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Ozoh OB, Dede SK, Ekete OA, Ojo OO, Dania MG. Risk factors for chronic obstructive pulmonary disease (COPD) in a tertiary health institution in Lagos, Nigeria. Ghana Med J 2023; 57:175-182. [PMID: 38957678 PMCID: PMC11216736 DOI: 10.4314/gmj.v57i3.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Abstract
Objective To describe the clinical characteristics and identifiable risk factors for Chronic Obstructive Pulmonary Disease (COPD) in a real-world clinical setting. Design Cross-sectional study among patients with COPD. Setting The Respiratory clinic of the Lagos University Teaching Hospital. Participants Consecutive patients with spirometry confirmed COPD on follow-up for ≥3 months. There were 79 participants. Intervention None. Main outcome measure COPD risk factors, disease severity, comorbidities, and the severity of airflow limitation. Results The mean age of the participants was 63.3± 12.4 years, and 47 (59.5) were male. There was a high symptom burden (73.4% had COPD assessment test (CAT) score >10), 33 (41.8%) and 4 (5.1%) had GOLD 3 and GOLD 4 airflow limitation, respectively. Risk factors were identified for 96.2% of the participants: history of asthma in 37 (46.8%), tobacco smoking 22 (27.8%), occupational exposure 15 (19%), biomass exposure 5 (6.6%), post-tuberculosis 3 (3.8%), old age (3.8%), and prematurity 1 (1.3%). Fifty-nine (74.7%) had Asthma COPD Overlap (ACO). There were no significant associations between the risk factors and disease severity. Participants with ACO had lower lung function and a high frequency of allergic rhinitis. Conclusion Asthma was the most commonly identifiable risk factor for COPD, underscoring asthma risk reduction and management optimisation as priorities toward COPD burden mitigation. Future studies need to validate these findings and identify the predominant COPD phenotypes in our setting. Funding None declared.
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Affiliation(s)
- Obianuju B Ozoh
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Sandra K Dede
- Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Ogochukwu A Ekete
- Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Oluwafemi O Ojo
- Department of Medicine, Lagos State University College of Medicine Ikeja, Lagos, Nigeria
| | - Michelle G Dania
- Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
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2
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Early chronic obstructive pulmonary disease: Associations of two spirometry criteria with clinical features. Respir Med 2022; 204:107011. [DOI: 10.1016/j.rmed.2022.107011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/16/2022] [Accepted: 10/08/2022] [Indexed: 11/22/2022]
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3
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Current Limitations and Recent Advances in the Management of Asthma. Dis Mon 2022:101483. [DOI: 10.1016/j.disamonth.2022.101483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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4
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Marcon A, Locatelli F, Dharmage SC, Svanes C, Heinrich J, Leynaert B, Burney P, Corsico A, Caliskan G, Calciano L, Gislason T, Janson C, Jarvis D, Jõgi R, Lytras T, Malinovschi A, Probst-Hensch N, Toren K, Casas L, Verlato G, Garcia-Aymerich J, Accordini S. The coexistence of asthma and COPD: risk factors, clinical history and lung function trajectories. Eur Respir J 2021; 58:13993003.04656-2020. [PMID: 33863744 PMCID: PMC8613837 DOI: 10.1183/13993003.04656-2020] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/06/2021] [Indexed: 11/05/2022]
Abstract
RATIONALE Patients with concomitant features of asthma and chronic obstructive pulmonary disease (COPD) have a heavy disease burden. OBJECTIVES Using data collected prospectively in the European Community Respiratory Health Survey, we compared the risk factors, clinical history, and lung function trajectories from early adulthood to the late sixties of middle aged subjects having asthma+COPD (n=179), past (n=263) or current (n=808) asthma alone, COPD alone (n=111), or none of these (n=3477). METHODS Interview data and prebronchodilator FEV1 and FVC were obtained during three clinical examinations in 1991-1993, 1999-2002, and 2010-2013. Disease status was classified in 2010-2013, when the subjects were aged 40-68, according to the presence of fixed airflow obstruction (postbronchodilator FEV1/FVC below the lower limit of normal), a lifetime history of asthma, and cumulative exposure to tobacco or occupational inhalants. Previous lung function trajectories, clinical characteristics, and risk factors of these phenotypes were estimated. MAIN RESULTS Subjects with asthma+COPD reported maternal smoking (28.2%) and respiratory infections in childhood (19.1%) more frequently than subjects with COPD alone (20.9 and 14.0%, respectively). Subjects with asthma+COPD had an impairment of lung function at age 20 that tracked over adulthood, and more than half of them had asthma onset in childhood. Subjects with COPD alone had the highest lifelong exposure to tobacco smoking and occupational inhalants, and they showed accelerated lung function decline during adult life. CONCLUSIONS The coexistence between asthma and COPD seems to have its origins earlier in life compared to COPD alone. These findings suggest that prevention of this severe condition, which is typical at older ages, should start in childhood.
