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Desjardins M, Jomphe V, Lagadec-Gaulin L, Cohen M, Verdolini Abbott K. Influence of Sensory Monitoring on Speech Breathing Planning Processes: An Exploratory Study in Aging Speakers Reporting Dyspnea. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:2483-2498. [PMID: 38980884 DOI: 10.1044/2024_jslhr-23-00673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
PURPOSE Previous studies have suggested that inspirations during speech pauses are influenced by the length of adjacent utterances, owing to respiratory motor planning and physiological recovery processes. The goal of this study was to examine how attention to respiratory sensations may influence these processes in aging speakers with dyspnea, by measuring the effect of sensory monitoring on the relationship between utterance length and the occurrence of inspirations, as well as on functional voice and respiratory measures. METHOD Seventeen adults aged 50 years and older with complaints of voicing-related dyspnea completed a repeated-measures protocol consisting of a 2-week baseline phase and a 4-week sensory monitoring phase. Audiovisual recordings of semistructured speech and self-report questionnaires were collected at study onset, after the baseline phase, and after the sensory monitoring phase. Repeated-measures logistic regressions were conducted to examine changes in the relationship between utterance length and the occurrence of inspirations in adjacent pauses, and repeated-measures analyses of variance were used to investigate any changes in functional voice and respiratory measures. RESULTS Planning and recovery processes appeared to remain constant across the baseline phase. From postbaseline to postsensory monitoring timepoints, a strengthening of the relationship between the presence of an inspiration during a speech pause and the length of the subsequent-but not preceding-utterance was noted. Significant improvements were noted in voice-related handicap from study onset to postsensory monitoring, but no changes were reported in respiratory comfort during speech. CONCLUSIONS Results suggest that respiratory planning processes, that is, the ability to plan breath intakes based on the length of upcoming utterances, may be modifiable behaviorally through targeted sensory monitoring. Further studies are warranted to validate the proposed role of respiratory sensation awareness in achieving skilled temporal coordination between voicing and breathing.
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Affiliation(s)
- Maude Desjardins
- School of Rehabilitation Sciences, Laval University, Quebec City, QC, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Quebec City, QC, Canada
| | | | | | - Matthew Cohen
- Department of Communication Sciences & Disorders, University of Delaware, Newark, DE, United States
| | - Katherine Verdolini Abbott
- Department of Communication Sciences & Disorders, University of Delaware, Newark, DE, United States
- Department of Linguistics and Cognitive Science, University of Delaware, Newark, DE, United States
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2
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Pehlivan E, Çetinkaya E, Özcan ZB, Karaahmetoğlu FS, Çörtük M, Ataç A, Çınarka H. Investigation of Inspiratory Muscle Training Efficiency Before Bronchoscopic Lung Volume Reduction: A Randomized Controlled Trial. Arch Bronconeumol 2024:S0300-2896(24)00226-6. [PMID: 39025760 DOI: 10.1016/j.arbres.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 07/20/2024]
Abstract
INTRODUCTION Pulmonary rehabilitation (PR) is recommended prior to bronchoscopic lung volume reduction (BLVR) procedures to optimize patient outcomes. However, there's a lack of clear guidance on PR content. The aim of our study is to examine the effect of adding inspiratory muscle training (IMT) to standard PR before BLVR on exercise capacity, dyspnea, fatigue level and quality of life. METHODS Sixty-four patients were randomly assigned to either the PR Group (PRGr) or the PR with IMT group (IMTGr). Both groups underwent an 8-week standard PR program, including breathing exercises, muscle strengthening, and walking. Additionally, IMTGr received IMT sessions. Outcome measures comprised six-minute walking distance (6MWD), maximal inspiratory and expiratory pressures (MIP, MEP), peripheral muscle strength, modified Medical Research Council dyspnea score, fatigue symptom scale, spirometric parameters, Saint George Quality of Life Questionnaire (SGRQ), International Physical Activity Questionnaire Short Form (IPAQ-SF), and Hospital Anxiety and Depression Scale. RESULTS Our study found no significant difference in exercise capacity improvement between IMTGr and PRGr. However, IMTGr showed significant improvement in MIP compared to PRGr. Both groups experienced improvements in dyspnea, fatigue, and depression scores, as well as enhancements in 6MWD, MEP, peripheral muscle strength, IPAQ-SF and SGRQ scores. CONCLUSION Adding IMT to PR did not show a significant difference between groups among BLVR-eligible patients. However, improved respiratory muscle strength may have positive clinical implications. Further research is needed to explore short and long-term effects.
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Affiliation(s)
- Esra Pehlivan
- University of Health Sciences, Faculty of Hamidiye Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey.
| | - Erdoğan Çetinkaya
- University of Health Sciences, Department of Chest Disease, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Zeynep Betül Özcan
- University of Health Sciences, Enstitute of Hamidiye Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey
| | - Fulya Senem Karaahmetoğlu
- University of Health Sciences, Enstitute of Hamidiye Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey
| | - Mustafa Çörtük
- University of Health Sciences, Department of Chest Disease, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Amine Ataç
- Istanbul Gedik University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey
| | - Halit Çınarka
- University of Health Sciences, Department of Chest Disease, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
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Takahashi N, Nakashima R, Nasu A, Hayashi M, Fujikawa H, Kawakami T, Eto Y, Kishimoto T, Fukuyama A, Ogasawara C, Kawano K, Fujiwara Y, Suico MA, Kai H, Shuto T. T 3 Intratracheal Therapy Alleviates Pulmonary Pathology in an Elastase-Induced Emphysema-Dominant COPD Mouse Model. Antioxidants (Basel) 2023; 13:30. [PMID: 38247455 PMCID: PMC10812479 DOI: 10.3390/antiox13010030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/10/2023] [Accepted: 12/14/2023] [Indexed: 01/23/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a complex pulmonary condition characterized by bronchitis, emphysema, and mucus stasis. Due to the variability in symptoms among patients, traditional approaches to treating COPD as a singular disease are limited. This led us to focus on phenotype/endotype classifications. In this study, we explore the potential therapeutic role of thyroid hormone (T3) by using mouse models: emphysema-dominant elastase-induced COPD and airway-dominant C57BL/6-βENaC-Tg to represent different types of the disease. Here, we showed that intratracheal T3 treatment (40, 80 μg/kg, i.t., every other day) resulted in significant improvements regarding emphysema and the enhancement of respiratory function in the elastase-induced COPD model. T3-dependent improvement is likely linked to the up-regulation of Ppargc1a, a master regulator of mitochondrial biogenesis, and Gclm, a factor associated with oxidative stress. Conversely, neither short- nor long-term T3 treatments improved COPD pathology in the C57BL/6-βENaC-Tg mice. Because the up-regulation of extrathyroidal T3-producing enzyme Dio2, which is also considered a marker of T3 requirement, was specifically observed in elastase-induced COPD lungs, these results demonstrate that exogenous T3 supplementation may have therapeutic potential for acute but not chronic COPD exacerbation. Moreover, this study highlights the relevance of considering not only COPD phenotypes but also COPD endotypes (expression levels of Ppargc1a and/or Dio2) in the research and development of better treatment approaches for COPD.
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Affiliation(s)
- Noriki Takahashi
- Department of Molecular Medicine, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan; (N.T.); (A.N.); (M.H.); (H.F.); (T.K.); (T.K.); (A.F.); (C.O.); (K.K.); (M.A.S.); (H.K.)
- Program for Leading Graduate Schools “HIGO (Health Life Science: Interdisciplinary and Global Oriented) Program”, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Ryunosuke Nakashima
- Department of Molecular Medicine, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan; (N.T.); (A.N.); (M.H.); (H.F.); (T.K.); (T.K.); (A.F.); (C.O.); (K.K.); (M.A.S.); (H.K.)
| | - Aoi Nasu
- Department of Molecular Medicine, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan; (N.T.); (A.N.); (M.H.); (H.F.); (T.K.); (T.K.); (A.F.); (C.O.); (K.K.); (M.A.S.); (H.K.)
- Program for Leading Graduate Schools “HIGO (Health Life Science: Interdisciplinary and Global Oriented) Program”, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Megumi Hayashi
- Department of Molecular Medicine, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan; (N.T.); (A.N.); (M.H.); (H.F.); (T.K.); (T.K.); (A.F.); (C.O.); (K.K.); (M.A.S.); (H.K.)
| | - Haruka Fujikawa
- Department of Molecular Medicine, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan; (N.T.); (A.N.); (M.H.); (H.F.); (T.K.); (T.K.); (A.F.); (C.O.); (K.K.); (M.A.S.); (H.K.)
- Program for Leading Graduate Schools “HIGO (Health Life Science: Interdisciplinary and Global Oriented) Program”, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Taisei Kawakami
- Department of Molecular Medicine, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan; (N.T.); (A.N.); (M.H.); (H.F.); (T.K.); (T.K.); (A.F.); (C.O.); (K.K.); (M.A.S.); (H.K.)
| | - Yuka Eto
- Department of Molecular Medicine, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan; (N.T.); (A.N.); (M.H.); (H.F.); (T.K.); (T.K.); (A.F.); (C.O.); (K.K.); (M.A.S.); (H.K.)
| | - Tomoki Kishimoto
- Department of Molecular Medicine, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan; (N.T.); (A.N.); (M.H.); (H.F.); (T.K.); (T.K.); (A.F.); (C.O.); (K.K.); (M.A.S.); (H.K.)
| | - Ayami Fukuyama
- Department of Molecular Medicine, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan; (N.T.); (A.N.); (M.H.); (H.F.); (T.K.); (T.K.); (A.F.); (C.O.); (K.K.); (M.A.S.); (H.K.)
| | - Choyo Ogasawara
- Department of Molecular Medicine, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan; (N.T.); (A.N.); (M.H.); (H.F.); (T.K.); (T.K.); (A.F.); (C.O.); (K.K.); (M.A.S.); (H.K.)
| | - Keisuke Kawano
- Department of Molecular Medicine, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan; (N.T.); (A.N.); (M.H.); (H.F.); (T.K.); (T.K.); (A.F.); (C.O.); (K.K.); (M.A.S.); (H.K.)
| | - Yukio Fujiwara
- Department of Cell Pathology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Kumamoto Chuo-ku, Kumamoto 860-8556, Japan;
| | - Mary Ann Suico
- Department of Molecular Medicine, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan; (N.T.); (A.N.); (M.H.); (H.F.); (T.K.); (T.K.); (A.F.); (C.O.); (K.K.); (M.A.S.); (H.K.)
- Global Center for Natural Resources Sciences, Faculty of Life Sciences, Kumamoto University, 5-1 Oe-Honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Hirofumi Kai
- Department of Molecular Medicine, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan; (N.T.); (A.N.); (M.H.); (H.F.); (T.K.); (T.K.); (A.F.); (C.O.); (K.K.); (M.A.S.); (H.K.)
- Global Center for Natural Resources Sciences, Faculty of Life Sciences, Kumamoto University, 5-1 Oe-Honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Tsuyoshi Shuto
- Department of Molecular Medicine, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan; (N.T.); (A.N.); (M.H.); (H.F.); (T.K.); (T.K.); (A.F.); (C.O.); (K.K.); (M.A.S.); (H.K.)
- Global Center for Natural Resources Sciences, Faculty of Life Sciences, Kumamoto University, 5-1 Oe-Honmachi, Chuo-ku, Kumamoto 862-0973, Japan
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Suzuki Y, Nagase H, Toyota H, Ohyatsu S, Kobayashi K, Takeshita Y, Uehara Y, Hattori S, Ishizuka M, Sakasegawa H, Kuramochi M, Kohyama T, Sugimoto N. Questionnaire for diagnosing asthma-COPD overlap in COPD: Development of ACO screening questionnaire (ACO-Q). Allergol Int 2023:S1323-8930(23)00005-9. [PMID: 36868950 DOI: 10.1016/j.alit.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 01/05/2023] [Accepted: 01/18/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND The considerable prevalence and worse outcomes of asthma-COPD overlap (ACO) in COPD have been reported, and optimal introduction of ICS is essential for ACO. However, diagnostic criteria for ACO consist of multiple laboratory tests, which is challenging during this COVID-19 era. The purpose of this study was to create a simple questionnaire to diagnose ACO in patients with COPD. METHODS Among 100 COPD patients, 53 were diagnosed with ACO based on the Japanese Respiratory Society Guidelines for ACO. Firstly, 10 candidate questionnaire items were generated and further selected by a logistic regression model. An integer-based scoring system was generated based on the scaled estimates of items. RESULTS Five items, namely a history of asthma, wheezing, dyspnea at rest, nocturnal awakening, and weather- or season-dependent symptoms, contributed significantly to the diagnosis of ACO in COPD. History of asthma was related to FeNO >35 ppb. Two points were assigned to history of asthma and 1 point to other items in the ACO screening questionnaire (ACO-Q), and the area under the receiver operating characteristic curve was 0.883 (95% CI: 0.806-0.933). The best cutoff point was 1 point, and the positive predictive value was 100% at a cutoff of 3 points or higher. The result was reproducible in the validation cohort of 53 patients with COPD. CONCLUSIONS A simple questionnaire, ACO-Q, was developed. Patients with scores ≥3 could be reasonably recommended to be treated as ACO, and additional laboratory testing would be recommended for patients with 1 and 2 points.
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Affiliation(s)
- Yuki Suzuki
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Hiroyuki Nagase
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan.
| | - Hikaru Toyota
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Sho Ohyatsu
- Department of Internal Medicine, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Konomi Kobayashi
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yuri Takeshita
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yuuki Uehara
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Saya Hattori
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Mana Ishizuka
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Hirokazu Sakasegawa
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Michio Kuramochi
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Tadashi Kohyama
- Department of Internal Medicine, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Naoya Sugimoto
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
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5
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Lee SY, Lee HS, Park HW. Transcriptome analysis of sputum cells reveals two distinct molecular phenotypes of “asthma and chronic obstructive pulmonary disease overlap” in the elderly. Eur J Med Res 2022; 27:215. [DOI: 10.1186/s40001-022-00861-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/18/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Little is known about the pathogenesis of asthma and chronic obstructive pulmonary disease (COPD) overlap (ACO). This study examined the molecular phenotypes of ACO in the elderly.
