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Tan DJ, Lodge CJ, Walters EH, Bui DS, Pham J, Lowe AJ, Bowatte G, Vicendese D, Erbas B, Johns DP, James AL, Frith P, Hamilton GS, Thomas PS, Wood-Baker R, Han MK, Washko GR, Abramson MJ, Perret JL, Dharmage SC. Can We Use Lung Function Thresholds and Respiratory Symptoms to Identify Pre-Chronic Obstructive Pulmonary Disease? A Prospective, Population-based Cohort Study. Am J Respir Crit Care Med 2024; 209:1431-1440. [PMID: 38236192 DOI: 10.1164/rccm.202212-2330oc] [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: 12/28/2023] [Accepted: 01/16/2024] [Indexed: 01/19/2024] Open
Abstract
Rationale: The term "pre-chronic obstructive pulmonary disease" ("pre-COPD") refers to individuals at high risk of developing COPD who do not meet conventional spirometric criteria for airflow obstruction. New approaches to identifying these individuals are needed, particularly in younger populations. Objectives: To determine whether lung function thresholds and respiratory symptoms can be used to identify individuals at risk of developing COPD. Methods: The Tasmanian Longitudinal Health Study comprises a population-based cohort first studied in 1968 (at age 7 yr). Respiratory symptoms, pre- and post-bronchodilator (BD) spirometry, diffusing capacity, and static lung volumes were measured in a subgroup at age 45, and the incidence of COPD was assessed at age 53. For each lung function measure, z-scores were calculated using Global Lung Function Initiative references. The optimal threshold for best discrimination of COPD incidence was determined by the unweighted Youden index. Measurements and Main Results: Among 801 participants who did not have COPD at age 45, the optimal threshold for COPD incidence by age 53 was pre-BD FEV1/FVC z-score less than -1.264, corresponding to the lowest 10th percentile. Those below this threshold had a 36-fold increased risk of developing COPD over an 8-year follow-up period (risk ratio, 35.8; 95% confidence interval, 8.88 to 144), corresponding to a risk difference of 16.4% (95% confidence interval, 3.7 to 67.4). The sensitivity was 88%, and the specificity was 87%. Positive and negative likelihood ratios were 6.79 and 0.14, respectively. Respiratory symptoms, post-BD spirometry, diffusing capacity, and static lung volumes did not improve on the classification achieved by pre-BD FEV1/FVC alone. Conclusions: This is the first study, to our knowledge, to evaluate the discriminatory accuracy of spirometry, diffusing capacity, and static lung volume thresholds for COPD incidence in middle-aged adults. Our findings support the inclusion of pre-BD spirometry in the physiological definition of pre-COPD and indicate that pre-BD FEV1/FVC at the 10th percentile accurately identifies individuals at high risk of developing COPD in community-based settings.
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Affiliation(s)
- Daniel J Tan
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Monash Lung, Sleep, Allergy & Immunology, Monash Health, Melbourne, Victoria, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - E Haydn Walters
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Dinh S Bui
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan Pham
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Gayan Bowatte
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Department of Basic Sciences, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Don Vicendese
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- School of Engineering and Mathematical Science and
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Violet Vines Marshman Centre for Rural Health Research, La Trobe University, Bendigo, Victoria, Australia
| | - David P Johns
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Alan L James
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Peter Frith
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Garun S Hamilton
- Monash Lung, Sleep, Allergy & Immunology, Monash Health, Melbourne, Victoria, Australia
- School of Clinical Sciences, and
| | - Paul S Thomas
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | | | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jennifer L Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia; and
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Teixeira EM, Ribeiro CO, Lopes AJ, de Melo PL. Respiratory Oscillometry and Functional Performance in Different COPD Phenotypes. Int J Chron Obstruct Pulmon Dis 2024; 19:667-682. [PMID: 38464561 PMCID: PMC10924760 DOI: 10.2147/copd.s446085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/27/2024] [Indexed: 03/12/2024] Open
Abstract
Purpose Chronic obstructive pulmonary disease (COPD) phenotypes may introduce different characteristics that need to be known to improve treatment. Respiratory oscillometry provides a detailed analysis and may offer insight into the pathophysiology of COPD. In this paper, we used this method to evaluate the differences in respiratory mechanics of COPD phenotypes. Patients and Methods This study investigated a sample of 83 volunteers, being divided into control group (CG = 20), emphysema (n = 23), CB (n = 20) and asthma-COPD overlap syndrome (ACOS, n = 20). These analyses were performed before and after bronchodilator (BD) use. Functional capacity was evaluated using the Glittre‑ADL test, handgrip strength and respiratory pressures. Results Initially it was observed that oscillometry provided a detailed description of the COPD phenotypes, which was consistent with the involved pathophysiology. A correlation between oscillometry and functional capacity was observed (r=-0.541; p = 0.0001), particularly in the emphysema phenotype (r = -0.496, p = 0.031). BD response was different among the studied phenotypes. This resulted in an accurate discrimination of ACOS from CB [area under the receiver operating curve (AUC) = 0.84] and emphysema (AUC = 0.82). Conclusion These results offer evidence that oscillatory indices may enhance the comprehension and identification of COPD phenotypes, thereby potentially improving the support provided to these patients.
