conclusion:(1)The application of FeNO combined with pulmonary ventilation function,serum total IgE,and allergen contributes to the diagnosis of ACOS.And the levels of ACOS were between asthma and COPD.(2)The level of airway inflammation and airway obstruction in patients with ACOS were between asthma and COPD.(3)For patients with COPD who were elevated in FeNO and/or serum total IgE or asthma patients with incomplete reversible airflow limitation should consider the possibility of ACOS.(4)ACOS patients with the application of Tian Qing Su Le combined with Symbicort with a good effect,the improvement degree was between asthma and COPD.