Methods
A genome-wide investigation of gene expression in sputum cells from the elderly with asthma, ACO, or COPD was performed using gene set variation analysis (GSVA) with predefined asthma- or COPD-specific gene signatures. We then performed a subsequent cluster analysis using enrichment scores (ESs) to identify molecular clusters in the elderly with ACO. Finally, a second GSVA was conducted with curated gene signatures to gain insight into the pathogenesis of ACO associated with the identified molecular clusters.
Results
Seventy elderly individuals were enrolled (17 with asthma, 41 with ACO, and 12 with COPD). Two distinct molecular clusters of ACO were identified. Clinically, ACO cluster 1 (N = 23) was characterized by male and smoker dominance, more obstructive lung function, and higher proportions of both neutrophil and eosinophil in induced sputum compared to ACO cluster 2 (N = 18). ACO cluster 1 had molecular features similar to both asthma and COPD, with mitochondria and peroxisome dysfunction as important mechanisms in the pathogenesis of these diseases. The molecular features of ACO cluster 2 differed from those of asthma and COPD, with enhanced innate immune reactions to microorganisms identified as being important in the pathogenesis of this form of ACO.
Conclusion
Recognition of the unique biological pathways associated with the two distinct molecular phenotypes of ACO will deepen our understanding of ACO in the elderly.
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Kumar K, Gupta PP, Verma AK, Yadav R. Assessment of prevalence and characteristics of asthma-COPD overlap among patients with chronic airflow obstruction. Monaldi Arch Chest Dis 2022; 93. [PMID: 36062505 DOI: 10.4081/monaldi.2022.2323] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/07/2022] [Indexed: 11/23/2022] Open
Abstract
Given the paucity of research on asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) and the high prevalence of co-morbidities and healthcare utilization associated with it, the current study looked at the prevalence of ACO and its clinico-radiological phenotype in patients with chronic airflow obstruction. The study was conducted at a tertiary care hospital in North India. Patients over 40 with COPD or asthma were screened for inclusion in the ACO, asthma, and COPD groups. The ACO and COPD groups were further investigated. The clinical characteristics, lung functions, health-related quality of life, and radiological features of both groups were investigated and compared. ACO was discovered in 16.3% of patients with chronic airflow obstruction (asthma and COPD). The most commonly observed symptoms at presentation in the evaluated ACO patients (n=77) were shortness of breath, wheezing, cough, and expectoration (mean age at presentation: 57.9; mean duration of illness: 8.62 years). Exacerbation rates in ACO patients were significantly higher than in COPD patients (p<0.001). The ACO group had a significantly greater mean change in FEV1 post-bronchodilator in millilitres (ml) and percentage (379.61 ml and 37.72%) than the COPD group (p<0.001). The proportion of patients with emphysema was lower in the ACO group than in the COPD group (p<0.001). The ACO and COPD groups did not differ significantly in major airway wall thickness (p=0.3), but the COPD group had a significantly higher proportion of patients with vascular attenuation and distortion (p<0.001). Patients with COPD had a higher degree of hyperinflation, according to high resolution computed tomography (HRCT) indices. This study found that patients with ACO have a distinct phenotype in terms of clinical presentation and HRCT features. More research on the radiological features of ACO is required to identify the anatomical abnormalities involved in the disease's pathogenesis and to validate the radiological features of ACO.
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Abstract
Asthma COPD Overlap has consistently reported to be associated with an increase burden of disease but the impact on lung function decline and mortality varies by study. The prevalence increases with age but the relationship with gender also varies with the study population. The variability in the prevalence and clinical characteristics of ACO is linked to differences in how chronic obstructive pulmonary disease (COPD) and asthma are defined, including diagnostic criteria (spirometry-based vs. clinical or symptom-based diagnoses vs. claims data), the population studied, the geographic region and environment and a consensus approach to the diagnosis of ACO is needed to allow meaningful and consistent epidemiologic information to be generated about this condition.
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Affiliation(s)
- Anne L Fuhlbrigge
- Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Fitzsimons Building | 13001 East 17th Place, Aurora, CO 80045, USA.
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8
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Godbout K, Gibson PG. Defining Asthma-Chronic Obstructive Pulmonary Disease Overlap. Immunol Allergy Clin North Am 2022; 42:507-519. [PMID: 35965041 DOI: 10.1016/j.iac.2022.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Much interest has been given to the asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) in the past 2 decades, but the condition is still ill-defined. There is general agreement that a patient with longstanding asthma who develops fixed airflow obstruction after years of smoking has ACO although defining asthma in the face of COPD can be challenging. Many features of asthma are also found in patients with COPD without indicating an overlap and no consensus exists on which characteristics should be included in the definition of ACO. Nevertheless, some guidance has been issued to help clinicians and researchers to make a diagnosis of ACO and these will be reviewed here.
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Affiliation(s)
| | - Peter G Gibson
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia; Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, New South Wales, Australia
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Yang IA, Jenkins CR, Salvi SS. Chronic obstructive pulmonary disease in never-smokers: risk factors, pathogenesis, and implications for prevention and treatment. THE LANCET. RESPIRATORY MEDICINE 2022; 10:497-511. [PMID: 35427530 DOI: 10.1016/s2213-2600(21)00506-3] [Citation(s) in RCA: 115] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/19/2021] [Accepted: 11/09/2021] [Indexed: 12/29/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) was traditionally thought to be caused by tobacco smoking. However, recognition of the importance of non-smoking-related risk factors for COPD has increased over the past decade, with evidence on the burden, risk factors, and clinical presentations of COPD in never-smokers. About half of all COPD cases worldwide are due to non-tobacco-related risk factors, which vary by geographical region. These factors include air pollution, occupational exposures, poorly controlled asthma, environmental tobacco smoke, infectious diseases, and low socioeconomic status. Impaired lung growth during childhood, caused by a range of early-life exposures, is associated with an increased risk of COPD. Potential mechanisms for the pathogenesis of COPD in never-smokers include inflammation, oxidative stress, airway remodelling, and accelerated lung ageing. Compared with smokers who develop COPD, never-smokers with COPD have relatively mild chronic respiratory symptoms, little or no emphysema, milder airflow limitation, and fewer comorbidities; however, exacerbations can still be frequent. Further research-including epidemiological, translational, clinical, and implementation studies-is needed to address gaps in understanding and to advance potential solutions to reduce the burden of COPD in never-smokers.
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Affiliation(s)
- Ian A Yang
- UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Health, Brisbane, QLD, Australia.
| | - Christine R Jenkins
- Respiratory Group, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Department of Thoracic Medicine, Concord General Hospital, Sydney, NSW, Australia; Concord Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Sundeep S Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, Maharashtra, India; Faculty of Health Sciences, Symbiosis International (Deemed University), Pune, Maharashtra, India
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Ishiura Y, Fujimura M, Ohkura N, Hara J, Nakahama K, Sawai Y, Tamaki T, Murai R, Shimizu T, Miyashita N, Nomura S. Tiotropium Add-On and Treatable Traits in Asthma-COPD Overlap: A Real-World Pilot Study. J Asthma Allergy 2022; 15:703-712. [PMID: 35651483 PMCID: PMC9148922 DOI: 10.2147/jaa.s360260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/06/2022] [Indexed: 01/14/2023] Open
Abstract
Purpose The ‘treatable traits’ strategy for patients with chronic inflammatory airway diseases, especially asthma and chronic obstructive pulmonary disease (COPD), is a focus of interest, because it implements precision and personalized medicine. Asthma-COPD overlap (ACO), a phenotype involving both asthma and COPD, is an important disease entity because patients with ACO have significantly worse outcomes, conferring greater economical and social burdens. Some guidelines for ACO recommend add-on therapy of long-acting muscarinic antagonists to inhaled corticosteroids and long-acting β2 agonists. However, this approach is based on extrapolation from patients with asthma or COPD alone. Consequently, a ‘treatable traits’ approach suitable for ACO remains obscure. Methods A 12-week open-label cross-over pilot study was conducted in patients with ACO to investigate the effect of tiotropium bromide (TIO) 5 µg/day add-on therapy to fluticasone propionate/formoterol fumarate (FP/FM) 500/20 µg/day compared with FP/FM 500/20 µg/day alone. A 4-week run-in period and two 4-week treatment periods were included. Results A total of 18 male patients with stable ACO participated in this pilot study. All patients were ex-smokers. Mean values ± standard deviation (SD) for forced expiratory volume in 1 second (FEV1) were 1.21 ± 0.49 L after the run-in period, 1.20 ± 0.51 L after the FP/FM combination therapy period, and 1.30 ± 0.48 L after the TIO add-on therapy to FP/FM period. FEV1 values after the TIO add-on therapy FP/FM period were significantly higher than those after the run-in period (p < 0.01). Conclusion TIO add-on therapy to FP/FM in patients with ACO, considered difficult to treat because of the presence of both asthma and COPD, resulted in improvements in lung function parameters in this real-world pilot study, indicating the potential value of TIO add-on therapy as a “treatable traits” option for standard treatment for ACO.
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Affiliation(s)
- Yoshihisa Ishiura
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
- Correspondence: Yoshihisa Ishiura, First Department of Internal Medicine, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan, Tel +81-6-6992-1001, Fax +81-6-6993-9837, Email ishiura-@p2322.nsk.ne.jp;
| | - Masaki Fujimura
- Respiratory Medicine, National Hospital Organization Nanao Hospital, Nanao, Japan
| | - Noriyuki Ohkura
- Respiratory Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Johsuke Hara
- Respiratory Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Kahori Nakahama
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Yusuke Sawai
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Takeshi Tamaki
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Ryuta Murai
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Toshiki Shimizu
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Naoyuki Miyashita
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Shosaku Nomura
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
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11
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Madore AM, Bossé Y, Margaritte-Jeannin P, Vucic E, Lam WL, Bouzigon E, Bourbeau J, Laprise C. Analysis of GWAS-nominated loci for lung cancer and COPD revealed a new asthma locus. BMC Pulm Med 2022; 22:155. [PMID: 35461280 PMCID: PMC9034599 DOI: 10.1186/s12890-022-01890-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Asthma, lung cancer (LC) and chronic obstructive pulmonary disease (COPD) are three respiratory diseases characterized by complex mechanisms underlying and genetic predispositions, with asthma having the highest calculated heritability. Despite efforts deployed in the last decades, only a small part of its heritability has been elucidated. It was hypothesized that shared genetic factors by these three diseases could help identify new asthma loci. METHODS GWAS-nominated LC and COPD loci were selected among studies performed in Caucasian cohorts using the GWAS Catalog. Genetic analyses were carried out for these loci in the Saguenay-Lac-Saint-Jean (SLSJ) asthma familial cohort and then replicated in two independent cohorts (the Canadian Cohort Obstructive Lung Disease [CanCOLD] and the Epidemiological Study of the Genetics and Environment of Asthma [EGEA]). RESULTS Analyses in the SLSJ cohort identified 2851 and 4702 genetic variants to be replicated in the CanCOLD and EGEA cohorts for LC and COPD loci respectively. Replication and meta-analyses allowed the association of one new locus with asthma, 2p24.3, from COPD studies. None was associated from LC studies reported. CONCLUSIONS The approach used in this study contributed to better understand the heritability of asthma with shared genetic backgrounds of respiratory diseases.
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Affiliation(s)
- Anne-Marie Madore
- Département des Sciences fondamentales, Université du Québec à Chicoutimi, Saguenay, QC, G7H 2B1, Canada
| | - Yohan Bossé
- Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Quebec, QC, G1V 4G5, Canada.,Department of Molecular Medicine, Université Laval, Quebec, QC, G1V 0A6, Canada
| | | | - Emily Vucic
- Department of Biochemistry and Molecular Pharmacology, New York University School of Medicine, New York, NY, 10016, USA.,Department of Integrative Oncology, British Columbia Cancer Research Centre, Vancouver, BC, V5Z 1L3, Canada.,Canadian Environmental Exposures in Cancer (CE2C) Network (CE2C.Ca), Halifax, Canada
| | - Wan L Lam
- Department of Integrative Oncology, British Columbia Cancer Research Centre, Vancouver, BC, V5Z 1L3, Canada.,Canadian Environmental Exposures in Cancer (CE2C) Network (CE2C.Ca), Halifax, Canada
| | | | - Jean Bourbeau
- Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, H3H 2R9, Canada
| | - Catherine Laprise
- Département des Sciences fondamentales, Université du Québec à Chicoutimi, Saguenay, QC, G7H 2B1, Canada. .,Centre intersectoriel en santé durable, Université du Québec à Chicoutimi, Saguenay, QC, G7H 2B1, Canada. .,Canada Research Chair on Environment and Genetics of Respiratory Diseases and Allergy, Université du Québec à Chicoutimi, Saguenay, QC, G7H 2B1, Canada.
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12
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Verga SR, Criner GJ. Device profile of the Zephyr endobronchial valve in heterogenous emphysema: overview of its safety and efficacy. Expert Rev Med Devices 2021; 18:823-832. [PMID: 34314290 DOI: 10.1080/17434440.2021.1957831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Emphysema affects millions of people; the underlying pathophysiology is hyperinflation due to destruction of lung parenchyma. The mainstay of treatment is medical therapy however there are two surgical treatment strategies approved by the FDA to reduce lung hyperinflation. First being lung volume reduction surgery (LVRS), which carries higher risk of mortality versus bronchoscopic lung volume reduction (BLVR). BLVR has reduced peri-operative morbidity without compromising improvement in post-bronchodilator forced expiratory volume 1s (FEV1) and patient-reported outcomes. The added benefit of BLVR is that older adults who have end-stage emphysema who otherwise would not be appropriate surgical candidates for LVRS or transplant have an alternative treatment option. AREAS COVERED This is a review paper focusing on Zephyr® endobronchial valves (EBV). Specifically, clinical outcomes of major trials, selection criteria, valve/deployment catheter features, description of procedure, discussing the Chartis™ Pulmonary Assessment System and StratX report, management of complications and discussing next steps in protocolizing post-EBV care. EXPERT OPINION The expert opinion section focuses on outcomes from the LIBERATE Trial and 1-yr post-hoc analysis. Further 5-year follow-up post Zephyr® EBV placement along with protocolization post-EBV placement are needed to minimize adverse events and/or be able to manage, especially with high risk of pneumothorax (PTX).
