1
|
Le BK, Hoang M. Prevalence of obstructive sleep apnea in patients with chronic obstructive pulmonary disease in Vietnam. Sleep Breath 2024; 28:1589-1595. [PMID: 38662313 DOI: 10.1007/s11325-024-03035-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/11/2024] [Accepted: 04/08/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE Chronic obstructive pulmonary disease and obstructive sleep apnea are two common respiratory diseases. Chronic obstructive pulmonary disease patients co-morbid with obstructive sleep apnea are associated with increased cardiovascular adverse events, frequent acute exacerbations, and higher mortality. Only a few studies on obstructive sleep apnea among patients with chronic obstructive pulmonary disease are available in Vietnam. The study aims to determine the prevalence of obstructive sleep apnea in patients with chronic obstructive pulmonary disease in Vietnam. METHODS This is a cross-sectional study in patients with chronic obstructive pulmonary disease at multi-sites in Vietnam: the People's Hospital of Gia Dinh, Bach Mai Hospital, Phoi Viet Clinics, and Lam Dong Medical College using type 3 sleep monitoring device at sleep labs to diagnose obstructive sleep apnea in all study participants. RESULTS Two hundred seventy-eight patients with chronic obstructive pulmonary disease were enrolled. Among the patients, 93.2% were male, with an average age of 66.9 ± 9.3 and a BMI of 21.9 ± 3.8 kg/m2; 82.0% were symptomatic including 44.6% in group B and 37.4% in group D with average post-FEV1 of 49.8 ± 18.3% predicted values. One hundred seventeen patients (42.1%) with chronic obstructive pulmonary disease presented obstructive sleep apnea defined by AHI ≥ 15 events/h. CONCLUSIONS The prevalence of obstructive sleep apnea in patients with chronic obstructive pulmonary disease in Vietnam was 42.1% for an AHI of ≥ 15 events/h.
Collapse
Affiliation(s)
- Bao Khac Le
- Ho Chi Minh City Association of Sleep Medicine, Ho Chi Minh, Viet Nam
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Việt Nam
| | - Minh Hoang
- Ho Chi Minh City Association of Sleep Medicine, Ho Chi Minh, Viet Nam.
- Medical Education Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Việt Nam.
| |
Collapse
|
2
|
Miyaoka C, Watanabe M, Nakamoto K, Yoshida Y, Hirata A, Aso J, Nunokawa H, Ishida M, Honda K, Takata S, Saraya T, Ishii H. Association of IL-33 in modeling type-2 airway inflammation and pulmonary emphysema in mice. Immun Inflamm Dis 2024; 12:e1252. [PMID: 38652015 PMCID: PMC11037248 DOI: 10.1002/iid3.1252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/29/2024] [Accepted: 03/20/2024] [Indexed: 04/25/2024] Open
Abstract
We developed pulmonary emphysema and a type 2 airway inflammation overlap mouse model. The bronchoalveolar lavage (BAL) interleukin 13 (IL-13), IL-4, and IL-5 levels in the overlap model were higher than in the pulmonary emphysema model and lower than in the type 2 airway inflammation model, but IL-33 level in the lung was higher than in other models. IL-33 and interferon-γ (IFNγ) in lungs may control the severity of a type 2 airway inflammation in lung.