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Affiliation(s)
- Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Francesca Locatelli
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Cecilie Svanes
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Joachim Heinrich
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Ludwig Maximilians University, Munich; Comprehensive Pneumology Centre Munich, German Centre for Lung Research, Muenchen, Germany
| | - Bénédicte Leynaert
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, , Villejuif, France
| | - Peter Burney
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.,MRC-PHE Centre for Environment and Health, Imperial College London, London, United Kingdom
| | - Angelo Corsico
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation - Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Gulser Caliskan
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Lucia Calciano
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Thorarinn Gislason
- Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland.,Medical Faculty, University of Iceland, Reykjavik, Iceland
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Deborah Jarvis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.,MRC-PHE Centre for Environment and Health, Imperial College London, London, United Kingdom
| | - Rain Jõgi
- Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Theodore Lytras
- Institute for Global Health (ISGlobal), Barcelona, Spain.,Present institution: School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Andrei Malinovschi
- Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Nicole Probst-Hensch
- Department Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Kjell Toren
- Occupational and Environmental Medicine, School of Public Health, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lidia Casas
- Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
| | - Giuseppe Verlato
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Judith Garcia-Aymerich
- Institute for Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Simone Accordini
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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5
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Tanabe N, Shimizu K, Terada K, Sato S, Suzuki M, Shima H, Oguma A, Oguma T, Konno S, Nishimura M, Hirai T. Central airway and peripheral lung structures in airway disease-dominant COPD. ERJ Open Res 2021; 7:00672-2020. [PMID: 33778061 PMCID: PMC7983277 DOI: 10.1183/23120541.00672-2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/21/2020] [Indexed: 01/14/2023] Open
Abstract
The concept that the small airway is a primary pathological site for all COPD phenotypes has been challenged by recent findings that the disease starts from the central airways in COPD subgroups and that a smaller central airway tree increases COPD risk. This study aimed to examine whether the computed tomography (CT)-based airway disease-dominant (AD) subtype, defined using the central airway dimension, was less associated with small airway dysfunction (SAD) on CT, compared to the emphysema-dominant (ED) subtype. COPD patients were categorised into mild, AD, ED and mixed groups based on wall area per cent (WA%) of the segmental airways and low attenuation volume per cent in the Kyoto–Himeji (n=189) and Hokkaido COPD cohorts (n=93). The volume per cent of SAD regions (SAD%) was obtained by nonrigidly registering inspiratory and expiratory CT. The AD group had a lower SAD% than the ED group and similar SAD% to the mild group. The AD group had a smaller lumen size of airways proximal to the segmental airways and more frequent asthma history before age 40 years than the ED group. In multivariable analyses, while the AD and ED groups were similarly associated with greater airflow limitation, the ED, but not the AD, group was associated with greater SAD%, whereas the AD, but not the ED, group was associated with a smaller central airway size. The CT-based AD COPD subtype might be associated with a smaller central airway tree and asthma history, but not with peripheral lung pathologies including small airway disease, unlike the ED subtype. This study shows that airway disease-dominant COPD, defined using central airway dimension on CT, is associated with a smaller central airway tree, less small airway dysfunction and slower lung function decline than the emphysema-dominant COPDhttps://bit.ly/3nNwxIC
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Affiliation(s)
- Naoya Tanabe
- Dept of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.,These authors contributed equally