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Affiliation(s)
- Elayne Moura Teixeira
- Biomedical Instrumentation Laboratory, Institute of Biology and Faculty of Engineering, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Caroline Oliveira Ribeiro
- Biomedical Instrumentation Laboratory, Institute of Biology and Faculty of Engineering, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- Pulmonary Function Laboratory, Pedro Ernesto University Hospital, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
- Pulmonary Rehabilitation Laboratory, Augusto Motta University Center, Rio de Janeiro, Brazil
| | - Pedro Lopes de Melo
- Biomedical Instrumentation Laboratory, Institute of Biology and Faculty of Engineering, State University of Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratory of Clinical and Experimental Research in Vascular Biology - Biomedical Center, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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Liu MC, Bagnasco D, Matucci A, Pilette C, Price RG, Maxwell AC, Alfonso-Cristancho R, Jakes RW, Lee JK, Howarth P. Mepolizumab in Patients With Severe Asthma and Comorbidities: 1-Year REALITI-A Analysis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3650-3661.e3. [PMID: 37507070 DOI: 10.1016/j.jaip.2023.07.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/22/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Severe asthma is complex; comorbidities may influence disease outcomes. OBJECTIVE To assess mepolizumab effectiveness in patients with severe asthma and comorbidities. METHODS REALITI-A was a 2-year international, prospective study enrolling adults with asthma newly prescribed mepolizumab (100 mg subcutaneously) at physician's discretion. This post hoc analysis assessed 1-year outcomes stratified by comorbidities at enrollment: chronic rhinosinusitis with nasal polyps (CRSwNP), gastroesophageal reflux disease (GERD), depression/anxiety, and chronic obstructive pulmonary disease (COPD). Outcomes included the rate of clinically significant asthma exacerbations (CSEs; requiring systemic corticosteroids and/or hospital/emergency room admission) between the 12 months pre- and post-mepolizumab treatment and changes from baseline in daily maintenance oral corticosteroid dose (mo 12), Asthma Control Questionnaire-5 score (mo 12) and forced expiratory volume in 1 second (FEV1; mo 9-12). RESULTS At enrollment (n = 822), 321 of 822 (39%), 309 of 801 (39%), 203 of 785 (26%), and 81 of 808 (10%) patients had comorbid CRSwNP, GERD, depression/anxiety, and COPD, respectively. Post- versus pre-treatment across all comorbidity subgroups: the rate of CSEs decreased by 63% or more; among 298 (39%) patients on maintenance oral corticosteroids at baseline, median dose decreased by 50% or more; Asthma Control Questionnaire-5 score decreased by 0.63 or more points; FEV1 increased by 74 mL or more. Patients with versus without CRSwNP had the greatest improvements (eg, rate of CSEs decreased by 75%). Patients without GERD, depression/anxiety, or COPD had greater improvements than those with the respective comorbidities, except for FEV1 in patients with COPD. CONCLUSIONS Mepolizumab improved disease outcomes in patients with severe asthma irrespective of comorbidities, with additional benefit for patients with CRSwNP.