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Affiliation(s)
- Steven R Verga
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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13
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Mekov E, Nuñez A, Sin DD, Ichinose M, Rhee CK, Maselli DJ, Coté A, Suppli Ulrik C, Maltais F, Anzueto A, Miravitlles M. Update on Asthma-COPD Overlap (ACO): A Narrative Review. Int J Chron Obstruct Pulmon Dis 2021; 16:1783-1799. [PMID: 34168440 PMCID: PMC8216660 DOI: 10.2147/copd.s312560] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/20/2021] [Indexed: 12/14/2022] Open
Abstract
Although chronic obstructive pulmonary disease (COPD) and asthma are well-characterized diseases, they can coexist in a given patient. The term asthma-COPD overlap (ACO) was introduced to describe patients that have clinical features of both diseases and may represent around 25% of COPD patients and around 20% of asthma patients. Despite the increasing interest in ACO, there are still substantial controversies regarding its definition and its position within clinical guidelines for patients with obstructive lung disease. In general, most definitions indicate that ACO patients must present with non-reversible airflow limitation, significant exposure to smoking or other noxious particles or gases, together with features of asthma. In patients with a primary diagnosis of COPD, the identification of ACO has therapeutic implication because the asthmatic component should be treated with inhaled corticosteroids and some studies suggest that the most severe patients may respond to biological agents indicated for severe asthma. This manuscript aims to summarize the current state-of-the-art of ACO. The definitions, prevalence, and clinical manifestations will be reviewed and some innovative aspects, such as genetics, epigenetics, and biomarkers will be addressed. Lastly, the management and prognosis will be outlined as well as the position of ACO in the COPD and asthma guidelines.
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Affiliation(s)
- Evgeni Mekov
- Department of Occupational Diseases, Medical Faculty, Medical University of Sofia, Sofia, Bulgaria
| | - Alexa Nuñez
- Pneumology Department, Hospital Universitari Vall d´Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Don D Sin
- Centre for Heart Lung Innovation, St. Paul’s Hospital, Department of Medicine (Respiratory Division), University of British Columbia, Vancouver, BC, Canada
| | | | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Diego Jose Maselli
- Division of Pulmonary Diseases & Critical Care, University of Texas Health, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Andréanne Coté
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Charlotte Suppli Ulrik
- Department of Pulmonary Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - François Maltais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Antonio Anzueto
- Division of Pulmonary Diseases & Critical Care, University of Texas Health, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d´Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
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14
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Fujikura K, Albini A, Barr RG, Parikh M, Kern J, Hoffman E, Hiura GT, Bluemke DA, Carr J, Lima JAC, Michos ED, Gomes AS, Prince MR. Aortic enlargement in chronic obstructive pulmonary disease (COPD) and emphysema: The Multi-Ethnic Study of Atherosclerosis (MESA) COPD study. Int J Cardiol 2021; 331:214-220. [PMID: 33587941 PMCID: PMC8026709 DOI: 10.1016/j.ijcard.2021.02.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 12/25/2020] [Accepted: 02/05/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The prevalence of abdominal aortic aneurysm is high in chronic obstructive pulmonary disease (COPD) population. Emphysema involves proteolytic destruction of elastic fibers. Therefore, emphysema may also contribute to thoracic aorta dilatation. This study assessed aorta dilation in smokers stratified by presence of COPD, emphysema and airway thickening. METHODS Aorta diameters were measured on 3D magnetic resonance angiography in smokers recruited from the Multi-Ethnic Study of Atherosclerosis (MESA), the Emphysema and Cancer Action Project (EMCAP), and the local community. COPD was defined by standard spirometric criteria; emphysema was measured quantitatively on computed tomography and bronchitis was determined from medical history. RESULTS Participants (n = 315, age 58-79) included 150 with COPD and 165 without COPD, of whom 56% and 19%, respectively, had emphysema. Subjects in the most severe quartile of emphysematous change showed the largest diameter at all four aorta locations compared to those in the least severe quartiles (all p < 0.001). Comparing subjects with and without COPD, aorta diameters were larger in participants with severe COPD in ascending and arch (both p < 0.001), and abdominal aorta (p = 0.001). Chronic bronchitis and bronchial wall thickness did not correlate with aorta diameter. In subjects with emphysema, subjects with coexistence of COPD showed larger aorta than those without COPD in ascending (p = 0.003), arch (p = 0.002), and abdominal aorta (p = 0.04). CONCLUSIONS This study showed larger aorta diameter in subjects with COPD and severe emphysema compared to COPD related to chronic bronchitis or bronchial wall thickening.
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Affiliation(s)
- Kana Fujikura
- Advanced Cardiovascular Imaging Laboratory, National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, ML, USA
| | | | - R Graham Barr
- Department of Medicine, Columbia University, New York, USA
| | - Megha Parikh
- Department of Medicine, Columbia University, New York, USA
| | - Julia Kern
- Department of Medicine, Columbia University, New York, USA
| | - Eric Hoffman
- Department of Radiology, Medicine and Biomedical Engineering, University of Iowa, Iowa City, USA
| | - Grant T Hiura
- Department of Medicine, Columbia University, New York, USA
| | - David A Bluemke
- Department of Radiology, University of Wisconsin, Madison, USA
| | - James Carr
- Department of Radiology, Northwestern University, Chicago, USA
| | - João A C Lima
- Division of Cardiology, Johns Hopkins University, Baltimore, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University, Baltimore, USA
| | - Antoinette S Gomes
- Department of Radiology, University of California-Los Angeles, School of Medicine, Los Angeles, USA
| | - Martin R Prince
- Department of Radiology, Weill Cornell Medicine, NY, New York, USA.
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15
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Busse PJ, McDonald VM, Wisnivesky JP, Gibson PG. Asthma Across the Ages: Adults. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:1828-1838. [PMID: 32499032 DOI: 10.1016/j.jaip.2020.03.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/18/2020] [Accepted: 03/25/2020] [Indexed: 02/06/2023]
Abstract
Asthma is a common disease affecting approximately 300 million people worldwide, across all age ranges. Despite advances in asthma outcomes of the last few decades, there remains room for improvement in asthma management and for patient outcomes, particularly in older patients. The heterogeneity of asthma is now well recognized, and is known to complicate response to treatment and patient behavior and impact health outcomes. Asthma and its heterogeneity change according to age. Asthma affects people differently across the life span. In adults, prevalence is highest among those in middle age; however, mortality is greater in the older age group. In this clinical commentary, we describe how age impacts asthma prevalence and incidence, outcomes, disease expression, and approach to management in adulthood and in older patients.
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Affiliation(s)
- Paula J Busse
- Division of Allergy and Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Vanessa M McDonald
- National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, NSW, Australia; Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, NSW, Australia; Viruses, Immunology, Vaccines, Asthma (VIVA) Programme, Hunter Medical Research Institute, Newcastle, NSW, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Peter G Gibson
- National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, NSW, Australia; Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, NSW, Australia; Viruses, Immunology, Vaccines, Asthma (VIVA) Programme, Hunter Medical Research Institute, Newcastle, NSW, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
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16
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Zhang Y, Wang Z, Cao Y, Zhang L, Wang G, Dong F, Deng R, Guo B, Zeng L, Wang P, Dai R, Ran Y, Lyu W, Miao P, Su S. The effect of consecutive ambient air pollution on the hospital admission from chronic obstructive pulmonary disease in the Chengdu region, China. AIR QUALITY, ATMOSPHERE, & HEALTH 2021; 14:1049-1061. [PMID: 33758631 PMCID: PMC7971392 DOI: 10.1007/s11869-021-00998-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/11/2021] [Indexed: 06/02/2023]
Abstract
Hospitalisation risks for chronic obstructive pulmonary disease (COPD) have been attributed to ambient air pollution worldwide. However, a rise in COPD hospitalisations may indicate a considerable increase in fatality rate in public health. The current study focuses on the association between consecutive ambient air pollution (CAAP) and COPD hospitalisation to offer predictable early guidance towards estimates of COPD hospital admissions in the event of consecutive exposure to air pollution. Big data analytics were collected from 3-year time series recordings (from 2015 to 2017) of both air data and COPD hospitalisation data in the Chengdu region in China. Based on the combined effects of CAAP and unit increase in air pollutant concentrations, a quasi-Poisson regression model was established, which revealed the association between CAAP and estimated COPD admissions. The results show the dynamics and outbreaks in the variations in COPD admissions in response to CAAP. Cross-validation and mean squared error (MSE) are applied to validate the goodness of fit. In both short-term and long-term air pollution exposures, Z test outcomes show that the COPD hospitalisation risk is greater for men than for women; similarly, the occurrence of COPD hospital admissions in the group of elderly people (> 65 years old) is significantly larger than that in lower age groups. The time lag between the air quality and COPD hospitalisation is also investigated, and a peak of COPD hospitalisation risk is found to lag 2 days for air quality index (AQI) and PM10, and 1 day for PM2.5. The big data-based predictive paradigm would be a measure for the early detection of a public health event in post-COVID-19. The study findings can also provide guidance for COPD admissions in the event of consecutive exposure to air pollution in the Chengdu region.
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Affiliation(s)
- Yi Zhang
- The School of Aeronautics and Astronautics, University of Electronic Science and Technology of China, Chengdu, 611731 China
- Aircraft Swarm Intelligent Sensing Cooperative Control Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, 611731 China
| | - Ziyue Wang
- The School of Aeronautics and Astronautics, University of Electronic Science and Technology of China, Chengdu, 611731 China
- Aircraft Swarm Intelligent Sensing Cooperative Control Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, 611731 China
| | - Yu Cao
- The School of Aeronautics and Astronautics, University of Electronic Science and Technology of China, Chengdu, 611731 China
- Aircraft Swarm Intelligent Sensing Cooperative Control Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, 611731 China
| | - Lifu Zhang
- The School of Aeronautics and Astronautics, University of Electronic Science and Technology of China, Chengdu, 611731 China
- Aircraft Swarm Intelligent Sensing Cooperative Control Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, 611731 China
| | - Guan Wang
- The School of Aeronautics and Astronautics, University of Electronic Science and Technology of China, Chengdu, 611731 China
- Aircraft Swarm Intelligent Sensing Cooperative Control Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, 611731 China
| | - Fangjie Dong
- The Centre for Health Statistics and Information National Health Commission of the P.R. of China, Beijing, 100000 China
| | - Ren Deng
- Health Information Center of Sichuan Province, Chengdu, 611731 China
| | - Baogen Guo
- TCM Hospital of Shuangliu District, Chengdu, 610200 China
| | - Li Zeng
- Longchang People’s Hospital, Neijiang, 642150 China
| | - Peng Wang
- The People’s Hospital of Weiyuan, Weiyuan, 642450 China
| | - Ruimei Dai
- Sichuan Post and Telecommunication College, Chengdu, 610067 China
| | - Yu Ran
- The School of Aeronautics and Astronautics, University of Electronic Science and Technology of China, Chengdu, 611731 China
- Aircraft Swarm Intelligent Sensing Cooperative Control Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, 611731 China
| | - Wenyi Lyu
- The School of Aeronautics and Astronautics, University of Electronic Science and Technology of China, Chengdu, 611731 China
- Aircraft Swarm Intelligent Sensing Cooperative Control Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, 611731 China
| | - Peiwen Miao
- Sichuan Agricultural University, Chengdu, 625014 China
| | - Steven Su
- The Biomedical Engineering School, University of Technology Sydney, Ultimo, NSW 2007 Australia
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17
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Dal Negro RW, Carone M, Cuttitta G, Gallelli L, Pistolesi M, Privitera S, Ceriana P, Pirina P, Balbi B, Vancheri C, Gallo FM, Chetta A, Turco P. Prevalence and clinical features of most frequent phenotypes in the Italian COPD population: the CLIMA Study. Multidiscip Respir Med 2021; 16:790. [PMID: 34733506 PMCID: PMC8506204 DOI: 10.4081/mrm.2021.790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/16/2021] [Indexed: 01/12/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a complex, progressive respiratory condition characterized by heterogeneous clinical presentations (phenotypes). The aim of this study was to assess the prevalence of the main COPD phenotypes and match of each phenotype to the most fitting clinical and lung function profile. Methods the CLIMA (Clinical Phenotypes in Actual Clinical Practice) study was an observational, cross-sectional investigation involving twenty-four sites evenly distributed throughout Italy. Patients were tentatively grouped based on their history and claimed prevailing symptoms at recruitment: chronic cough (CB, suggesting chronic bronchitis); dyspnoea (possible emphysema components, E); recurrent wheezing (presuming asthma components, A). Variables collected were: anagraphics; smoking habit; history of asthma; claim of >1 exacerbations in the previous year; blood eosinophil count; total blood IgE and alpha1 anti-trypsin (α1-AT) levels; complete lung function, and the chest X-ray report. mMRC, CAT, BCS, EQ5d-5L were also used. The association between variables and phenotypes were checked by Chi-square test and multinomial logistic regression. Results The CB phenotype was prevalent (48.3%), followed by the E and the A phenotypes (38.8% and 12.8%, respectively). When dyspnoea was the prevailing symptom, the probability of belonging to the COPD-E phenotype was 3.40 times higher. Recurrent wheezing was mostly related to the COPD-A phenotype. Lung function proved more preserved in the COPD-CB phenotype. Smoke; n. exacerbations/year; VR, and BODE index were positively correlated with the COPD-E phenotype, while SpO2, FEV1/FVC, FEV1/VC, and FEV1 reversibility were negatively correlated. Lower DLco values were highly probative for the COPD-E phenotype (p<0.001). Conversely, smoke, wheezing, plasma eosinophils, FEV1 reversibility, and DLco were positively correlated with the COPD-A phenotype. The probability of belonging to the COPD-A phenotype raised by 2.71 times for any increase of one unit in % plasma eosinophils (p<0.001). Also multiparametrical scores contributed to discriminate the three phenotypes. Conclusion The recognition of the main phenotypes of COPD can be effectively pursued by means of a few clinical and instrumental parameters, easy to obtain also in current daily practice. The phenotypical approach is crucial in the management of COPD as it allows to individualize the therapeutic strategy and to obtain more effective clinical outcomes.