| | - Kaoruko Shimizu
- Dept of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan.,These authors contributed equally
| | - Kunihiko Terada
- Terada Clinic, Respiratory Medicine and General Practice, Himeji, Japan
| | - Susumu Sato
- Dept of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masaru Suzuki
- Dept of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroshi Shima
- Dept of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akira Oguma
- Dept of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Tsuyoshi Oguma
- Dept of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Satoshi Konno
- Dept of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Masaharu Nishimura
- Dept of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan.,Hokkaido Institute of Respiratory Diseases, Sapporo, Japan
| | - Toyohiro Hirai
- Dept of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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6
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Mart MF, Peebles RS. Asthma-chronic obstructive pulmonary disease overlap syndrome. Curr Opin Immunol 2020; 66:161-166. [PMID: 33238202 DOI: 10.1016/j.coi.2020.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 10/04/2020] [Indexed: 01/13/2023]
Abstract
Overlap of asthma and chronic obstructive lung disease (ACO) in patients with obstructive lung disease is growing in recognition, though there is no consistent agreement on the diagnostic criteria for the disease process. Patients with ACO have distinct clinical characteristics and trajectories, which are representative of a heterogenous, multifactorial, and incompletely understood inflammatory pathophysiology. Current treatment strategies are focused on titration of inhaled therapies such as long-acting bronchodilators, with increasing interest in the use of targeted biologic therapies aimed at the underlying inflammatory mechanisms. Future directions for research will focus on elucidating the varied inflammatory signatures leading to ACO, the development of consistent diagnostic criteria and biomarkers of disease, and improving the clinical management with an eye toward targeted therapies.
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Affiliation(s)
- Matthew F Mart
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Ray Stokes Peebles
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Tennessee Valley Healthcare System, United States Department of Veterans Affairs, Nashville, TN, USA.
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7
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Influence of Asthma Onset on Airway Dimensions on Ultra-high-resolution Computed Tomography in Chronic Obstructive Pulmonary Disease. J Thorac Imaging 2020; 36:224-230. [PMID: 33156159 DOI: 10.1097/rti.0000000000000568] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE Asthma onset before the age of 40 years is associated with distinct clinical manifestations in chronic obstructive pulmonary disease (COPD) patients, but its morphologic features remain unestablished. This study aimed to explore airway morphology in COPD patients with asthma onset before 40 years of age using ultra-high-resolution computed tomography (U-HRCT), which allows a more accurate quantitation of the lumen and the wall in smaller airways than using conventional CT. MATERIALS AND METHODS Clinical data of 500 consecutive patients undergoing full inspiratory U-HRCT (1024×1024 matrix and 0.25 mm slice thickness) were retrospectively analyzed. COPD patients without asthma, COPD patients with asthma onset at age below or 40 years and above, and non-COPD smoker controls (N=137, 29, 34, and 22, respectively) were enrolled. The length, lumen area (LA), wall thickness and area (WA), and wall area percent (WA%) of the segmental (third-generation) to sub-subsegmental (fifth-generation) bronchus and the low attenuation volume percent (LAV%) were measured. RESULTS LA and WA were smaller in the fourth and fifth generation in COPD patients than in non-COPD controls, regardless of the age of asthma onset. LA was smaller and WA% was larger in the fourth-generation and fifth-generation airways in COPD with asthma onset before 40 years than COPD without asthma, whereas WA did not differ between them. In multivariate analyses, asthma onset before 40 years was associated with smaller LA in COPD patients independent of demographics, use of inhaled corticosteroids and long-acting bronchodilators, airflow limitation, and LAV%. CONCLUSIONS Asthma onset before 40 years of age could be associated with greater lumen narrowing of the airways in COPD.