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Affiliation(s)
- Mark C Liu
- Divisions of Allergy and Clinical Immunology, Pulmonary and Critical Care Medicine, Johns Hopkins Asthma and Allergy Center, Baltimore, Md.
| | - Diego Bagnasco
- Allergy and Respiratory Diseases, DIMI Department of Internal Medicine, University of Genoa, Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Matucci
- Immunoallergology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Charles Pilette
- Department of Pulmonary Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Pole of Pneumology, ENT and Dermatology, Institute of Experimental and Clinical Research, UCLouvain, Brussels, Belgium
| | | | - Aoife C Maxwell
- Real World Study Delivery, Value Evidence and Outcomes, Global Medical, GSK, Stevenage, UK
| | | | - Rupert W Jakes
- Epidemiology, Value Evidence and Outcomes, Global Medical, GSK, Brentford, UK
| | - Jason K Lee
- Evidence Based Medical Educator, Toronto Allergy and Asthma Clinic, Toronto, Ontario, Canada
| | - Peter Howarth
- Global Medical, Global Specialty & Primary Care, GSK, Brentford, UK
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Taniuchi N, Hino M, Yoshikawa A, Miyanaga A, Tanaka Y, Seike M, Gemma A. Usefulness of simultaneous impulse oscillometry and spirometry with airway response to bronchodilator in the diagnosis of asthmatic cough. J Asthma 2023; 60:769-783. [PMID: 35759776 DOI: 10.1080/02770903.2022.2094803] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: Some of the most common causes of chronic cough include cough variant asthma (CVA), bronchial asthma (BA), and asthma-COPD overlap (ACO). Although there is some overlap in the etiology of these diseases, it is clinically important to attempt an early differential diagnosis due to treatment strategies and prognoses.Methods: Spirometry and impulse oscillometry (IOS) before and after bronchodilator inhalation were analyzed for clinically diagnosed CVA (cCVA, n = 203), BA (cBA, n = 222), and ACO (cACO, n = 61).Results: A significant difference in ΔFEV1 was observed between cBA and cCVA (ΔFEV1 improvement of 122.5 mL/5.4% and 65.7 mL/2.2%, respectively), but no difference was observed in ΔPEF, ΔV50, or ΔV25. Except for R20 (resistance at 20 Hz), significant differences between the three groups were observed in IOS. In IOS, cCVA and cBA showed comparable peripheral airway response to bronchodilator which was thought to be commensurate with changes in V50 and V25. cACO improved ΔFEV1 improvement of 81.0 mL/6.2% and was distinguished by a downward respiratory system reactance (Xrs) waveform with a limited bronchodilator response. FEV1/FVC, %FEV1, and %V25 had relatively strong correlations with the three IOS parameters, X5 (reactance at 5 Hz), resonant frequency (Fres), and low-frequency reactance area (ALX), in the correlation between IOS and spirometers.Conclusion: Changes in IOS parameters were more sensitive in this study than changes in FEV1 or the flow-volume curve. Considering the benefits and relevance of the two different tests, simultaneous IOS and spirometry testing were useful in the diagnosis of asthmatic cough.