Collapse
Affiliation(s)
- Chika Miyaoka
- Department of Respiratory MedicineKyorin University Faculty of MedicineMitaka CityTokyoJapan
| | - Masato Watanabe
- Department of Respiratory MedicineKyorin University Faculty of MedicineMitaka CityTokyoJapan
| | - Keitaro Nakamoto
- Department of Respiratory MedicineKyorin University Faculty of MedicineMitaka CityTokyoJapan
| | - Yuki Yoshida
- Department of Respiratory MedicineKyorin University Faculty of MedicineMitaka CityTokyoJapan
| | - Aya Hirata
- Department of Respiratory MedicineKyorin University Faculty of MedicineMitaka CityTokyoJapan
| | - Jumpei Aso
- Department of Respiratory MedicineKyorin University Faculty of MedicineMitaka CityTokyoJapan
| | - Hiroki Nunokawa
- Department of Respiratory MedicineKyorin University Faculty of MedicineMitaka CityTokyoJapan
| | - Manabu Ishida
- Department of Respiratory MedicineKyorin University Faculty of MedicineMitaka CityTokyoJapan
| | - Koujiro Honda
- Department of Respiratory MedicineKyorin University Faculty of MedicineMitaka CityTokyoJapan
| | - Saori Takata
- Department of Respiratory MedicineKyorin University Faculty of MedicineMitaka CityTokyoJapan
| | - Takeshi Saraya
- Department of Respiratory MedicineKyorin University Faculty of MedicineMitaka CityTokyoJapan
| | - Haruyuki Ishii
- Department of Respiratory MedicineKyorin University Faculty of MedicineMitaka CityTokyoJapan
| |
Collapse
|
3
|
Nguyen-Nhu V, Nguyen LP, Duong-Quy S, Le An P, Bui-Minh T. Classification of chronic obstructive pulmonary disease as ABCD according to the GOLD 2011 and 2017 versions in patients at the University Medical Center in Ho Chi Minh City, Vietnam. Monaldi Arch Chest Dis 2023; 94. [PMID: 37522870 DOI: 10.4081/monaldi.2023.2619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/21/2023] [Indexed: 08/01/2023] Open
Abstract
In 2017, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) substantially changed its ABCD group categorization. Although several studies had been conducted to assess the impact of the new GOLD category, there was no research on the change in the GOLD classification in Vietnam. This retrospective analysis was conducted at the Asthma and Chronic Obstructive Pulmonary Disease (COPD) Clinic at the University Medical Center in Ho Chi Minh City, Vietnam. Our study population comprised patients visiting the medical center from January 2018 to January 2020. We categorized patients' demographics, clinical characteristics, and pharmacotherapy based on GOLD 2011 and 2017 guidelines. A comparison between the two versions was also determined. A total of 457 patients were included in this study. The percentage of groups A, B, C, and D according to GOLD 2011 was 5%, 20.8%, 13.1%, and 61.1%, respectively, and according to GOLD 2017, it was 6.1%, 34.1%, 12%, and 47.8%, respectively. In terms of gender, male patients constituted nearly 95% of the study's population (433/457 patients). Regarding pharmacotherapy, approximately 20% of the low-risk group (groups A and B) was overtreated with inhaled corticosteroid (ICS) components: long-acting β-agonists (LABA) + ICS (15.8%) and long-acting muscarinic antagonist + LABA + ICS (3.8%). There were 13.3% and 1.1% of patients transferred from D to B and from C to A, respectively. All of them had a lower predicted percentage of forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and FEV1/FVC than the patients who remained in groups B or A (p<0.005). This is the first research in Vietnam to show the distribution of COPD patients using both the GOLD 2011 and GOLD 2017 criteria. 14% of patients were reclassified from high-risk to low-risk groups when changing from the 2011 version to the 2017 one, and there was discordance of medications between guidelines and real-life practice. Therefore, clinicians should use their clinical competence to consider patients' conditions before deciding on the appropriate therapeutic approach. Consequently, further studies were required to evaluate the effect of the change in the GOLD classification.
Collapse
Affiliation(s)
- Vinh Nguyen-Nhu
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City; Department of Respiratory Functional Exploration, University Medical Center, Ho Chi Minh City.
| | - Lam-Phuoc Nguyen
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City.
| | - Sy Duong-Quy
- Bio-Medical Research Center, Lam Dong Medical College, Da Lat.
| | - Pham Le An
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City; Grant Innovation Center, University of Medicine and Pharmacy at Ho Chi Minh City.
| | - Tri Bui-Minh
- Grant Innovation Center, University of Medicine and Pharmacy at Ho Chi Minh City.