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Affiliation(s)
- Roberto W Dal Negro
- National Center for Respiratory Pharmacoeconomics and Pharmacoepidemiology, Verona
| | | | - Giuseppina Cuttitta
- Institute of Biomedicine and Molecular Immunology, National Research Council, Palermo
| | - Luca Gallelli
- Pharmacology Operative Unit, University Hospital Authority "Mater Domini", Catanzaro
| | - Massimo Pistolesi
- Pneumologia e Fisiopatologia Toraco-Polmonare, Azienda Ospedaliera Universitaria Careggi, Firenze
| | | | - Piero Ceriana
- Occupational Health and Rehabilitation Clinic, ICS Maugeri IRCCS, Pavia
| | - Pietro Pirina
- Pneumology Operative Unit, University Hospital Authority, Sassari
| | - Bruno Balbi
- Pneumology Rehabilitation Unit, ICS Maugeri IRCCS, Veruno (NO)
| | - Carlo Vancheri
- Pneumology Rehabilitation Unit, University Hospital Authority, Policlinico Vittorio Emanuele, Catania
| | - Franca M Gallo
- Departmental Structure for Territorial Pneumology, Local Health Authority, Matera
| | - Alfredo Chetta
- Pneumology Clinic, University Hospital Authority, Hospital "G. Rasori", Parma
| | - Paola Turco
- Research and Clinical Governance, Verona, Italy
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18
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Abstract
The term asthma chronic obstructive pulmonary disease (COPD) overlap (ACO) has been popularized to describe people who simultaneously have features of both diseases. Analysis of the basis of disease classification and comparison of the clinical, pathophysiological, and therapeutic features of asthma and COPD concludes that it is not useful to use the term ACO. Rather, it is important to make the individual diagnoses, recognizing that both diseases may coexist. If a concurrent diagnosis of COPD is suspected in people with asthma, pharmacotherapy should primarily follow asthma guidelines, but pharmacologic and nonpharmacologic approaches also may be needed for COPD.
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Affiliation(s)
- David M G Halpin
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter EX1 2LU, UK.
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19
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A Randomized, Noninferiority Trial Comparing ICS + LABA with ICS + LABA + LAMA in Asthma-COPD Overlap (ACO) Treatment: The ACO Treatment with Optimal Medications (ATOMIC) Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1304-1311.e2. [PMID: 33184024 DOI: 10.1016/j.jaip.2020.09.066] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/02/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Current guidelines for the treatment of asthma and chronic obstructive pulmonary disease overlap (ACO) recommend initial treatment using inhaled corticosteroids (ICSs) plus 1 or more bronchodilators. OBJECTIVE To clarify which therapeutic effect is better between the ICS + long-acting β2 agonist (LABA) and ICS + LABA + long-acting muscarinic antagonist (LAMA) treatment in patients with ACO. METHODS We conducted a multicenter, 48-week, randomized, noninferiority trial. Patients with ACO were enrolled if they were treated with a moderate to high dose of ICS + LABA. In total, 303 patients were involved in the present trial, with 149 receiving ICS + LABA + LAMA. The primary end point was the time to first exacerbation. Secondary outcomes included changes in FEV1, forced vital capacity, FEV1/forced vital capacity ratio, asthma control, blood eosinophil count, and fractional exhaled nitric oxide. RESULTS In the ICS + LABA treatment group, 29 of 154 patients (18.83%) experienced exacerbation, whereas 28 of 149 patients (18.79%) experienced exacerbation in the ICS + LABA + LAMA treatment group. The results of this noninferiority study were ultimately inconclusive (hazard ratio, 1.1; 95% CI, 0.66-1.84). However, the patients treated with the addition of LAMA showed significant improvements in FEV1 and forced vital capacity (P < .001). Asthma control did not improve in either group. CONCLUSIONS Although this study was unable to conclude that ICS + LABA treatment is not inferior to ICS + LABA + LAMA in terms of exacerbation, it is obvious that the ICS + LABA + LAMA treatment group had improved lung function in ACO.
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20
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Zantah M, Gangemi AJ, Criner GJ. Bronchoscopic lung volume reduction: status quo. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1469. [PMID: 33313214 PMCID: PMC7723581 DOI: 10.21037/atm-20-1551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Emphysema is associated with irreversible loss of lung compliance leading to gas trapping and hyperinflation. Surgical lung volume reduction has proven to improve lung function, exercise capacity, cardiac health and survival in patients with advanced emphysema; however, this procedure is associated with significant morbidity and mortality. Bronchoscopic lung volume reduction (BLVR) has emerged as an alternative approach for these patients. In this article, we review the different techniques used for the purpose of this procedure, its advantages and disadvantages. In addition, we discuss in length valve therapy and the studies that led to its recent FDA approval. Finally, we provide thought-provoking challenges that may be topics for further future investigation to enhance the efficacy and benefit of this technique.
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Affiliation(s)
- Massa Zantah
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Andrew J Gangemi
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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21
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Gagnat AA, Gjerdevik M, Lie SA, Gulsvik A, Bakke P, Nielsen R. Acute exacerbations of COPD and risk of lung cancer in COPD patients with and without a history of asthma. Eur Clin Respir J 2020; 7:1799540. [PMID: 32944202 PMCID: PMC7480432 DOI: 10.1080/20018525.2020.1799540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Rationale There is limited knowledge on the effect of acute exacerbations in chronic obstructive pulmonary disease (AECOPD) on lung cancer risk in COPD patients with and without a history of asthma. This study aims to examine whether AECOPD is associated with risk of lung cancer, and whether the effect depends on a history of asthma. Methods In the GenKOLS study of 2003–2005, 852 subjects with COPD performed spirometry, and filled out questionnaires on smoking habits, symptoms and disease history. These data were linked to lung cancer data from the Cancer Registry of Norway through 2013. AECOPD, measured at baseline was the main predictor. To quantify differences in lung cancer risk, we performed Cox-proportional hazards regression. We adjusted for sex, age, smoking variables, body mass index, and lung function. Measurements and results During follow-up, 8.8% of the subjects with, and 5.9% of the subjects without exacerbations were diagnosed with lung cancer. Cox regression showed a significant increased risk of lung cancer with one or more exacerbations in COPD patients without a history of asthma, HRR = 2.77 (95% CI 1.39–5.52). We found a significant interaction between a history of asthma and AECOPD on lung cancer. Conclusions AECOPD is associated with an increased risk of lung cancer in COPD patients without a history of asthma.
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Affiliation(s)
- Ane Aamli Gagnat
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Miriam Gjerdevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Stein Atle Lie
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Amund Gulsvik
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Per Bakke
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Rune Nielsen
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
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22
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Hough KP, Curtiss ML, Blain TJ, Liu RM, Trevor J, Deshane JS, Thannickal VJ. Airway Remodeling in Asthma. Front Med (Lausanne) 2020; 7:191. [PMID: 32509793 PMCID: PMC7253669 DOI: 10.3389/fmed.2020.00191] [Citation(s) in RCA: 169] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/21/2020] [Indexed: 02/06/2023] Open
Abstract
Asthma is an inflammatory disease of the airways that may result from exposure to allergens or other environmental irritants, resulting in bronchoconstriction, wheezing, and shortness of breath. The structural changes of the airways associated with asthma, broadly referred to as airway remodeling, is a pathological feature of chronic asthma that contributes to the clinical manifestations of the disease. Airway remodeling in asthma constitutes cellular and extracellular matrix changes in the large and small airways, epithelial cell apoptosis, airway smooth muscle cell proliferation, and fibroblast activation. These pathological changes in the airway are orchestrated by crosstalk of different cell types within the airway wall and submucosa. Environmental exposures to dust, chemicals, and cigarette smoke can initiate the cascade of pro-inflammatory responses that trigger airway remodeling through paracrine signaling and mechanostimulatory cues that drive airway remodeling. In this review, we explore three integrated and dynamic processes in airway remodeling: (1) initiation by epithelial cells; (2) amplification by immune cells; and (3) mesenchymal effector functions. Furthermore, we explore the role of inflammaging in the dysregulated and persistent inflammatory response that perpetuates airway remodeling in elderly asthmatics.
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Affiliation(s)
- Kenneth P Hough
- Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Miranda L Curtiss
- Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Trevor J Blain
- Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Rui-Ming Liu
- Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jennifer Trevor
- Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jessy S Deshane
- Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Victor J Thannickal
- Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
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23
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Shen T, Bimali M, Faramawi M, Orloff MS. Consumption of Vitamin K and Vitamin A Are Associated With Reduced Risk of Developing Emphysema: NHANES 2007-2016. Front Nutr 2020; 7:47. [PMID: 32391372 PMCID: PMC7192023 DOI: 10.3389/fnut.2020.00047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/25/2020] [Indexed: 12/31/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) comprising of emphysema and chronic bronchitis are the most common chronic respiratory diseases that impart a huge economic and clinical burden. Factors other than smoking and air pollutants can cause inflammation and emphysematous changes in the lung airspaces or alveoli have been understudied. Using a cross-sectional study design, we assessed the association of dark green vegetables, vitamin K and Vitamin A with emphysema status among adults at U.S. These nutrients have a role in lung biology. A complete case NHANES data (n = 17,681) was used. After adjusting for modifiable and non-modifiable confounders, consumption of recommended amounts of vitamin K was associated with 39% decrease in odds (Odds Ratio: 0.61; 95% CI: 0.40–0.92, P-val: 0.02) of emphysema. Similarly consumption of recommended amounts vitamin A dose was associated with 33% decrease in odds (Odds Ratio: 0.67; 95% CI: 0.44–1.00, P-val: 0.05) of emphysema. Vitamin K shows an inverse association suggesting that it may be important in slowing the emphysematous process. Vitamin A is important in maintaining the anti-inflammatory process. Together vitamin K and vitamin A are important in the lung health.
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Affiliation(s)
- Tianjiao Shen
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Milan Bimali
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, United States.,Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Mohammed Faramawi
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Mohammed S Orloff
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR, United States.,Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States
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24
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Ishiura Y, Fujimura M, Ohkura N, Hara J, Kasahara K, Ishii N, Sawai Y, Shimizu T, Tamaki T, Nomura S. Triple Therapy with Budesonide/Glycopyrrolate/Formoterol Fumarate Improves Inspiratory Capacity in Patients with Asthma-Chronic Obstructive Pulmonary Disease Overlap. Int J Chron Obstruct Pulmon Dis 2020; 15:269-277. [PMID: 32103926 PMCID: PMC7014958 DOI: 10.2147/copd.s231004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 01/09/2020] [Indexed: 12/29/2022] Open
Abstract
Purpose Asthma-chronic obstructive pulmonary disease overlap (ACO), characterized by airway limitation, is an important condition with high incidence and mortality. Although some guidelines recommend triple therapy with inhaled corticosteroids/long-acting muscarinic antagonists/long-acting β2 agonists, this treatment approach is based on the extrapolation of data from studies of asthma or chronic obstructive pulmonary disease (COPD) alone. Methods A 12-week, randomized, open-label cross-over pilot study was conducted in 19 patients with ACO to investigate the effect of triple therapy with glycopyrrolate (GLY) 50 µg/day on budesonide/formoterol fumarate (BUD/FORM) 640/18 µg/day. The study period included a 4-week wash-out, 4-week run-in, and 4-week treatment period. Respiratory function tests, fractional exhaled nitric oxide (FeNO), a COPD assessment test (CAT) and an asthma control questionnaire (ACQ) were carried out 0, 4, and 8 weeks after randomization. Results A total of 19 patients with stable ACO (19 males and no females) with a mean age of 70.7 ± 7.6 years (± standard deviation, SD; range 55-83 years) participated in this study. All patients were ex-smokers with a smoking history of 63.1 ± 41.1 pack-years (± SD). Mean values for inspiratory capacity (IC), an index of hyperinflation of the lung that causes exertional dyspnea and reduced exercise, were 1.93 L (± 0.47 L) after the run-in, 1.85 L (± 0.51 L) after the BUD/FORM dual therapy period and 2.11 L (± 0.58 L) after the BUD/GLY/FORM triple therapy period. IC values after the BUD/GLY/FORM triple therapy were significantly higher than those after the run-in (p < 0.02). FeNO values, ACQ, and CAT scores were not significantly different among the run-in, wash-out, and triple-therapy periods. Conclusion The present pilot study showed that triple therapy with BUD/GLY/FORM results in an improvement in lung function parameters including IC, indicating the potential value of triple therapy as standard treatment for ACO.
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Affiliation(s)
- Yoshihisa Ishiura
- First Department of Internal Medicine, Kansai Medical University, Moriguchi, Osaka, Japan
- Respiratory Medicine, Toyama City Hospital, Toyama, Japan
| | - Masaki Fujimura
- Respiratory Medicine, National Hospital Organization Nanao Hospital, Nanao, Japan
| | - Noriyuki Ohkura
- Respiratory Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Johsuke Hara
- Respiratory Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Kazuo Kasahara
- Respiratory Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Nobuyasu Ishii
- First Department of Internal Medicine, Kansai Medical University, Moriguchi, Osaka, Japan
| | - Yusuke Sawai
- First Department of Internal Medicine, Kansai Medical University, Moriguchi, Osaka, Japan
| | - Toshiki Shimizu
- First Department of Internal Medicine, Kansai Medical University, Moriguchi, Osaka, Japan
| | - Takeshi Tamaki
- First Department of Internal Medicine, Kansai Medical University, Moriguchi, Osaka, Japan
| | - Shosaku Nomura
- First Department of Internal Medicine, Kansai Medical University, Moriguchi, Osaka, Japan
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25
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Rebordosa C, Houben E, Laugesen K, Bothner U, Montonen J, Aguado J, Overbeek JA, Ehrenstein V, Asmar J, Wallace L, Gilsenan AW. No Evidence of Off-label Use of Olodaterol and Indacaterol in Denmark, France, and the Netherlands: A Drug Utilization Study. Sci Rep 2020; 10:586. [PMID: 31953521 PMCID: PMC6968970 DOI: 10.1038/s41598-019-57397-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/23/2019] [Indexed: 12/19/2022] Open
Abstract
To characterize the use of olodaterol and indacaterol in clinical practice and to quantify the off-label use in asthma. Drug utilization study of new users of olodaterol or indacaterol between 2014 and 2017 in the PHARMO Database Network in the Netherlands, the Danish population registers, and the IMS Real-World Evidence Longitudinal Patient Database panels in France. On-label use was defined as use among adults with a recorded diagnosis of COPD. Off-label use was defined as use among adults with a recorded diagnosis of asthma without a recorded diagnosis of COPD or as use among patients aged ≤18 years. Potential off-label use was defined as no recorded diagnosis of either COPD or asthma. The study included 4,158 new users of olodaterol and 9,966 new users of indacaterol. Prevalence of off-label use ranged from 3.5% for both drugs to 12.4% for olodaterol and 11.9% for indacaterol. Prevalence of on-label use ranged from 47.8% to 77.7% for olodaterol and from 28.7% to 70.1% for indacaterol. The remaining new users of olodaterol and indacaterol were classified as potential off-label users, with prevalence ranging from 17.3% to 48.6% for olodaterol and from 20.5% to 66.6% for indacaterol. This study provides no evidence of a major concern in Europe for olodaterol or indacaterol for off-label use in asthma or for pediatric use.