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Affiliation(s)
- Namiko Taniuchi
- Nippon Medical School, Respiratory Care Clinic, Tokyo, Japan
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Mitsunori Hino
- Nippon Medical School, Respiratory Care Clinic, Tokyo, Japan
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Akiko Yoshikawa
- Nippon Medical School, Respiratory Care Clinic, Tokyo, Japan
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Akihiko Miyanaga
- Nippon Medical School, Respiratory Care Clinic, Tokyo, Japan
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yosuke Tanaka
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Masahiro Seike
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Akihiko Gemma
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
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Kim JG, Kang J, Lee JH, Koo HK. Association of rheumatoid arthritis with bronchial asthma and asthma-related comorbidities: A population-based national surveillance study. Front Med (Lausanne) 2023; 10:1006290. [PMID: 36968830 PMCID: PMC10036351 DOI: 10.3389/fmed.2023.1006290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 02/20/2023] [Indexed: 03/12/2023] Open
Abstract
BackgroundThe aim of this study was to investigate the impact of rheumatoid arthritis (RA) on the prevalence of bronchial asthma and asthma-related comorbidities. We also aimed to identify the influence of RA on interrelationship between asthma and asthma-related comorbidities.MethodsFrom the Korean National Health and Nutrition Examination Survey, participants >40 years of age who completed questionnaires and spirometry tests were enrolled. Patient data on RA, asthma, allergic rhinitis, atopic dermatitis, chronic obstructive pulmonary disease (COPD), sinusitis, otitis media, and body mass index (BMI) were collected. Logistic regression and network analyses were performed.ResultsA total of 14,272 subjects were enrolled, among which, 334 (2.4%) had RA. RA was significantly associated with asthma (OR 2.32; 95% CI 1.51–3.57), allergic rhinitis (OR 1.51; 95% CI 1.08–2.10), and sinusitis (OR 1.64; 95% CI 1.08–2.50). The network analysis of total patients revealed a positive interrelationship between asthma and allergic rhinitis, sinusitis, otitis media, atopic dermatitis, BMI, and RA. The interrelationship between asthma and sinusitis was stronger in the RA group. Of note, the relationship between asthma and BMI was distinctively found only in the RA group (r = 0.214, P < 0.05). In patients with asthma, the prevalence of obesity was 64% in the presence of RA, and 40% in the absence of RA (P = 0.034).ConclusionThis study supports the positive association of RA with asthma, allergic rhinitis, and sinusitis. Our analysis suggests a notable interrelationship between the presence of asthma and higher BMI values in patients with RA, indicating that asthma is more obesity-related in patients with RA.
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Affiliation(s)
- Jung Gon Kim
- Division of Rheumatology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang-si, Republic of Korea
| | - Jiyeon Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang-si, Republic of Korea
| | - Joo-Hyun Lee
- Division of Rheumatology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang-si, Republic of Korea
| | - Hyeon-Kyoung Koo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang-si, Republic of Korea
- *Correspondence: Hyeon-Kyoung Koo,
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Sukhan VS. PULMONARY DISEASE DIAGNOSTIC AND REHABILITATION TREATMENT FOR PATIENTS WITH OVERLAP ASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASES. POLSKI MERKURIUSZ LEKARSKI : ORGAN POLSKIEGO TOWARZYSTWA LEKARSKIEGO 2023; 51:314-320. [PMID: 37756449 DOI: 10.36740/merkur202304103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
OBJECTIVE Aim: To analyze the effectiveness of rehabilitation treatment in the conditions of halo aerosol therapy and when using different groups of fixed-dose aerosol inhalers in patients with asthma, chronic obstructive pulmonary diseases and asthma-chronic obstructive pulmonary diseases overlap. PATIENTS AND METHODS Materials and Methods: A total 112 patients with asthma, chronic obstructive pulmonary diseases and asthma-chronic obstructive pulmonary diseases overlap. All patients carefully collected allergic history, anamnesis of life, and disease. The study includes assessment of resting anthropometric data, physical activity habits, blood pressure, structure and quality of nutrition, family and economic data. RESULTS Result: After a course of rehabilitation treatment, lung ventilation improved in all groups of patients compared to controls. The dynamics of FER indicators after the rehabilitation treatment had some differences for each group of patients in relation to the control groups. If in all A groups (control) the increase in FER indicators was insignificant, then in all B groups of patients it was significant, and differed from 14,6% up to 36%. CONCLUSION Conclusions: Thus, a differentiated approach to the use of fixed-dose aerosol inhalers increases the effectiveness of rehabilitation treatment under conditions of halo aerosol therapy in patients with various genesis of bronchi-obstructive syndrome.