| |
Collapse
|
4
|
Wang J, Wu K, Cheng X, Chen X, Qi Y, Zhao L. The value of concentration of alveolar nitric oxide in diagnosing small airway dysfunction in patients with stable asthma. THE CLINICAL RESPIRATORY JOURNAL 2022; 17:357-363. [PMID: 36508744 DOI: 10.1111/crj.13565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 11/15/2022] [Accepted: 11/20/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Exhaled nitric oxide (FeNO) is a simple, noninvasive, and reproducible test, and FeNO (50 ml/s) is often used to reflect airway inflammation. The peripheral small airway/alveolar nitric oxide (NO) concentration is derived from the output of NO at multiple flow rates. Concentration of alveolar NO (CANO), which has been reported to reflect peripheral small airway inflammation, may be related to parameters that reflect abnormal small airway function. AIM This study aims to investigate the relationship among CANO levels, clinical features, and small airway function-related indicators in patients with stable asthma and to provide a simple method for monitoring small airway function in asthma. DESIGN AND METHODS We recruited 144 patients with well-controlled, stable asthma, including 69 patients with normal small airway function (normal group) and 75 patients with small airway dysfunction (abnormal group). CANO and pulmonary function were measured. RESULTS CANO was significantly higher in the abnormal group ([7.28 ± 3.25] ppb) than the normal group CANO ([2.87 ± 1.50] ppb). FEF25-75%pred ([55.0 ± 16.5]%), FEF50%pred ([46.4 ± 13.2]%), and FEF75%pred ([41.9 ± 13.1]%) in abnormal group were significantly lower compared with normal group ([89.9 ± 7.5]%), ([80.9 ± 6.8]%), and ([73.8 ± 5.0]%). CANO was negatively correlated and FEF25-75%pred, FEF50%pred, and FEF75%pred (r = -0.87, P < 0.001; r = -0.82, P < 0.001; r = -0.78, P < 0.001). CANO was positively correlated with age (r = 0.27, P = 0.001). The area under the ROC curve was 0.875 for CANO. The optimal cutoff point of 5.3 ppb had sensitivity and specificity values of 72% and 92% in diagnosing small airway dysfunction. CONCLUSION CANO has diagnostic value for small airway dysfunction, and the optimal cutoff value is 5.3 ppb. However, the diagnostic evidence is still insufficient, so it still needs further exploration for its value in detecting small airway dysfunction.
Collapse
Affiliation(s)
- Jing Wang
- Department of Infectious and Respiratory Critical Care Medicine, Xinxiang Central Hospital, The Fourth Clinical College of Xinxiang Medical University, Xinxiang, China
| | - Ke Wu
- School of Clinical Medicine, Guizhou Medical University, Guiyang, China
| | - Xianliang Cheng
- Department of Respiratory and Critical Care Medicine, Huazhong Fuwai Cardiovascular Disease Hospital, Zhengzhou, China
| | - Xiangsong Chen
- Department of Respiratory and Critical Care Medicine, Huazhong Fuwai Cardiovascular Disease Hospital, Zhengzhou, China
| | - Yanan Qi
- Department of Respiratory and Critical Care Medicine, Huazhong Fuwai Cardiovascular Disease Hospital, Zhengzhou, China
| | - Limin Zhao
- Department of Pulmonary and Critical Care Medicine, Henan Provincial People's Hospital; People's Hospital of Zhengzhou University; People's Hospital of Henan University, Zhengzhou, 450003, China
| |
Collapse
|
5
|
Peng J, Wang M, Wu Y, Shen Y, Chen L. Clinical Indicators for Asthma-COPD Overlap: A Systematic Review and Meta-Analysis. Int J Chron Obstruct Pulmon Dis 2022; 17:2567-2575. [PMID: 36259043 PMCID: PMC9572492 DOI: 10.2147/copd.s374079] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/24/2022] [Indexed: 11/05/2022] Open
Abstract
Background Some clinical indicators have been reported to be useful in differentiating asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) from pure asthma/COPD, but the results were inconsistent. This study aims to evaluate the diagnostic value of these indicators for ACO. Methods Databases of PubMed, EMBASE, Ovid and Web of Science were retrieved. Pooled standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated in random-effects models. Results 48 eligible studies were included. The pooled results indicated, compared with pure asthma, ACO patients had lower levels of forced expiratory volume in the first second (FEV1)% predicted (pred) (SMD=−1.09, 95% CI −1.3 to −0.87), diffusion lung capacity for carbon monoxide (DLCO)% pred (SMD=−0.83, 95% CI −1.24 to −0.42), fractional exhaled nitric oxide (FeNO) (SMD=−0.23, 95% CI −0.36 to −0.11), and higher levels of induced sputum neutrophil (SMD = 0.51, 95% CI 0.21 to 0.81), circulating YKL-40 (SMD = 0.96, 95% CI 0.27 to 1.64). However, relative to COPD alone, ACO patients had higher levels of FEV1% pred (SMD = 0.15, 95% CI 0.05 to 0.26), DLCO% pred (SMD = 0.38, 95% CI 0.16 to 0.6), FeNO (SMD = 0.59, 95% CI 0.40 to 0.78), serum total immunoglobulin (Ig)E (SMD = 0.42, 95% CI 0.1 to 0.75), blood eosinophil (SMD = 0.44, 95% CI 0.29 to 0.59), induced sputum eosinophil (SMD = 0.62, 95% CI 0.42 to 0.83), and lower levels of induced sputum neutrophil (SMD=−0.48, 95% CI −0.7 to −0.27), circulating YKL-40 (SMD=−1.09, 95% CI −1.92 to −0.26). Conclusion Compared with pure asthma/COPD, ACO patients have different levels of FEV1% pred, DLCO% pred, FeNO, serum total IgE, blood eosinophil, induced sputum eosinophil/neutrophil, and circulating YKL-40, which could be helpful to establish a clinical diagnosis of ACO.
