Abstract

The two common progressive lung diseases, asthma and chronic obstructive pulmonary disease (COPD), are the leading causes of morbidity and mortality worldwide. Asthma-COPD overlap, referred to as ACO, is another complex pulmonary disease that manifests itself with features of both asthma and COPD. The disease has no clear diagnostic or therapeutic guidelines, thereby making both diagnosis and treatment challenging. Though a number of studies on ACO have been documented, gaps in knowledge regarding the pathophysiologic mechanism of this disorder exist. Addressing this issue is an urgent need for improved diagnostic and therapeutic management of the disease. Metabolomics, an increasingly popular technique, reveals the pathogenesis of complex diseases and holds promise in biomarker discovery. This comprehensive narrative review, comprising 99 original research articles in the last five years (2017–2022), summarizes the scientific advances in terms of metabolic alterations in patients with asthma, COPD, and ACO. The analytical tools, nuclear magnetic resonance (NMR), gas chromatography-mass spectrometry (GC-MS), and liquid chromatography-mass spectrometry (LC-MS), commonly used to study the expression of the metabolome, are discussed. Challenges frequently encountered during metabolite identification and quality assessment are highlighted. Bridging the gap between phenotype and metabotype is envisioned in the future.

摘要

哮喘和慢性阻塞性肺病 (COPD) 这两种常见的进行性肺病是全球发病率和死亡率的主要原因。哮喘-COPD 重叠，简称 ACO，是另一种复杂的肺部疾病，其自身表现为哮喘和 COPD 的特征。该疾病没有明确的诊断或治疗指南，从而使诊断和治疗都具有挑战性。尽管已经记录了许多关于 ACO 的研究，但关于这种疾病的病理生理机制的知识仍然存在差距。解决这个问题迫切需要改进该疾病的诊断和治疗管理。代谢组学是一种日益流行的技术，它揭示了复杂疾病的发病机制，并有望在生物标志物发现方面发挥作用。这篇全面的叙事评论，包含过去五年（2017-2022 年）的 99 篇原创研究文章，总结了哮喘、COPD 和 ACO 患者代谢改变方面的科学进展。讨论了常用于研究代谢组表达的分析工具，核磁共振 (NMR)、气相色谱-质谱 (GC-MS) 和液相色谱-质谱 (LC-MS)。强调了代谢物鉴定和质量评估过程中经常遇到的挑战。设想在未来弥合表型和代谢型之间的差距。讨论了常用于研究代谢组表达的气相色谱-质谱 (GC-MS) 和液相色谱-质谱 (LC-MS)。强调了代谢物鉴定和质量评估过程中经常遇到的挑战。设想在未来弥合表型和代谢型之间的差距。讨论了常用于研究代谢组表达的气相色谱-质谱 (GC-MS) 和液相色谱-质谱 (LC-MS)。强调了代谢物鉴定和质量评估过程中经常遇到的挑战。设想在未来弥合表型和代谢型之间的差距。