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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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Suzuki Y, Kitaguchi Y, Ueno F, Droma Y, Goto N, Kinjo T, Wada Y, Yasuo M, Hanaoka M. Associations Between Morphological Phenotypes of COPD and Clinical Characteristics in Surgically Resected Patients with COPD and Concomitant Lung Cancer. Int J Chron Obstruct Pulmon Dis 2022; 17:1443-1452. [PMID: 35761955 PMCID: PMC9233490 DOI: 10.2147/copd.s366265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/22/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The associations between morphological phenotypes of COPD based on the chest computed tomography (CT) findings and clinical characteristics in surgically resected patients with COPD and concomitant lung cancer are unclear. The purpose of this study was to clarify the differences in clinical characteristics and prognosis among morphological phenotypes based on the chest CT findings in these patients. Patients and Methods We retrospectively reviewed the medical records of 132 patients with COPD and concomitant lung cancer who had undergone pulmonary resection for primary lung cancer. According to the presence of emphysema and bronchial wall thickness on chest CT, patients were classified into three phenotypes: non-emphysema phenotype, emphysema phenotype, or mixed phenotype. Results The mixed phenotype was associated with poorer performance status, higher score on the modified British Medical Research Council (mMRC) dyspnea scale, higher residual volume in pulmonary function, and higher proportion of squamous cell carcinoma than the other phenotypes. Univariate and multivariate Cox proportional hazards regression analyses showed that the extent of emphysema on chest CT, presented as a low attenuation area (LAA) score, was an independent determinant that predicted prognosis. In the Kaplan-Meier analysis, the Log rank test showed significant differences in survival between the non-emphysema and mixed phenotypes, and between the emphysema and mixed phenotypes. Conclusion The cross-sectional pre-operative LAA score can predict the prognosis in surgically resected patients with COPD and concomitant lung cancer. The COPD phenotype with both emphysema and bronchial wall thickness on chest CT was associated with poorer performance status, greater extent of dyspnea, greater impairment of pulmonary function, and worse prognosis.
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Affiliation(s)
- Yusuke Suzuki
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yoshiaki Kitaguchi
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Fumika Ueno
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yunden Droma
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Norihiko Goto
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Takumi Kinjo
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yosuke Wada
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Masanori Yasuo
- Departments of Clinical Laboratory Sciences, Shinshu University School of Health Sciences, Matsumoto, Nagano, Japan
| | - Masayuki Hanaoka
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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Kaminsky DA, Irvin CG. The Physiology of Asthma-Chronic Obstructive Pulmonary Disease Overlap. Immunol Allergy Clin North Am 2022; 42:575-589. [DOI: 10.1016/j.iac.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tung NT, Ho SC, Lu YH, Chen TT, Lee KY, Chen KY, Wu CD, Chung KF, Kuo HP, Thao HNX, Dung HB, Thuy TPC, Wu SM, Kou HY, Lee YL, Chuang HC. Higher alveolar deposition of particulate matter in emphysematous lobes of COPD. ERJ Open Res 2021; 7:00324-2021. [PMID: 34476255 PMCID: PMC8405879 DOI: 10.1183/23120541.00324-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 06/27/2021] [Indexed: 11/24/2022] Open
Abstract
Emphysema can be examined quantitatively on high-resolution computed tomography (HRCT) by measuring the low-attenuation areas of the lung and has been associated with decrease in lung function in patients with COPD [1]. Previous studies have associated levels of air pollution with emphysema severity of the total lung [2, 3]. However, the relationship between inhaled particulate matter (PM) deposition in the lungs and the degree of emphysema at the lung lobar level remains poorly understood. We examined the association of lung lobe-deposited doses of PM2.5 (particles with a 50% cut-off aerodynamic diameter of 2.5 μm) with the extent of emphysema in different lung lobes of COPD subjects. The novelty of this study is that it identified the associations between PM2.5 deposition in the lung and the degree of emphysema in different lung lobes of COPD patients, especially in the right middle lobe and both upper lobeshttps://bit.ly/3k21ri0
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Affiliation(s)
- Nguyen Thanh Tung
- International PhD Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Otorhinolaryngology Dept, Cho Ray Hospital, Ho Chi Minh City, Vietnam.,These authors contributed equally
| | - Shu-Chuan Ho
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan.,These authors contributed equally
| | - Yueh-Hsun Lu
- Dept of Radiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Dept of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tzu-Tao Chen
- Division of Pulmonary Medicine, Dept of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Kang-Yun Lee
- Division of Pulmonary Medicine, Dept of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Division of Pulmonary Medicine, Dept of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kuan-Yuan Chen
- Division of Pulmonary Medicine, Dept of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chih-Da Wu
- Dept of Geomatics, National Cheng Kung University, Tainan, Taiwan.,National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Han-Pin Kuo