Collapse
Affiliation(s)
- Junjie Peng
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People’s Republic of China
| | - Min Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People’s Republic of China
| | - Yanqiu Wu
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People’s Republic of China
| | - Yongchun Shen
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People’s Republic of China
| | - Lei Chen
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People’s Republic of China,Correspondence: Lei Chen; Yongchun Shen, Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People’s Republic of China, Email ;
| |
Collapse
|
6
|
Odimba U, Senthilselvan A, Farrell J, Gao Z. Current Knowledge of Asthma-COPD Overlap (ACO) Genetic Risk Factors, Characteristics, and Prognosis. COPD 2021; 18:585-595. [PMID: 34555990 DOI: 10.1080/15412555.2021.1980870] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Asthma-COPD overlap (ACO) is a newly identified phenotype of chronic obstructive airway diseases with shared asthma and COPD features. Patients with ACO are poorly defined, and some evidence suggests that they have worse health outcomes and greater disease burden than patients with COPD or asthma. Generally, there is no evidence-based and universal definition for ACO; several consensus documents have provided various descriptions of the phenotype. In addition, the mechanisms underlying the development of ACO are not fully understood. Whether ACO is a distinct clinical entity with its particular discrete genetic determinant different from asthma and COPD alone or an intermediate phenotype with overlapping genetic markers within asthma and COPD spectrum of obstructive airway disease remains unproven. This review summarizes the current knowledge of the genetic risk factors, characteristics, and prognosis of ACO.
Collapse
Affiliation(s)
- Ugochukwu Odimba
- Clinical Epidemiology Unit, Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | | | - Jamie Farrell
- Clinical Epidemiology Unit, Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.,Faculty of Medicine, Health Sciences Centre (Respirology Department), Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Zhiwei Gao
- Clinical Epidemiology Unit, Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| |
Collapse
|
7
|
Hoang-Duc H, Pham-Huy Q, Vu-Minh T, Duong-Quy S. Study of the Correlation between HRCT Semi-quantitative Scoring, Concentration of Alveolar Nitric Oxide, and Clinical-functional Parameters of Systemic Sclerosis-induced Interstitial Lung Disease. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2020; 93:657-667. [PMID: 33380926 PMCID: PMC7757067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: The correlation between alveolar nitric oxide (CANO) and the severity of interstitial lung disease (ILD) evaluated by high resolution computed tomography (HRCT) has not been well demonstrated. Methods: It was a perspective and observational study, including patients with diagnosed systemic sclerosis (SSc). They performed lung function testing (LFT), exhaled nitric oxide (NO) measurements, exercise testing, chest X-ray, and HRCT. Study patients were divided into SSc with ILD (SSc-ILD+) or without ILD (SSc-ILD-). SSC-ILD+ patients were revisited after 6 months and 12 months to complete the study. Results: Thirty-one control subjects and 74 patients with SSc (33 SSc-ILD- and 41 SSc-ILD+) were included. Forty-one SSc-ILD+ patients were followed-up at 6 months and 12 months. Lung functional parameters of patients with SSc-ILD+ were lower than that of SSc-ILD- patients. The level of CANO was significantly higher in SSc-ILD+ than SSc-ILD- patients (8.6 ± 2.5 vs 4.2 ± 1.3 ppb and P<0.01). Warrick and Goldin scores of patients with SSc-ILD+ were respectively 16.5 ± 5.2 and 12.7 ± 4.3. Warrick scores were reduced after 6 and 12 months of follow-up vs at inclusion (12.4 ± 4.3 and 9.1 ± 3.2 vs 16.5 ± 5.2; P<0.05, P<0.01, and P<0.05; respectively). ΔWarrick and ΔGoldin scores were significantly and inversely correlated with ΔFVC, ΔTLC, ΔTLCO, ΔVO2 max; that was also correlated with ΔCANO (R= 0.783, P<0.01 and R= 0.719 and P<0.05). Conclusion: CANO is a relevant biomarker for the diagnosis of ILD in patients with SSc, especially in combination with HRCT.