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Affiliation(s)
- Cristina Rebordosa
- RTI Health Solutions, Av. Diagonal 605, 9-1, 08028, Barcelona, Spain.
- Research Triangle Park, NC, North Carolina, USA.
| | - Eline Houben
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40 3528 AE, Utrecht, Netherlands
| | - Kristina Laugesen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Ulrich Bothner
- Boehringer Ingelheim International GmbH, Binger Str. 173, 55216, Ingelheim am Rhein, Germany
| | - Jukka Montonen
- Boehringer Ingelheim International GmbH, Binger Str. 173, 55216, Ingelheim am Rhein, Germany
| | - Jaume Aguado
- RTI Health Solutions, Av. Diagonal 605, 9-1, 08028, Barcelona, Spain
- Research Triangle Park, NC, North Carolina, USA
| | | | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Joelle Asmar
- IQVIA, RWI, Tour D2, 17 Bis Place des Reflets, TSA 64567, 92099, La Défense Cedex, France
| | - Laura Wallace
- Boehringer Ingelheim International GmbH, 900 Ridgebury Road, Ridgefield, CT, 06877, USA
| | - Alicia W Gilsenan
- RTI Health Solutions, Av. Diagonal 605, 9-1, 08028, Barcelona, Spain
- Research Triangle Park, NC, North Carolina, USA
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26
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Ye W, Li X, Gu W, Guo X, Han F, Liu S. A comparison of diagnostic consistency for asthma-chronic obstructive pulmonary disease overlap and clinical characteristics study. BMC Pulm Med 2019; 19:249. [PMID: 31852476 PMCID: PMC6921380 DOI: 10.1186/s12890-019-1024-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 12/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The diagnostic criteria for asthma-chronic obstructive pulmonary disease overlap have not been unified. Different studies have used different criteria, and this has led to diagnostic inconsistencies. METHODS We collected data of patients who were older than 40 years and hospitalised because of chronic bronchial diseases. One hundred and seventy-one patients were included in this study. We compared seven different diagnostic criteria, examined their consistency, and analysed differences among groups classified with each set. RESULTS The prevalence of ACO ranged between 7.02 and 27.49% depending on the criteria applied. The patients who met the Soler-Cataluna et al. criteria also met the GesEPOC criteria. Rhee has proposed the strictest diagnostic criteria; hence, the number of patients who met these criteria was the smallest, and those patients also met the diagnostic criteria proposed by the other studies. We found that applying the different sets of criteria did not lead to the selection of the same population, while there were no statistical differences in age, disease duration, allergens, and inflammatory markers. CONCLUSIONS The diagnostic criteria of ACO have not been unified, which hinders the design and progress of clinical studies that would investigate the ACO phenotypes and underlying mechanisms.
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Affiliation(s)
- Wenjing Ye
- Department of Respiratory Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665, Kongjiang Road, Shanghai, 200092, China
| | - Xiaoming Li
- Department of Respiratory Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665, Kongjiang Road, Shanghai, 200092, China
| | - Wen Gu
- Department of Respiratory Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665, Kongjiang Road, Shanghai, 200092, China.
| | - Xuejun Guo
- Department of Respiratory Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665, Kongjiang Road, Shanghai, 200092, China.
| | - Fengfeng Han
- Department of Respiratory Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665, Kongjiang Road, Shanghai, 200092, China
| | - Song Liu
- Department of Respiratory Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665, Kongjiang Road, Shanghai, 200092, China
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Boueiz A, Pham B, Chase R, Lamb A, Lee S, Naing ZZC, Cho MH, Parker MM, Sakornsakolpat P, Hersh CP, Crapo JD, Stergachis AB, Tal-Singer R, DeMeo DL, Silverman EK, Zhou X, Castaldi PJ. Integrative Genomics Analysis Identifies ACVR1B as a Candidate Causal Gene of Emphysema Distribution. Am J Respir Cell Mol Biol 2019; 60:388-398. [PMID: 30335480 DOI: 10.1165/rcmb.2018-0110oc] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Genome-wide association studies (GWAS) have identified multiple associations with emphysema apicobasal distribution (EABD), but the biological functions of these variants are unknown. To characterize the functions of EABD-associated variants, we integrated GWAS results with 1) expression quantitative trait loci (eQTL) from the Genotype Tissue Expression (GTEx) project and subjects in the COPDGene (Genetic Epidemiology of COPD) study and 2) cell type epigenomic marks from the Roadmap Epigenomics project. On the basis of these analyses, we selected a variant near ACVR1B (activin A receptor type 1B) for functional validation. SNPs from 168 loci with P values less than 5 × 10-5 in the largest GWAS meta-analysis of EABD were analyzed. Eighty-four loci overlapped eQTL, with 12 of these loci showing greater than 80% likelihood of harboring a single, shared GWAS and eQTL causal variant. Seventeen cell types were enriched for overlap between EABD loci and Roadmap Epigenomics marks (permutation P < 0.05), with the strongest enrichment observed in CD4+, CD8+, and regulatory T cells. We selected a putative causal variant, rs7962469, associated with ACVR1B expression in lung tissue for additional functional investigation, and reporter assays confirmed allele-specific regulatory activity for this variant in human bronchial epithelial and Jurkat immune cell lines. ACVR1B expression levels exhibit a nominally significant association with emphysema distribution. EABD-associated loci are preferentially enriched in regulatory elements of multiple cell types, most notably T-cell subsets. Multiple EABD loci colocalize to regulatory elements that are active across multiple tissues and cell types, and functional analyses confirm the presence of an EABD-associated functional variant that regulates ACVR1B expression, indicating that transforming growth factor-β signaling plays a role in the EABD phenotype. Clinical trial registered with www.clinicaltrials.gov (NCT00608764).
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Affiliation(s)
- Adel Boueiz
- 1 Channing Division of Network Medicine.,2 Division of Pulmonary and Critical Care Medicine
| | | | | | | | - Sool Lee
- 1 Channing Division of Network Medicine
| | | | - Michael H Cho
- 1 Channing Division of Network Medicine.,2 Division of Pulmonary and Critical Care Medicine
| | | | | | - Craig P Hersh
- 1 Channing Division of Network Medicine.,2 Division of Pulmonary and Critical Care Medicine
| | - James D Crapo
- 3 Pulmonary Medicine, National Jewish Health, Denver, Colorado; and
| | | | | | - Dawn L DeMeo
- 1 Channing Division of Network Medicine.,2 Division of Pulmonary and Critical Care Medicine
| | - Edwin K Silverman
- 1 Channing Division of Network Medicine.,2 Division of Pulmonary and Critical Care Medicine
| | - Xiaobo Zhou
- 1 Channing Division of Network Medicine.,2 Division of Pulmonary and Critical Care Medicine
| | - Peter J Castaldi
- 1 Channing Division of Network Medicine.,6 Division of General Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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28
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Izbicki G, Teo V, Liang J, Russell GM, Holland AE, Zwar NA, Bonevski B, Mahal A, Eustace P, Paul E, Phillips K, Wilson S, George J, Abramson MJ. Clinical Characteristics Of Patients With Asthma COPD Overlap (ACO) In Australian Primary Care. Int J Chron Obstruct Pulmon Dis 2019; 14:2745-2752. [PMID: 31819406 PMCID: PMC6899160 DOI: 10.2147/copd.s220346] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/31/2019] [Indexed: 12/30/2022] Open
Abstract
Purpose Many older adults with a history of smoking and asthma develop clinical features of both asthma and COPD, an entity sometimes called asthma-COPD overlap (ACO). Patients with ACO may be at higher risk of poor health outcomes than those with asthma or COPD alone. However, understanding of ACO is limited in the primary care setting and more information is needed to better inform patient management. We aimed to compare the characteristics of patients with ACO or COPD in Australian general practices. Patients and methods Data were from the RADICALS (Review of Airway Dysfunction and Interdisciplinary Community-based care of Adult Long-term Smokers) trial, an intervention study of an interdisciplinary community-based model of care. Baseline demographic and clinical characteristics, pre- and post-bronchodilator spirometry, dyspnoea and St. George’s Respiratory Questionnaire scores were compared between 60 ACO patients and 212 with COPD alone. Results Pre-bronchodilator Forced Expiratory Volume in 1 second (mean±SD 58.4±14.3 vs 67.5±20.1% predicted) and Forced Vital Capacity (mean 82.1±16.9 v 91.9±17.2% predicted) were significantly lower in the ACO group (p<0.001), but no difference was found in post-bronchodilator spirometry. Demographic and clinical characteristics, dyspnoea, quality of life, comorbidities and treatment prescribed did not differ significantly between groups. Conclusion This is the first study describing the clinical characteristics of ACO patients in Australian general practices. Our finding of lower pre-bronchodilator lung function in the ACO group compared to those with COPD reinforces the importance of spirometry in primary care to inform management. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12614001155684.
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Affiliation(s)
- Gabriel Izbicki
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia.,Shaare Zedek Medical Center and The Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Valerie Teo
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia.,National Healthcare Group Polyclinics, Singapore
| | - Jenifer Liang
- Centre For Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Grant M Russell
- Southern Academic Primary Care Research Unit, Department of General Practice, Monash University, Notting Hill, Australia
| | - Anne E Holland
- Discipline of Physiotherapy, La Trobe University and Alfred Health, Melbourne, Australia
| | - Nicholas A Zwar
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Ajay Mahal
- The Nossal Institute For Global Health, University of Melbourne, Melbourne, Australia
| | | | - Eldho Paul
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Sally Wilson
- Centre For Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia.,Department of Infrastructure Engineering, The University of Melbourne, Melbourne, Australia
| | - Johnson George
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia.,Centre For Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
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29
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Milne S, Mannino D, Sin DD. Asthma-COPD Overlap and Chronic Airflow Obstruction: Definitions, Management, and Unanswered Questions. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:483-495. [PMID: 31740296 DOI: 10.1016/j.jaip.2019.10.044] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/03/2019] [Accepted: 10/31/2019] [Indexed: 12/17/2022]
Abstract
Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) is a common clinical presentation of chronic airways disease in which patients show some features usually associated with asthma, and some usually associated with COPD. There is ongoing debate over whether ACO is a discrete clinical entity, or if it is part of a continuum of airways disease. Furthermore, there is considerable variation among current definitions of ACO, which makes diagnosis potentially challenging for clinicians. Treating ACO may be equally challenging because ACO is an understudied population, and the evidence base for its management comes largely from asthma and COPD studies, the relevance of which deserves careful consideration. In this review, we synthesize the various approaches to ACO diagnosis and evaluate the role of currently available diagnostic tests. We describe the potential benefits of existing asthma and COPD therapies in treating patients with ACO, and the value of a "treatable traits" approach to ACO management. Throughout the review, we highlight some of the pressing, unanswered questions surrounding ACO that are relevant to the clinical community. Ultimately, addressing these questions is necessary if we are to improve clinical outcomes for this complex and heterogeneous patient population.
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Affiliation(s)
- Stephen Milne
- Centre for Heart Lung Innovation, St Paul's Hospital and Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - David Mannino
- Department of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky College of Medicine, Lexington, Ky
| | - Don D Sin
- Centre for Heart Lung Innovation, St Paul's Hospital and Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada.
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Chisholm JF, Shenoy SK, Shade JK, Kim V, Putcha N, Carson KA, Wise R, Hansel NN, Hanes JS, Suk JS, Neptune E. Nanoparticle diffusion in spontaneously expectorated sputum as a biophysical tool to probe disease severity in COPD. Eur Respir J 2019; 54:13993003.00088-2019. [PMID: 31164433 DOI: 10.1183/13993003.00088-2019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 04/26/2019] [Indexed: 01/20/2023]
Abstract
Perturbations in airway mucus properties contribute to lung function decline in patients with chronic obstructive pulmonary disease (COPD). While alterations in bulk mucus rheology have been widely explored, microscopic mucus properties that directly impact on the dynamics of microorganisms and immune cells in the COPD lungs are yet to be investigated.We hypothesised that a tightened mesh structure of spontaneously expectorated mucus (i.e. sputum) would contribute to increased COPD disease severity. Here, we investigated whether the mesh size of COPD sputum, quantified by muco-inert nanoparticle (MIP) diffusion, correlated with sputum composition and lung function measurements.The microstructure of COPD sputum was assessed based on the mean squared displacement (MSD) of variously sized MIPs measured by multiple particle tracking. MSD values were correlated with sputum composition and spirometry. In total, 33 samples collected from COPD or non-COPD individuals were analysed.We found that 100 nm MIPs differentiated microstructural features of COPD sputum. The mobility of MIPs was more hindered in sputum samples from patients with severe COPD, suggesting a tighter mucus mesh size. Specifically, MSD values inversely correlated with lung function.These findings suggest that sputum microstructure may serve as a novel risk factor for COPD progression and severity.