- Division of Pulmonary Medicine, Dept of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | | | - Hoang Ba Dung
- Otorhinolaryngology Dept, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Tran Phan Chung Thuy
- Otorhinolaryngology Dept, Faculty of Medicine, Vietnam National University Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Sheng-Ming Wu
- Division of Pulmonary Medicine, Dept of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Division of Pulmonary Medicine, Dept of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsiao-Yun Kou
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yueh-Lun Lee
- Dept of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsiao-Chi Chuang
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Division of Pulmonary Medicine, Dept of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Cell Physiology and Molecular Image Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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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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Górka K, Gross-Sondej I, Górka J, Stachura T, Polok K, Celejewska-Wójcik N, Mikrut S, Andrychiewicz A, Sładek K, Soja J. Assessment of Airway Remodeling Using Endobronchial Ultrasound in Asthma-COPD Overlap. J Asthma Allergy 2021; 14:663-674. [PMID: 34163179 PMCID: PMC8214023 DOI: 10.2147/jaa.s306421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/30/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the structural changes of the airways using the endobronchial ultrasound (EBUS) in ACO patients compared to severe asthma and COPD patients. PATIENTS AND METHODS The study included 17 patients with ACO, 17 patients with COPD and 33 patients with severe asthma. Detailed clinical data were obtained from all participants. Basic laboratory tests were performed, including measurement of eosinophil counts in blood and serum immunoglobulin E (IgE) concentrations. All patients underwent spirometry and bronchoscopy with EBUS (a 20‑MHz ultrasound probe) to measure the total thicknesses of the bronchial walls and their particular layers in segmental bronchi of the right lower lobe. EBUS allows to distinguish five layers of the bronchial wall. Layer 1 (L1) and layer 2 (L2) were analyzed separately, while the outer layers (layers 3-5 [L3-5]) that correspond to cartilage were assessed together. RESULTS In patients with ACO the thicknesses of the L1 and L2 layers, which are mainly responsible for remodeling, were significantly greater than in patients with COPD and significantly smaller than in patients with severe asthma (median L1= 0.17 mm vs 0.16 mm vs 0.18 mm, p<0.001; median L2= 0.18 mm vs 0.17 mm vs 0.20 mm, p<0.001, respectively). The thicknesses of the total bronchial walls (L1+L2+L3-5) and L3-5 were significantly smaller in ACO and COPD patients compared to asthma patients (median L1+L2+L3-5= 1.2 mm vs 1.14 mm vs 1.31 mm, p<0.001; median L3-5= 0.85 mm vs, 0.81 mm vs 0.92 mm, p=0.001, respectively). CONCLUSION The process of structural changes in the airways assessed by EBUS is more advanced in individuals with ACO compared to patients with COPD, and less pronounced compared to patients with severe asthma. It seems that EBUS may provide useful information about differences in airway remodeling between ACO, COPD and severe asthma.
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Affiliation(s)
- Karolina Górka
- Department of Pulmonology and Allergology, University Hospital, Kraków, Poland
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Iwona Gross-Sondej
- Department of Pulmonology and Allergology, University Hospital, Kraków, Poland
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Jacek Górka
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Tomasz Stachura
- Department of Pulmonology and Allergology, University Hospital, Kraków, Poland
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Kamil Polok
- Department of Pulmonology and Allergology, University Hospital, Kraków, Poland
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Natalia Celejewska-Wójcik
- Department of Pulmonology and Allergology, University Hospital, Kraków, Poland
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Sławomir Mikrut
- Faculty of Mining Surveying and Environmental Engineering, AGH University of Science and Technology, Kraków, Poland
| | | | - Krzysztof Sładek
- Department of Pulmonology and Allergology, University Hospital, Kraków, Poland
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy Soja
- Department of Pulmonology and Allergology, University Hospital, Kraków, Poland
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland
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Kraposhina AY, Sobko EA, Demko IV, Kacer AB, Kazmerchuk OV, Abramov YI. Modern understanding of bronchial asthma with fixed airflow obstruction. TERAPEVT ARKH 2021; 93:337-342. [DOI: 10.26442/00403660.2021.03.200661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 11/22/2022]
Abstract
The review provides data on one of the phenotypes of severe bronchial asthma it is asthma with fixed airway obstruction. According to data published today, there is no single pathway for the formation of fixed airway obstruction in patients with severe asthma. Increasing knowledge of the pathophysiology of fixed airway obstruction, as well as identifying the most significant risk factors, is essential for the successful treatment of such patients. In addition, the development of fixed obstruction is associated with a worse and sometimes fatal prognosis. Expanding the existing views is also necessary to overcome the difficulties of differential diagnosis between bronchial asthma with fixed airway obstruction and bronchial asthma in combination with COPD. All this will optimize the approach to the management of patients with bronchial asthma to prevent the formation of fixed airway obstruction.