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8
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Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is a heterogeneous syndrome and may comprise several different phenotypes that are driven by different molecular mechanisms (endotypes). Several different clinical, genetic, and inflammatory phenotypes of COPD have been recognized and this may lead to more precise effective therapies. AREAS COVERED The different clinical phenotypes, including smoking versus nonsmoking COPD, small airway disease versus emphysema, non-exacerbators versus frequent exacerbators are discussed. Rare genetic endotypes (alpha1-antitrypsin deficiency, telomerase polymorphisms), and inflammatory phenotypes (eosinophilic versus neutrophilic) are also recognized in stable and exacerbating patients and have implications for the choice of therapy. EXPERT OPINION Clinical phenotypes have so far not proved to be very useful in selecting more personalized therapy for COPD. Even with genetic endotypes, this has not led to improved therapy. More promising is the recognition that COPD patients who have increased sputum or blood eosinophils tend to have more frequent exacerbations and inhaled corticosteroids are more effective in preventing exacerbation. Increased blood eosinophils have proved to be a useful biomarker now used to target ICS more effectively. Furthermore, COPD patients with low eosinophils are more likely to get pneumonia with ICS and to have lower airway bacterial colonization.
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Affiliation(s)
- Peter J Barnes
- National Heart and Lung Institute, Imperial College London , London, UK
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9
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Abstract
PURPOSE OF REVIEW Asthma and chronic obstructive pulmonary disease (COPD) are common diseases that often overlap. The term asthma-COPD overlap (ACO) has been used to define this entity but there remain several speculations on its exact definition, impact, pathophysiology, clinical features, and management. We reviewed recent publications on ACO to obtain more insight of current knowledge and outline future needs. RECENT FINDINGS Criteria for ACO vary from one publication to another and the many variable features of these patients underline the need to reconsider the evaluation and approach of patients with overlapping features based on clinical traits and underlying biological mechanisms. Epidemiological studies reveal that ACO patients have generally an increased burden of illness and healthcare use in addition to poorer quality of life (QoL) compared with asthma and higher or equal to COPD. However, their long-term outcome seems better than patients with COPD alone. Various methods have been proposed to evaluate these patients but their usefulness compared to 'classical' investigation of obstructive lung diseases remains speculative and needs further evaluation. Furthermore, there are no formal studies that examined and compared the different treatment strategies of well-characterized patients with ACO as such patients are usually excluded from clinical trials. SUMMARY ACO is a common condition with variable features and a high burden of disease. There is no consensus on its definition, diagnostic, and clinical features and more research should be done on its optimal management and long-term outcomes.
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10
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Abstract
This review provides an evidence-based guide for the diagnosis, evaluation, and treatment of patients with asthma. It addresses typical questions that arise in the clinic-based care of patients with asthma and provides a basic and comprehensive resource for asthma care.
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11
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Maselli DJ, Bhatt SP, Anzueto A, Bowler RP, DeMeo DL, Diaz AA, Dransfield MT, Fawzy A, Foreman MG, Hanania NA, Hersh CP, Kim V, Kinney GL, Putcha N, Wan ES, Wells JM, Westney GE, Young KA, Silverman EK, Han MK, Make BJ. Clinical Epidemiology of COPD: Insights From 10 Years of the COPDGene Study. Chest 2019; 156:228-238. [PMID: 31154041 PMCID: PMC7198872 DOI: 10.1016/j.chest.2019.04.135] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 04/08/2019] [Accepted: 04/28/2019] [Indexed: 12/16/2022] Open
Abstract
The Genetic Epidemiology of COPD (COPDGene) study is a noninterventional, multicenter, longitudinal analysis of > 10,000 subjects, including smokers with a ≥ 10 pack-year history with and without COPD and healthy never smokers. The goal was to characterize disease-related phenotypes and explore associations with susceptibility genes. The subjects were extensively phenotyped with the use of comprehensive symptom and comorbidity questionnaires, spirometry, CT scans of the chest, and genetic and biomarker profiling. The objective of this review was to summarize the major advances in the clinical epidemiology of COPD from the first 10 years of the COPDGene study. We highlight the influence of age, sex, and race on the natural history of COPD, and the impact of comorbid conditions, chronic bronchitis, exacerbations, and asthma/COPD overlap.