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Affiliation(s)
- Jane F Chisholm
- Center for Nanomedicine, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Dept of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Siddharth K Shenoy
- Center for Nanomedicine, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Dept of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julie K Shade
- Center for Nanomedicine, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Dept of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Victor Kim
- Dept of Thoracic Medicine and Surgery, Temple University School of Medicine, Philadelphia, PA, USA
| | - Nirupama Putcha
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathryn A Carson
- Dept of Epidemiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Justin S Hanes
- Center for Nanomedicine, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Dept of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA.,Dept of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Dept of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA.,Indicates equal contribution to this work
| | - Jung Soo Suk
- Center for Nanomedicine, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Dept of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA.,Dept of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Indicates equal contribution to this work
| | - Enid Neptune
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA .,Indicates equal contribution to this work
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Ishiura Y, Fujimura M, Ohkura N, Hara J, Kasahara K, Ishii N, Tamaki T, Shimizu T, Nomura S. Effect of triple therapy in patients with asthma-COPD overlap
. Int J Clin Pharmacol Ther 2019; 57:384-392. [PMID: 31232275 PMCID: PMC6637394 DOI: 10.5414/cp203382] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 07/18/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) is of increasing interest because ACO patients have significantly worse outcomes, leading to greater social and economic burdens compared with asthma or COPD alone. Some guidelines for ACO recommend triple therapy with inhaled corticosteroids, long-acting β2 agonists, and long-acting muscarinic antagonists. However, this approach is based on extrapolating data from patients with asthma or COPD alone. Therapeutic studies for ACO have not previously been conducted. MATERIALS AND METHODS A 12-week, randomized, open-label cross-over pilot study was conducted in 17 ACO patients to evaluate the effect of umeclidinium (UMEC) 62.5 µg once-daily added to fluticasone furoate/vilanterol (FF/VI) 200/25 µg once-daily. A 4-week run-in, a first and a second 4-week treatment period were included. Respiratory function, respiratory impedance, fractional exhaled nitric oxide, COPD assessment test, and asthma control test scores were evaluated 0, 4, and 8 weeks after randomization. RESULTS Mean values of post-bronchodilator forced expiratory volume in 1 second as a percentage of the predicted value (%FEV1), after UMEC was added to FF/VI, were significantly higher than after the run-in (p < 0.01). Mean values of resonant frequency during inspiration (Fres), after UMEC was added to FF/VI, were significantly lower than after the run-in (p < 0.01). CONCLUSION Adding UMEC to FF/VI provides greater improvement in lung function, indicating that triple therapy is a suitable regular treatment for ACO.
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Affiliation(s)
- Yoshihisa Ishiura
- First Department of Internal Medicine, Kansai Medical University, Osaka
- Respiratory Medicine, Toyama City Hospital, Toyama
| | - Masaki Fujimura
- Respiratory Medicine, National Hospital Organization Nanao Hospital, Nanao, and
| | - Noriyuki Ohkura
- Respiratory Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Johsuke Hara
- Respiratory Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Kazuo Kasahara
- Respiratory Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Nobuyasu Ishii
- First Department of Internal Medicine, Kansai Medical University, Osaka
| | - Takeshi Tamaki
- First Department of Internal Medicine, Kansai Medical University, Osaka
| | - Toshiki Shimizu
- First Department of Internal Medicine, Kansai Medical University, Osaka
| | - Shosaku Nomura
- First Department of Internal Medicine, Kansai Medical University, Osaka
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Kim M, Tillis W, Patel P, Davis RM, Asche CV. Association between asthma/chronic obstructive pulmonary disease overlap syndrome and healthcare utilization among the US adult population. Curr Med Res Opin 2019; 35:1191-1196. [PMID: 30612470 DOI: 10.1080/03007995.2019.1565531] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objectives: Asthma/chronic obstructive pulmonary disease (COPD) overlap (ACO) is a recently described phenomenon defined as the coexistence of both asthma and COPD. Both asthma and COPD are known to result in increased emergency department (ED) visits and hospitalizations, but it is unclear how the ACO population utilizes these same healthcare resources. The objective of this study was to compare healthcare utilization in the ACO population versus the general population, the asthma population and the COPD population. Methods: We conducted a pooled cross-sectional statistical analysis using the 2012-2015 National Health Interview Survey (NHIS) data. We focused on adults 18 years of age and older and excluded pregnant women. We employed an adjusted logit regression model, where the primary outcomes were dichotomous indicators on healthcare utilizations including ED visits and hospital stays. A key covariate was a four-category variable: 1) no asthma or COPD; 2) asthma only; 3) COPD only; and 4) ACO. Other covariates included age, sex, race, education level, marital status, household income level, medical insurance status, smoking status, body mass index (BMI) category, region, year and comorbidities (cancer, diabetes, hypertension, coronary heart disease and ulcer). Results: Adults with ACO were 134%, 53% and 21% more likely to have ED visits than the general population, asthma group and COPD group, respectively. For hospital stay, the ACO group was 120% and 86% more likely to be hospitalized than the general population and the asthma group respectively. In addition, adults with ACO were 61% and 130% more likely to have asthma exacerbations and asthma-related ED visits than the asthma group. Conclusions: ACO is a considerable risk factor for healthcare utilization versus the general population, the asthma population and the COPD population. Future focus should be placed on the ACO population to identify ways to reduce their healthcare utilization.
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Affiliation(s)
- Minchul Kim
- a Center for Outcomes Research , University of Illinois College of Medicine at Peoria , Peoria , IL , USA
| | - William Tillis
- b Department of Internal Medicine , University of Illinois College of Medicine at Peoria , Peoria , IL , USA
- c OSF St. Francis Medical Center , Peoria , IL , USA
| | - Preeti Patel
- b Department of Internal Medicine , University of Illinois College of Medicine at Peoria , Peoria , IL , USA
- c OSF St. Francis Medical Center , Peoria , IL , USA
| | - Rachael M Davis
- b Department of Internal Medicine , University of Illinois College of Medicine at Peoria , Peoria , IL , USA
- c OSF St. Francis Medical Center , Peoria , IL , USA
| | - Carl V Asche
- a Center for Outcomes Research , University of Illinois College of Medicine at Peoria , Peoria , IL , USA
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Yoon HY, Park SY, Lee CH, Byun MK, Na JO, Lee JS, Lee WY, Yoo KH, Jung KS, Lee JH. Prediction of first acute exacerbation using COPD subtypes identified by cluster analysis. Int J Chron Obstruct Pulmon Dis 2019; 14:1389-1397. [PMID: 31388298 PMCID: PMC6607981 DOI: 10.2147/copd.s205517] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/17/2019] [Indexed: 12/16/2022] Open
Abstract
Purpose In patients with COPD, acute exacerbation (AE) is not only an important determinant of prognosis, but also an important factor in choosing therapeutic agents. In this study, we evaluated the usefulness of COPD subtypes identified through cluster analysis to predict the first AE. Patients and methods Among COPD patients in the Korea COPD Subgroup Study (KOCOSS) cohort, 1,195 who had follow-up data for AE were included in our study. We selected seven variables for cluster analysis – age, body mass index, smoking status, history of asthma, COPD assessment test (CAT) score, post-bronchodilator (BD) FEV1 % predicted, and diffusing capacity of carbon monoxide % predicted. Results K-means clustering identified four clusters for COPD that we named putative asthma-COPD overlap (ACO), mild COPD, moderate COPD, and severe COPD subtypes. The ACO group (n=196) showed the second-best post-BD FEV1 (75.5% vs 80.9% [mild COPD, n=313] vs 52.4% [moderate COPD, n=345] vs 46.7% [severe COPD, n=341] predicted), the longest 6-min walking distance (424 m vs 405 m vs 389 m vs 365 m), and the lowest CAT score (12.2 vs 13.7 vs 15.6 vs 17.5) among the four groups. ACO group had greater risk for first AE compared to the mild COPD group (HR, 1.683; 95% CI, 1.175–2.410). The moderate COPD and severe COPD group HR values were 1.587 (95% CI, 1.145–2.200) and 1.664 (95% CI, 1.203–2.302), respectively. In addition, St. George’s Respiratory Questionnaire score (HR: 1.019; 95% CI, 1.014–1.024) and gastroesophageal reflux disease were independent factors associated with the first AE (HR: 1.535; 95% CI, 1.116–2.112). Conclusion Our cluster analysis revealed an exacerbator subtype of COPD independent of FEV1. Since these patients are susceptible to AE, a more aggressive treatment strategy is needed in these patients.
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Affiliation(s)
- Hee-Young Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans Seoul Hospital, Ewha Womans University, Seoul, Korea
| | - So Young Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans Seoul Hospital, Ewha Womans University, Seoul, Korea
| | - Chang Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Min-Kwang Byun
- Division of Pulmonary Medicine, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Joo Ock Na
- Division of Pulmonology, Department of Internal Medicine, Soonchunhyang University, College of Medicine, Cheonan, Korea
| | - Jae Seung Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | - Won-Yeon Lee
- Department of Internal Medicine, Wonju Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Kwang Ha Yoo
- Department of Internal Medicine, Konkuk University College of Medicine, Seoul, Korea
| | - Ki-Suck Jung
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea
| | - Jin Hwa Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans Seoul Hospital, Ewha Womans University, Seoul, Korea
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Baliatsas C, Smit LAM, Dückers MLA, van Dijk CE, Heederik D, Yzermans CJ. Patients with overlapping diagnoses of asthma and COPD: is livestock exposure a risk factor for comorbidity and coexisting symptoms and infections? BMC Pulm Med 2019; 19:105. [PMID: 31182085 PMCID: PMC6558812 DOI: 10.1186/s12890-019-0865-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 05/21/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Epidemiological research on health effects of livestock exposure in population subgroups with compromised respiratory health is still limited. The present study explored the association between livestock exposure and comorbid/concurrent conditions in patients with overlapping diagnoses of asthma and COPD. METHODS Electronic health record data from 23 general practices in the Netherlands were collected from 425 patients diagnosed with both asthma and COPD, living in rural areas with high livestock density ("study area"). Data of 341 patients with the same overlapping diagnoses, living in rural areas with lower livestock density ("control areas") were obtained from 19 general practices. First, the prevalence of comorbid disorders and symptoms/infections were compared between the study and control area. Second, the examined health outcomes were analyzed in relation to measures of individual livestock exposure. RESULTS Pneumonia was twice as common among patients living in areas with a high livestock density (OR 2.29, 99% CI 0.96-5.47); however, there were generally no statistically significant differences in the investigated outcomes between the study and control area. Significant associations were observed between presence of goats within 1000 m and allergic rhinitis (OR 5.71, 99% CI 1.11-29.3, p < 0.01), number of co-occurring symptoms (IRR 1.69, 99% CI 1.03-2.77, p < 0.01) and anxiety (OR 8.18, 99% 1.5-44.7, p < 0.01). Presence of cattle within 500 m was associated with pneumonia prevalence (OR 2.48, 99% CI 1.05-5.84, p < 0.01). CONCLUSION Livestock exposure is not associated with comorbid chronic conditions but appears to be a risk factor for symptomatic effects in patients with overlapping diagnoses of asthma and COPD.
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Affiliation(s)
- Christos Baliatsas
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-124, 3513 CR Utrecht, The Netherlands
| | - Lidwien A. M. Smit
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
| | - Michel L. A. Dückers
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-124, 3513 CR Utrecht, The Netherlands
| | - Christel E. van Dijk
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-124, 3513 CR Utrecht, The Netherlands
| | - Dick Heederik
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
| | - C. Joris Yzermans
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-124, 3513 CR Utrecht, The Netherlands
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Ghosh N, Choudhury P, Subramani E, Saha D, Sengupta S, Joshi M, Banerjee R, Roychowdhury S, Bhattacharyya P, Chaudhury K. Metabolomic signatures of asthma-COPD overlap (ACO) are different from asthma and COPD. Metabolomics 2019; 15:87. [PMID: 31165288 DOI: 10.1007/s11306-019-1552-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 05/29/2019] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Asthma-chronic obstructive pulmonary disease (COPD) overlap, termed as ACO, is a complex heterogeneous disease without any clear diagnostic or therapeutic guidelines. The pathophysiology of the disease, its characteristic features, and existence as a unique disease entity remains unclear. Individuals with ACO have a faster lung function decline, more frequent exacerbations, and worse quality of life than those with COPD or asthma alone. OBJECTIVES The present study aims to determine whether ACO has a distinct metabolic profile in comparison to asthma and COPD. METHODS Two different groups of patients were recruited as discovery (D) and validation (V) cohorts. Serum samples obtained from moderate and severe asthma patients diagnosed as per GINA guidelines [n = 34(D); n = 32(V)], moderate and severe COPD cases identified by GOLD guidelines [n = 30(D); 32(V)], ACO patients diagnosed by joint GOLD and GINA guidelines [n = 35(D); 40(V)] and healthy controls [n = 33(D)] were characterized using nuclear magnetic resonance (NMR) spectrometry. RESULTS Multivariate and univariate analysis indicated that 12 metabolites [lipid, isoleucine, N-acetylglycoproteins (NAG), valine, glutamate, citric acid, glucose, L-leucine, lysine, asparagine, phenylalanine and histidine] were dysregulated in ACO patients when compared with both asthma and COPD. These metabolites were further validated in a fresh cohort of patients, which again exhibited a similar expression pattern. CONCLUSIONS Our findings suggest that ACO has an enhanced energy and metabolic burden associated with it as compared to asthma and COPD. It is anticipated that our results will stimulate researchers to further explore ACO and unravel the pathophysiological complexities associated with the disease.
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Affiliation(s)
- Nilanjana Ghosh
- School of Medical Science and Technology (SMST), Indian Institute of Technology Kharagpur, Kharagpur, 721302, India
| | - Priyanka Choudhury
- School of Medical Science and Technology (SMST), Indian Institute of Technology Kharagpur, Kharagpur, 721302, India
| | - Elavarasan Subramani
- School of Medical Science and Technology (SMST), Indian Institute of Technology Kharagpur, Kharagpur, 721302, India
| | | | | | - Mamata Joshi
- National Facility for High-field NMR, Tata Institute of Fundamental Research, Mumbai, India
| | - Rintu Banerjee
- Department of Agricultural & Food Engineering, Indian Institute of Technology Kharagpur, Kharagpur, India
| | | | | | - Koel Chaudhury
- School of Medical Science and Technology (SMST), Indian Institute of Technology Kharagpur, Kharagpur, 721302, India.