Collapse
Affiliation(s)
- Ha Hoang-Duc
- Hai Phong University of Medicine and Pharmacy, Hai
Phong, Vietnam,Radiology Department, Hai Phong International Hospital,
Hai Phong, Vietnam
| | - Quyen Pham-Huy
- Hai Phong University of Medicine and Pharmacy, Hai
Phong, Vietnam
| | - Thuc Vu-Minh
- Hai Phong University of Medicine and Pharmacy, Hai
Phong, Vietnam
| | - Sy Duong-Quy
- Hai Phong University of Medicine and Pharmacy, Hai
Phong, Vietnam,Clinical Research Center, Lam Dong Medical College,
Dalat, Vietnam,Division of Immuno-Allergology, Hershey Medical Center,
Penn State Medical College, Hershey, PA, USA,To whom all correspondence should be addressed:
Pr. Sy Duong-Quy, MD, PhD, FCCP, Clinical Research Center, Lam Dong Medical
College, 16 Ngo Quyen, Dalat city, Vietnam; Tel: +842633822153, Fax:
+842633815000, ; ORCID iD: https://orcid.org/0002-5926-9544
| |
Collapse
|
8
|
Abstract
PURPOSE OF REVIEW Asthma and chronic obstructive pulmonary disease (COPD) are common diseases that often overlap. The term asthma-COPD overlap (ACO) has been used to define this entity but there remain several speculations on its exact definition, impact, pathophysiology, clinical features, and management. We reviewed recent publications on ACO to obtain more insight of current knowledge and outline future needs. RECENT FINDINGS Criteria for ACO vary from one publication to another and the many variable features of these patients underline the need to reconsider the evaluation and approach of patients with overlapping features based on clinical traits and underlying biological mechanisms. Epidemiological studies reveal that ACO patients have generally an increased burden of illness and healthcare use in addition to poorer quality of life (QoL) compared with asthma and higher or equal to COPD. However, their long-term outcome seems better than patients with COPD alone. Various methods have been proposed to evaluate these patients but their usefulness compared to 'classical' investigation of obstructive lung diseases remains speculative and needs further evaluation. Furthermore, there are no formal studies that examined and compared the different treatment strategies of well-characterized patients with ACO as such patients are usually excluded from clinical trials. SUMMARY ACO is a common condition with variable features and a high burden of disease. There is no consensus on its definition, diagnostic, and clinical features and more research should be done on its optimal management and long-term outcomes.
Collapse
|
9
|
Duong-Quy S. Clinical Utility Of The Exhaled Nitric Oxide (NO) Measurement With Portable Devices In The Management Of Allergic Airway Inflammation And Asthma. J Asthma Allergy 2019; 12:331-341. [PMID: 31632093 PMCID: PMC6789173 DOI: 10.2147/jaa.s190489] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 09/12/2019] [Indexed: 01/11/2023] Open
Abstract
Nitric oxide (NO) is a potential bioactive gas produced continuously and constantly in the airways of healthy subjects. In allergic airway inflammation, the level of exhaled NO is usually increased and mediated by inducible nitric oxide synthase (iNOS) enzyme presenting in the epithelium and different inflammatory cells. The measurement of NO concentration in the airway is possible with portable devices which use an electroluminescence technique. In subjects with upper airway with allergic inflammation such as in allergic rhinitis, the measurement of nasal NO (nNO) may help to diagnose and manage the disease. In the lower airway, increased fractional exhaled NO (FENO) reflects directly the inflammatory process that occurs in the airways that are typically seen in asthma. It has been shown that there is a strong correlation between FENO levels and increased activity of airway inflammation mediated by immuno-allergic cells and mediators. Thus, FENO has higher specificity and sensitivity than other methods in diagnosing the severity of inflammation in asthmatic patients. Moreover, the correlation between increased FENO levels and a high risk of bronchial hyperresponsiveness has also been demonstrated. FENO is also a relevant biomarker to evaluate asthma status due to the change of its values occurring earlier than clinical manifestations and spirometry parameters. In addition, the measurement of FENO with portable devices helps to support the diagnosis of asthma, to follow-up the control of asthma and to personalize asthmatic patients for target treatment with biologic therapy. Therefore, measuring FENO with portable devices in the diagnosis and treatment of allergic airway inflammation, especially in asthma, is one of the most essential applications of NO biomarkers in exhaled breath.
Collapse
Affiliation(s)
- Sy Duong-Quy
- Department of Respiratory Diseases, Medical and Biological Research Centre, Lam Dong Medical College, Dalat City, Lam Dong Province, Vietnam
- Department of Immuno-Allergology, Penn State Medical College, Hershey, PA, USA
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|