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Affiliation(s)
- Diego J Maselli
- Division of Pulmonary Diseases and Critical Care, UT Health San Antonio, and South Texas Veterans Health System, San Antonio, TX
| | - Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Antonio Anzueto
- Division of Pulmonary Diseases and Critical Care, UT Health San Antonio, and South Texas Veterans Health System, San Antonio, TX
| | - Russell P Bowler
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO
| | - Dawn L DeMeo
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Ashraf Fawzy
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Marilyn G Foreman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX
| | - Craig P Hersh
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Victor Kim
- Department of Thoracic Medicine and Surgery, Temple University School of Medicine, Philadelphia, PA
| | - Gregory L Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | - Nirupama Putcha
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Emily S Wan
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; VA Boston Healthcare System, Jamaica Plain, MA
| | - J Michael Wells
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Gloria E Westney
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Kendra A Young
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI
| | - Barry J Make
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO.
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12
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Abstract
Chronic obstructive pulmonary disease (COPD) is a major global health problem that is poorly treated by current therapies as it has proved difficult to treat the underlying inflammation, which is largely corticosteroid-resistant in most patients. Although rare genetic endotypes of COPD have been recognized, despite the clinical heterogeneity of COPD, it has proved difficult to identify distinct inflammatory endotypes. Most patients have increased neutrophils and macrophages in sputum, reflecting the increased secretion of neutrophil and monocyte chemotactic mediators in the lungs. However, some patients also have increased eosinophils in sputum and this may be reflected by increased blood eosinophils. Increased blood and sputum eosinophils are associated with more frequent exacerbations and predict a good response to corticosteroids in reducing and treating acute exacerbations. Eosinophilic COPD may represent an overlap with asthma but the mechanism of eosinophilia is uncertain as, although an increase in sputum IL-5 has been detected, anti-IL-5 therapies are not effective in preventing exacerbations. More research is needed to link inflammatory endotypes to clinical manifestations and outcomes in COPD and in particular to predict response to precision medicines.
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Affiliation(s)
- Peter J. Barnes
- National Heart and Lung Institute Imperial College London UK
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13
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Washko GR, Parraga G. COPD biomarkers and phenotypes: opportunities for better outcomes with precision imaging. Eur Respir J 2018; 52:13993003.01570-2018. [PMID: 30337445 DOI: 10.1183/13993003.01570-2018] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 09/27/2018] [Indexed: 01/08/2023]
Abstract
A number of chronic diseases have benefited from both imaging and personalised medicine, but unfortunately, for patients with chronic obstructive pulmonary disease (COPD), there has been little clinical uptake or recognition of the key advances in thoracic imaging that might help detect disease early, or, perhaps more importantly, might help develop and phenotype patients for novel or personalised therapies that may halt disease progression. We outline our vision for how computed tomography and magnetic resonance imaging may be used to better inform COPD patient care, and, perhaps more importantly, how these may be used to help develop new therapies directed at early disease. We think that imaging and precision medicine should be considered and used together as "precision imaging" at specific stages of COPD when the major pathologies may be more responsive to therapy. While "precision medicine" is the tailoring of medical treatment to individual patients, we define "precision imaging" as the tailoring of specific therapies and interventions to individual patients with a detailed quantitative understanding of their specific imaging phenotypes and measurements. Finally, we stress the importance of "seeing" the pathology, because without this understanding, you can neither treat nor cure patients with COPD.