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Candela M, Costorella R, Stassaldi A, Maestrini V, Curradi G. Treatment of COPD: the simplicity is a resolved complexity. Multidiscip Respir Med 2019; 14:18. [PMID: 31171968 PMCID: PMC6545670 DOI: 10.1186/s40248-019-0181-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/20/2019] [Indexed: 12/30/2022] Open
Affiliation(s)
- Marco Candela
- Director of the Department of Medicina Area Vasta 2, ASUR Marche, Via Aldo Moro 25, Jesi (AN), 60035 Italy
| | - Rosario Costorella
- Medical & Scientific Department, GlaxoSmithKline Spa - Pharmaceutical, Via Fleming 2, Verona, 37135 Italy
| | - Annalisa Stassaldi
- Medical & Scientific Department, GlaxoSmithKline Spa - Pharmaceutical, Via Fleming 2, Verona, 37135 Italy
| | - Vanessa Maestrini
- Medical & Scientific Department, GlaxoSmithKline Spa - Pharmaceutical, Via Fleming 2, Verona, 37135 Italy
| | - Giacomo Curradi
- Medical & Scientific Department, GlaxoSmithKline Spa - Pharmaceutical, Via Fleming 2, Verona, 37135 Italy
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Muhammed A, Moiz JA, Singla D, Ali MS, Talwar D. Postural abnormalities in phenotypes of chronic obstructive pulmonary disease. Braz J Phys Ther 2019; 24:325-332. [PMID: 31151892 DOI: 10.1016/j.bjpt.2019.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 03/16/2019] [Accepted: 05/14/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Few studies have demonstrated postural abnormalities in patients with chronic obstructive pulmonary disease - when compared with healthy individuals. However, none of these studies have compared postural abnormalities in different phenotypes of chronic obstructive pulmonary disease. OBJECTIVE To compare the thoracic posture between two phenotypes of chronic obstructive pulmonary disease (emphysema and chronic bronchitis) with healthy individuals. METHODS Forty individuals with chronic obstructive pulmonary disease (20 with chronic bronchitis, 67±3.5 years, 20 with emphysema, 67.7±4 years) and 20 age-matched healthy individuals (67.3±3.9 years) underwent postural assessment which was performed using photogrammetric measurements of head protraction, shoulder protraction, thoracic kyphosis angle, coronal shoulder angle, and scapular elevation. RESULTS Significant differences were found amongst the groups in protraction of head (emphysema vs. chronic bronchitis, mean difference=7.63°, 95% confidence interval [CI]=2.10, 13.15°; emphysema vs. healthy, 7.91°, 95% CI=2.38, 13.43°), protraction of shoulder (emphysema vs. healthy, 13.69°, 95% CI=6.96, 20.43°; chronic bronchitis vs. healthy, 8.11°, 95% CI=1.38, 14.85°), thoracic kyphosis (emphysema vs. healthy, -11.59°, 95% CI=-17.26, -5.92°; chronic bronchitis vs. healthy, -6.75°, 95% CI=-12.41, -1.08°), coronal shoulder angle (emphysema vs. chronic bronchitis, 1.01°, 95% CI=.22, 1.80°; emphysema vs. healthy, 1.59°, 95% CI=.80, 2.38°) and scapular elevation (emphysema vs. chronic bronchitis, =.74cm, 95% CI=.34, 1.15cm; emphysema vs. healthy, .99cm, 95% CI=.59, 1.40cm). CONCLUSION People with emphysema show greater degree of postural malalignments in terms of head and shoulder protraction, thoracic kyphosis, symmetry of shoulders and scapular elevation than patients with chronic bronchitis and age-matched healthy individuals. These observations emphasize the importance of postural assessment in individuals with chronic obstructive pulmonary disease, particularly if they are emphysematous.
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Affiliation(s)
- Ansari Muhammed
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India
| | - Jamal Ali Moiz
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India.
| | - Deepika Singla
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India
| | - Mir Shad Ali
- Department of Pulmonary Rehabilitation, Metro Centre for Respiratory Diseases, Metro Hospital and Multispecialty Institute, Noida, Uttar Pradesh, India
| | - Deepak Talwar
- Department of Pulmonology Allergy Sleep and Critical Care Medicine, Metro Centre for Respiratory Diseases, Metro Hospital and Multispecialty Institute, Noida, Uttar Pradesh, India
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Janssen R, Piscaer I, Franssen FME, Wouters EFM. Emphysema: looking beyond alpha-1 antitrypsin deficiency. Expert Rev Respir Med 2019; 13:381-397. [DOI: 10.1080/17476348.2019.1580575] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Rob Janssen
- Department of Pulmonary Medicine, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Ianthe Piscaer
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frits M. E. Franssen
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
- CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Emiel F. M. Wouters
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
- CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
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Park SY, Jung H, Kim JH, Seo B, Kwon OY, Choi S, Oh B, Kwon HS, Cho YS, Moon HB, Won S, Park T, Kim TB. Longitudinal analysis to better characterize Asthma-COPD overlap syndrome: Findings from an adult asthma cohort in Korea (COREA). Clin Exp Allergy 2019; 49:603-614. [PMID: 30657218 DOI: 10.1111/cea.13339] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 12/06/2018] [Accepted: 12/11/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS), which has received much attention, has not been unanimously defined. OBJECTIVE In this study, we tried to demonstrate that longitudinally defined ACOS is more useful in the real world than blending patients with asthma and COPD. METHODS The study patients had undergone two consecutive pulmonary function tests measured at least 3 months apart (n = 1889). We selected the patients who had positive bronchodilator response or methacholine provocation tests (n = 959). Next, we defined ACOS as a patient with a persistent airflow obstruction [forced expiratory volume in 1 second (FEV1)/forced vital capacity <0.7] that was identified twice consecutively by an interval of at least 3 months (n = 228). RESULTS The proportions of patients who were older, male and smokers were significantly higher, and baseline lung function was lower in patients with ACOS. In the longitudinal analysis, the mean change in lung function was high, and a greater decline in FEV1 was observed in patients with ACOS. In addition, we compared ACOS and severe asthma, and we also performed a cluster analysis and compared the results with our definition of ACOS. According to our definition, ACOS is an independent subtype with distinctive characteristics. Finally, a genome-wide association study (GWAS) was performed to identify genetic variations associated with ACOS, but no significant single nucleotide polymorphisms were identified. CONCLUSION Our findings suggest that ACOS should be defined longitudinally and considered as an independent subgroup distinguished by inherited environmental factors rather than as a genetically distinct independent group.
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Affiliation(s)
- So-Young Park
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, Ulsan University School of Medicine, Seoul, Korea.,Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Heewon Jung
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, Ulsan University School of Medicine, Seoul, Korea.,Department of Applied Statistics, Chung-Ang University, Seoul, Korea
| | - Jung-Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Bomi Seo
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Oh Young Kwon
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, Ulsan University School of Medicine, Seoul, Korea
| | - Sungkyoung Choi
- Department of Pharmacology, Yonsei University College of Medicine, Seoul, Korea
| | - Bermseok Oh
- Department of Biochemistry and Molecular Biology, School of Medicine, Kyung-Hee University, Seoul, Korea
| | - Hyouk-Soo Kwon
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, Ulsan University School of Medicine, Seoul, Korea
| | - You Sook Cho
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, Ulsan University School of Medicine, Seoul, Korea
| | - Hee-Bom Moon
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, Ulsan University School of Medicine, Seoul, Korea
| | - Sungho Won
- Department of Public Health Science, Seoul National University, Seoul, Korea
| | - Taesung Park
- Department of Statistics, Seoul National University, Seoul, Korea
| | - Tae-Bum Kim
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, Ulsan University School of Medicine, Seoul, Korea
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40
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Jou SS, Yagihashi K, Zach JA, Lynch D, Suh YJ. Relationship between current smoking, visual CT findings and emphysema index in cigarette smokers. Clin Imaging 2019; 53:195-199. [PMID: 30419414 PMCID: PMC6633913 DOI: 10.1016/j.clinimag.2018.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 10/19/2018] [Accepted: 10/30/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate whether visual CT findings could account for the effect of current smoking. METHODS 500 CT scans were visually evaluated within each lobe. A multivariate model for emphysema index was constructed containing previously described confounders in addition to the visual components associated with smoking status. RESULTS Current smokers displayed 23% less visual emphysema, 19% more airway wall thickening, and 188% more centrilogular nodule than former smokers (all p < 0.001). The effect of current smoking on the emphysema index decreased after adjustment with confounders and visual parameters. CONCLUSIONS Visual CT findings could partially account for the effect of current smoking.
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Affiliation(s)
- Sung Shick Jou
- Department of Radiology, Soonchunhyang University Cheonan Hospital, 31 Soonchunhyang 6-gil, Dongnamgu, Cheonan-si, Chungchengnam-do 311511, Republic of Korea.
| | - Kunihiro Yagihashi
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki 216-8511, Japan
| | | | - David Lynch
- Division of Radiology, National Jewish Health, Denver, CO, United States of America
| | - Young Ju Suh
- Department of Biomedical Sciences College of Medicine, Inha University Incheon, Republic of Korea
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41
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Ioachimescu OC, Desai NS. Nonallergic Triggers and Comorbidities in Asthma Exacerbations and Disease Severity. Clin Chest Med 2018; 40:71-85. [PMID: 30691718 DOI: 10.1016/j.ccm.2018.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Asthma triggers are exogenous or endogenous factors that could worsen asthma acutely to cause an exacerbation, or perpetuate chronic symptoms and airflow limitation. Because it is well known that recent asthma exacerbations and poor symptom control are strong predictors of future disease activity, it is not surprising that the number of (allergic or nonallergic) asthma triggers in the environment correlates with the disease-related quality of life. There is a need to identify and avoid specific triggers as the centerpiece of disease management, especially in those with heightened sensitivity to certain factors.
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Affiliation(s)
- Octavian C Ioachimescu
- Pulmonary, Critical Care and Sleep Medicine, Emory University, Atlanta VA Medical Center, Atlanta, GA, USA
| | - Nikita S Desai
- Pulmonary and Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.
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42
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Cheng SL. Blood eosinophils and inhaled corticosteroids in patients with COPD: systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis 2018; 13:2775-2784. [PMID: 30233168 PMCID: PMC6132232 DOI: 10.2147/copd.s175017] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background COPD is a highly heterogeneous disease. Potential biomarkers to identify patients with COPD who will derive the greatest benefit from inhaled corticosteroid (ICS) treatment are needed. Blood eosinophil count can serve as a predictive biomarker for the efficacy of ICS treatment. The aim of this systematic review and meta-analysis was to assess whether a blood eosinophil count of ≥2% in patients undergoing ICS therapy was associated with a greater reduction in COPD exacerbation rate and pneumonia incidence. Materials and methods An electronic search was performed using the keywords "COPD", "eosinophil", and "clinical trial" in the PubMed and EMBASE databases to retrieve articles, up to 2017, relevant to our focus. Data were extracted, and a meta-analysis was conducted using RevMan 5 (version 5.3.5). Results Five studies comprising 12,496 patients with moderate-to-very severe COPD were included. At baseline, 60% of the patients had ≥2% blood eosinophils. Our meta-analysis showed a 17% reduction in exacerbation of moderate/severe COPD in patients with ≥2% blood eosinophils undergoing ICS therapy compared to the non-ICS/ICS withdrawal/placebo group. The difference between the two types of treatment was significant (risk ratio [RR], 0.816; 95% CI, 0.67-0.99; P=0.03). Furthermore, the risk of pneumonia-related events was significantly increased in the subgroup with eosinophil count ≥2% undergoing ICS-containing treatments (RR, 1.969; 95% CI, 1.369-2.833; P<0.001). There was no significant difference in the subgroup with eosinophil count <2% (RR, 1.29; 95% CI, 0.888-1.879; P<0.181). Conclusion The results of our meta-analysis suggest that the 2% threshold for blood eosinophils could accurately predict ICS treatment response in patients with COPD, but increased the risk of pneumonia.
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Affiliation(s)
- Shih-Lung Cheng
- Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan, .,Department of Chemical Engineering and Materials Science, Yuan-Ze University, Taoyuan, Taiwan,
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43
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Abstract
PURPOSE OF REVIEW To describe the rationale on which the treatable traits approach to the management of airways disease is based and the issues that need to be considered for its implementation in clinical practice. RECENT FINDINGS In clinical practice, treatable traits can be classified according to both endotypes and phenotypes, broadly grouped within pulmonary, extrapulmonary, environmental and behavioural factors. Specific investigations and treatments are undertaken for each of the traits rather than a 'one size fits all' stepwise approach to pharmacological treatment which currently represents the core of asthma and chronic obstructive pulmonary disease (COPD) guidelines. Although there is strong evidence of the benefit of the treatable traits approach to specific traits in asthma and/or COPD, there is uncertainty regarding the preferred method of implementation, efficacy and cost-effectiveness of multidimensional intervention programmes in clinical practice. It is likely that 'master protocols' for randomized controlled trials will be required to evaluate such multiple interventions in broad populations of patients with airways disease. SUMMARY Current evidence suggests that the precision medicine approach based on the identification and treatment of treatable traits is preferable to a 'one-size-fits-all' stepwise approach to the treatment of airways disease, although high-quality evidence to guide the practical application of this multidimensional management strategy is now required. VIDEO ABSTRACT.
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44
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Turner RM, DePietro M, Ding B. Overlap of Asthma and Chronic Obstructive Pulmonary Disease in Patients in the United States: Analysis of Prevalence, Features, and Subtypes. JMIR Public Health Surveill 2018; 4:e60. [PMID: 30126831 PMCID: PMC6121140 DOI: 10.2196/publichealth.9930] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/10/2018] [Accepted: 05/10/2018] [Indexed: 01/05/2023] Open
Abstract
Background Although asthma and chronic obstructive pulmonary disease (COPD) are clinically distinct diseases, they represent biologically diverse and overlapping clinical entities and it has been observed that they often co-occur. Some research and theorizing suggest there is a common comorbid condition termed asthma-chronic obstructive pulmonary disease overlap (ACO). However, the existence of ACO is controversial. Objective The objective of this study is to describe patient characteristics and estimate prevalence, health care utilization, and costs of ACO using claims-based diagnoses confirmed with medical record information. Methods Eligible patients were commercial US health plan enrollees; ≥40 years; had asthma, COPD, or ACO; ≥3 prescription fills for asthma/COPD medications; and ≥2 spirometry tests. Records for a random sample of 5000 patients with ACO were reviewed to validate claims-based diagnoses. Results The estimated ACO prevalence was 6% (estimated 10,250/183,521) among 183,521 full study patients. In the claims-based cohorts, the comorbidity burden for ACO was greater versus asthma but similar to COPD cohorts. Medication utilization was higher in ACO versus asthma and COPD. Mean total health care costs were significantly higher for ACO versus asthma but similar to COPD. In confirmed diagnoses cohorts, mean total health care costs (medical plus pharmacy) were lower for ACO versus COPD but similar to asthma (US $20,035; P=.56). Among confirmed cases, where there was medical record evidence, smoking history was higher in ACO (300/343, 87.5%) versus asthma cohorts (100/181, 55.2%) but similar to COPD (68/84, 81%). Conclusions ACO had more comorbidities, medication utilization, and costs than patients with asthma or COPD but differences were not seen after confirmation with medical records.
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Affiliation(s)
| | | | - Bo Ding
- AstraZeneca Pharmaceuticals, Gothenburg, Sweden
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45
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Zhang X, Chen Y, Fan L, Ye J, Fan J, Xu X, You D, Liu S, Chen X, Luo P. Pharmacological mechanism of roflumilast in the treatment of asthma-COPD overlap. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:2371-2379. [PMID: 30122895 PMCID: PMC6078181 DOI: 10.2147/dddt.s165161] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Asthma-COPD overlap (ACO) is a type of incomplete obstructive airway disease that has a high incidence and mortality. Nevertheless, there is currently no clear definition of ACO and no effective intervention. The newly discovered phosphodiesterase-4 inhibitor, roflumilast, has shown initial efficacy for treating asthma, COPD, and ACO. The mechanism of roflumilast, however, remains unclear, and there has been no interpretation through systematic review to date. The determination of a definite mechanism of roflumilast will guide the clinician's decisions regarding medication use, standardized diagnosis, and treatment guidelines. For this reason, we have systematically reviewed the therapeutic mechanism of roflumilast for ACO and provided reference for the clinical application of roflumilast in ACO.
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Affiliation(s)
- Xiaoli Zhang
- Department of Respiratory Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, China, ,
| | - Yuqing Chen
- Department of Respiratory Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, China, ,
| | - Liyu Fan
- Department of Respiratory Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, China, ,
| | - Jiaqi Ye
- Department of Respiratory Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, China, ,
| | - Junsheng Fan
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China
| | - Xinjie Xu
- Department of Respiratory Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, China, ,
| | - Danming You
- Department of Respiratory Medicine, Nangfang Hospital of Southern Medical University, Guangzhou, China
| | - Sihan Liu
- Department of Respiratory Medicine, Nangfang Hospital of Southern Medical University, Guangzhou, China
| | - Xin Chen
- Department of Respiratory Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, China, ,
| | - Peng Luo
- Department of Respiratory Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, China, ,
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46
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Uchida A, Sakaue K, Inoue H. Epidemiology of asthma-chronic obstructive pulmonary disease overlap (ACO). Allergol Int 2018; 67:165-171. [PMID: 29551279 DOI: 10.1016/j.alit.2018.02.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 02/09/2018] [Indexed: 12/27/2022] Open
Abstract
The term "asthma-COPD overlap" (ACO) has been applied to the condition in which a person has persistent airflow limitation with clinical features of both asthma and COPD. The certain definition and diagnostic criteria for ACO have not yet been established, and ACO prevalence has varied widely in studies: from 0.9% to 11.1% in the general population, from 11.1% to 61.0% in asthma patients, and from 4.2% to 66.0% in COPD patients. Furthermore, the frequency of exacerbations and prognosis in ACO patients have not been clearly demonstrated. Although ACO consists with several subgroups of patients with distinct clinical and pathophysiological features, it would be important to propose a standardized definition of and/or diagnostic criteria for ACO based on biomarkers and objective measures, even if it is tentative. It may lead cohort studies with large population or clinical trials around the world.
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47
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Guerriero M, Caminati M, Viegi G, Senna G, Pomari C. Prevalence and features of asthma-chronic obstructive pulmonary disease overlap in Northern Italy general population. J Asthma 2018; 56:27-33. [PMID: 29420087 DOI: 10.1080/02770903.2018.1424190] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE There is controversy about the diagnostic criteria, prevalence, symptoms, and spirometry characteristics of asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO). Recent data indicate that the fixed method for diagnosing airway obstruction (AO) may overestimate ACO prevalence in the elderly, and a variable method may be more accurate. We aimed at estimating ACO prevalence in a general population sample and comparing patient and clinical features in subjects with ACO, COPD, and asthma. METHODS We analyzed data from a cross-sectional study estimating COPD prevalence in randomly selected adults aged 20-79 years in Verona, Italy, and estimated prevalence and analyzed characteristics of asthma, COPD, and ACO. ACO was defined as AO (Forced Expiratory Volume in one second-FEV1/ Forced Vital Capacity-FVC < Lower Limit of Normal-LLN), highly positive bronchodilator test (≥15% increase in FEV1 and FVC ≥400 mL), and personal self-reported history of physician diagnosed asthma and atopy. RESULTS One thousand two hundred and thirty-six patients were included; 207 (16.7%) had asthma, COPD, or ACO (mean ages: 61.2, 59.7, and 57.2 years, respectively). The 3 groups had similar clinical and demographic variables; however, spirometry revealed differences between ACO and COPD patients, particularly post-bronchodilator FEV1 reversibility, which was detected in ACO and asthma patients but not in those with COPD. CONCLUSION ACO prevalence in Northern Italy was estimated at 2.1%, in the range of values reported by previous studies. Marked differences between ACO and COPD revealed by spirometry may have important clinical implications in terms of treatment for patients with ACO.
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Affiliation(s)
- Massimo Guerriero
- a Department of Computer Science , University of Verona , Verona , Italy
| | - Marco Caminati
- b Asthma Center and Allergy Unit , Verona University and General Hospital , Verona , Italy
| | - Giovanni Viegi
- c Institutes of Biomedicine and Molecular Immunology "Alberto Monroy" (IBIM) , Palermo , Italy , and Clinical Physiology (IFC) , CNR , Pisa , Italy
| | - Gianenrico Senna
- b Asthma Center and Allergy Unit , Verona University and General Hospital , Verona , Italy
| | - Carlo Pomari
- d Pulmonary Unit, Sacro Cuore-Don Calabria Hospital , Negrar , Verona , Italy
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48
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Pavord ID, Beasley R, Agusti A, Anderson GP, Bel E, Brusselle G, Cullinan P, Custovic A, Ducharme FM, Fahy JV, Frey U, Gibson P, Heaney LG, Holt PG, Humbert M, Lloyd CM, Marks G, Martinez FD, Sly PD, von Mutius E, Wenzel S, Zar HJ, Bush A. After asthma: redefining airways diseases. Lancet 2018; 391:350-400. [PMID: 28911920 DOI: 10.1016/s0140-6736(17)30879-6] [Citation(s) in RCA: 667] [Impact Index Per Article: 111.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 02/26/2017] [Accepted: 03/07/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Ian D Pavord
- Respiratory Medicine Unit, Nuffield Department of Medicine and NIHR Oxford Biomedical Research Centre, University of Oxford, UK.
| | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Alvar Agusti
- Respiratory Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain; CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Gary P Anderson
- Lung Health Research Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Elisabeth Bel
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Netherlands
| | - Guy Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium; Departments of Epidemiology and Respiratory Medicine, Erasmus Medical Center, Rotterdam, Netherlands
| | - Paul Cullinan
- National Heart and Lung Institute, Imperial College, London, UK
| | | | - Francine M Ducharme
- Departments of Paediatrics and Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada
| | - John V Fahy
- Cardiovascular Research Institute, and Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Urs Frey
- University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Peter Gibson
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, Newcastle, NSW, Australia; Priority Research Centre for Asthma and Respiratory Disease, The University of Newcastle, Newcastle, NSW, Australia
| | - Liam G Heaney
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Patrick G Holt
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Marc Humbert
- L'Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Paris, France; Service de Pneumologie, Hôpital Bicêtre, Paris, France; INSERM UMR-S 999, Hôpital Marie Lannelongue, Paris, France
| | - Clare M Lloyd
- National Heart and Lung Institute, Imperial College, London, UK
| | - Guy Marks
- Department of Respiratory Medicine, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Fernando D Martinez
- Asthma and Airway Disease Research Center, The University of Arizona, Tuscon, AZ, USA
| | - Peter D Sly
- Department of Children's Health and Environment, Children's Health Queensland, Brisbane, QLD, Australia; Centre for Children's Health Research, Brisbane, QLD, Australia
| | - Erika von Mutius
- Dr. von Haunersches Kinderspital, Ludwig Maximilians Universität, Munich, Germany
| | - Sally Wenzel
- University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross Children's Hospital and Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Andy Bush
- Department of Paediatrics, Imperial College, London, UK; Department of Paediatric Respiratory Medicine, Imperial College, London, UK
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49
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Henriksen AH, Langhammer A, Steinshamn S, Mai XM, Brumpton BM. The Prevalence and Symptom Profile of Asthma-COPD Overlap: The HUNT Study. COPD 2017; 15:27-35. [PMID: 29257905 DOI: 10.1080/15412555.2017.1408580] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The concept of asthma and COPD as separate conditions has been questioned, and the term asthma-COPD overlap syndrome has been introduced. We assessed the prevalence, symptoms, and lifestyle factors of asthma-COPD overlap (ACO) in a large Norwegian population-based study. From 2006 to 2008, a total of 50,777 residents of Nord-Trøndelag participated in the Nord-Trøndelag Health Study, Norway. They completed questionnaires regarding respiratory symptoms, disease status, and medication use. We estimated the prevalence and 95% confidence intervals of ACO. Additionally, spirometry was used to estimate the prevalence of ACO in a subgroup. The prevalence of self-reported ACO was 1.9%, and in age groups <40, 40-60 and ≥60 years it was 0.7%, 1.4%, and 3.2%, respectively. Among those reporting COPD, the proportion of ACO was 0.56. In the spirometry subgroup when ACO was defined as doctor diagnosed asthma ever and FEV1/FVC < 0.70, the prevalence of ACO was 2.0%. All respiratory symptoms, separately or in combination, as well as medication use were reported most frequently in those with ACO compared to the other groups. Strikingly, we observed a two-fold higher proportion of allergic rhinitis in ACO compared to COPD only. In this Norwegian population, the prevalence of self-reported ACO was 1.9%, and the corresponding proportion of ACO among those with COPD was 0.56. Participants with ACO generally had the highest proportions of respiratory symptoms compared to asthma or COPD.
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Affiliation(s)
- Anne H Henriksen
- a Department of Thoracic and Occupational Medicine , Trondheim University Hospital , Trondheim , Norway.,b Department of Circulation and Medical Imaging , Norwegian University of Science and Technology , Trondheim , Norway
| | - Arnulf Langhammer
- c Department of Public Health and Nursing , Faculty of Medicine, Norwegian University of Science and Technology , Trondheim , Norway
| | - Sigurd Steinshamn
- a Department of Thoracic and Occupational Medicine , Trondheim University Hospital , Trondheim , Norway.,b Department of Circulation and Medical Imaging , Norwegian University of Science and Technology , Trondheim , Norway
| | - Xiao-Mei Mai
- c Department of Public Health and Nursing , Faculty of Medicine, Norwegian University of Science and Technology , Trondheim , Norway
| | - Ben M Brumpton
- a Department of Thoracic and Occupational Medicine , Trondheim University Hospital , Trondheim , Norway.,d K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences , Norwegian University of Science and Technology , Trondheim , Norway
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50
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Fingleton J, Huang K, Weatherall M, Guo Y, Ivanov S, Bruijnzeel P, Zhang H, Wang W, Beasley R, Wang C. Phenotypes of symptomatic airways disease in China and New Zealand. Eur Respir J 2017; 50:50/6/1700957. [PMID: 29217598 DOI: 10.1183/13993003.00957-2017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/29/2017] [Indexed: 11/05/2022]
Abstract
It is uncertain whether phenotypes of asthma and chronic obstructive pulmonary disease (COPD) vary between populations with different genetic and environmental characteristics. Here, our objective was to compare the phenotypes of airways disease in two separate populations.This was a cross-sectional observational study in adult populations from New Zealand and China. Participants aged 40-75 years who reported wheeze and breathlessness in the last 12 months were randomly selected from the general population and underwent detailed characterisation. Complete data for cluster analysis were available for 345 participants. Hierarchical cluster analysis was undertaken, based on 12 variables: forced expiratory volume in 1 s (FEV1), FEV1/forced vital capacity ratio, bronchodilator reversibility, peak expiratory flow variability, transfer coefficient of the lung for carbon monoxide, exhaled nitric oxide fraction, total IgE, C-reactive protein, age of symptom onset, body mass index, health status and cigarette smoke exposure.Cluster analysis of the combined dataset described five phenotypes: "severe late-onset asthma/COPD overlap group", "moderately severe early-onset asthma/COPD overlap group", "moderate to severe asthma group with type 2 predominant disease", and two groups with minimal airflow obstruction, differentiated by age of onset. Separate analyses by country showed similar patterns; however, a distinct obese/comorbid group was observed in the New Zealand population.Cluster analysis of adults with symptomatic airways disease suggests the presence of similar asthma/COPD overlap phenotypes within populations with different genetic and environmental characteristics, and an obese/comorbid phenotype in a Western population.
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Affiliation(s)
- James Fingleton
- Medical Research Institute of New Zealand, Wellington, New Zealand .,Capital and Coast District Health Board, Wellington, New Zealand.,Victoria University of Wellington, Wellington, New Zealand.,Joint first authors
| | - Kewu Huang
- Dept of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China.,Joint first authors
| | - Mark Weatherall
- Capital and Coast District Health Board, Wellington, New Zealand.,University of Otago Wellington, Wellington, New Zealand
| | - Yanfei Guo
- Dept of Pulmonary and Critical Care Medicine, Beijing Hospital, Ministry of Health, Beijing, PR China
| | | | | | - Hong Zhang
- Dept of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
| | - Wei Wang
- Dept of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
| | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand.,Capital and Coast District Health Board, Wellington, New Zealand.,Victoria University of Wellington, Wellington, New Zealand.,Joint last authors
| | - Chen Wang
- Dept of Pulmonary and Critical Care Medicine, Beijing Hospital, Ministry of Health, Beijing, PR China.,Dept of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, PR China.,Capital Medical University, Beijing, PR China.,Joint last authors
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