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Affiliation(s)
- George R Washko
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Grace Parraga
- Robarts Research Institute, Western University, London, ON, Canada.,Dept of Medical Biophysics, Western University, London, ON, Canada
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14
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Hayden LP, Cho MH, Raby BA, Beaty TH, Silverman EK, Hersh CP. Childhood asthma is associated with COPD and known asthma variants in COPDGene: a genome-wide association study. Respir Res 2018; 19:209. [PMID: 30373671 PMCID: PMC6206739 DOI: 10.1186/s12931-018-0890-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/12/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Childhood asthma is strongly influenced by genetics and is a risk factor for reduced lung function and chronic obstructive pulmonary disease (COPD) in adults. This study investigates self-reported childhood asthma in adult smokers from the COPDGene Study. We hypothesize that childhood asthma is associated with decreased lung function, increased risk for COPD, and that a genome-wide association study (GWAS) will show association with established asthma variants. METHODS We evaluated current and former smokers ages 45-80 of non-Hispanic white (NHW) or African American (AA) race. Childhood asthma was defined by self-report of asthma, diagnosed by a medical professional, with onset at < 16 years or during childhood. Subjects with a history of childhood asthma were compared to those who never had asthma based on lung function, development of COPD, and genetic variation. GWAS was performed in NHW and AA populations, and combined in meta-analysis. Two sets of established asthma SNPs from published literature were examined for association with childhood asthma. RESULTS Among 10,199 adult smokers, 730 (7%) reported childhood asthma and 7493 (73%) reported no history of asthma. Childhood asthmatics had reduced lung function and increased risk for COPD (OR 3.42, 95% CI 2.81-4.18). Genotype data was assessed for 8031 subjects. Among NHWs, 391(7%) had childhood asthma, and GWAS identified one genome-wide significant association in KIAA1958 (rs59289606, p = 4.82 × 10- 8). Among AAs, 339 (12%) had childhood asthma. No SNPs reached genome-wide significance in the AAs or in the meta-analysis combining NHW and AA subjects; however, potential regions of interest were identified. Established asthma SNPs were examined, seven from the NHGRI-EBI database and five with genome-wide significance in the largest pediatric asthma GWAS. Associations were found in the current childhood asthma GWAS with known asthma loci in IL1RL1, IL13, LINC01149, near GSDMB, and in the C11orf30-LRRC32 region (Bonferroni adjusted p < 0.05 for all comparisons). CONCLUSIONS Childhood asthmatics are at increased risk for COPD. Defining asthma by self-report is valid in populations at risk for COPD, identifying subjects with clinical and genetic characteristics known to associate with childhood asthma. This has potential to improve clinical understanding of asthma-COPD overlap (ACO) and enhance future research into ACO-specific treatment regimens. TRIAL REGISTRATION ClinicalTrials.gov, NCT00608764 (Active since January 28, 2008).
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Affiliation(s)
- Lystra P. Hayden
- Division of Respiratory Diseases, Boston Children’s Hospital, Boston, MA USA
- Channing Division of Network Medicine, Brigham and Women’s Hospital, 181 Longwood Avenue, Boston, MA 02115 USA
| | - Michael H. Cho
- Channing Division of Network Medicine, Brigham and Women’s Hospital, 181 Longwood Avenue, Boston, MA 02115 USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - Benjamin A. Raby
- Division of Respiratory Diseases, Boston Children’s Hospital, Boston, MA USA
- Channing Division of Network Medicine, Brigham and Women’s Hospital, 181 Longwood Avenue, Boston, MA 02115 USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - Terri H. Beaty
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Edwin K. Silverman
- Channing Division of Network Medicine, Brigham and Women’s Hospital, 181 Longwood Avenue, Boston, MA 02115 USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - Craig P. Hersh
- Channing Division of Network Medicine, Brigham and Women’s Hospital, 181 Longwood Avenue, Boston, MA 02115 USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA USA
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