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Hashimoto S, Sorimachi R, Jinnai T, Ichinose M. Asthma and Chronic Obstructive Pulmonary Disease Overlap According to the Japanese Respiratory Society Diagnostic Criteria: The Prospective, Observational ACO Japan Cohort Study. Adv Ther 2021; 38:1168-1184. [PMID: 33355907 PMCID: PMC7889677 DOI: 10.1007/s12325-020-01573-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/12/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Patients with asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) present with chronic respiratory symptoms with features of both asthma and COPD. New ACO diagnostic criteria (2018) were suggested by the Japanese Respiratory Society (JRS). This prospective, multicenter, observational cohort study was conducted to investigate the proportion of patients who meet the JRS ACO diagnostic criteria among COPD patients in clinical practice. METHODS This 2-year ongoing study enrolled consecutive outpatients aged ≥ 40 years with COPD who visited one of 27 Japanese centers at which the medical examinations/tests required for ACO diagnosis were routinely conducted. At registration, the proportion of ACO or non-ACO patients was determined using the JRS diagnostic criteria, and the characteristics of the two groups were compared using analysis of variance and chi-square test. RESULTS Of 708 COPD patients analyzed at registration, 396 (55.9%) had the data necessary for ACO diagnosis to be conducted, and 312 (44.1%) were lacking these data. Of the 396 patients who had the data necessary for ACO diagnosis, 101 (25.5%) met the diagnostic criteria for ACO, and 295 (74.5%) did not (non-ACO patients). ACO patients were younger, had a greater rate of asthma based on a physician's diagnosis, and used more medications, including inhaled corticosteroids (p < 0.05), compared with non-ACO patients. CONCLUSIONS We have determined the proportion of patients with the data necessary to diagnose ACO using the JRS criteria, and the proportion of these who met the ACO criteria among the COPD population at the time of registration. Patients, including those lacking necessary examination/test data at registration, will continue to undergo follow-up to explore changes in their testing and ACO diagnostic status over time. Analyses of study data over 2 years will provide relevant information on the ACO symptoms, clinical course, and real-world treatment patterns. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT03577795.
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Affiliation(s)
- Shu Hashimoto
- Nihon University, Itabashi-ku, Tokyo, Japan.
- Hibiya Kokusai Clinic, Chiyoda-ku, Tokyo, Japan.
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Boulet LP, Boulay ME, Coxson HO, Hague CJ, Milot J, Lepage J, Maltais F. Asthma with Irreversible Airway Obstruction in Smokers and Nonsmokers: Links between Airway Inflammation and Structural Changes. Respiration 2020; 99:1-11. [PMID: 33291112 DOI: 10.1159/000508163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 04/20/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The development of irreversible airway obstruction (IRAO) in asthma is related to lung/airway inflammatory and structural changes whose characteristics are likely influenced by exposure to tobacco smoke. OBJECTIVE To investigate the interplay between airway and lung structural changes, airway inflammation, and smoking exposure in asthmatics with IRAO. METHODS We studied asthmatics with IRAO who were further classified according to their smoking history, those with ≥20 pack-years of tobacco exposure (asthmatics with smoking-related IRAO [AwS-IRAO]) and those with <5 pack-years of tobacco exposure (asthmatics with nonsmoking-related IRAO [AwNS-IRAO]). In addition to recording baseline clinical and lung function features, all patients had a chest computed tomography (CT) from which airway wall thickness was measured and quantitative and qualitative assessment of emphysema was performed. The airway inflammatory profile was documented from differential inflammatory cell counts on induced sputum. RESULTS Ninety patients were recruited (57 AwS-IRAO and 33 AwNS-IRAO). There were no statistically significant differences in the extent of emphysema and gas trapping between groups on quantitative chest CT analysis, although Pi10, a marker of airway wall thickness, was significantly higher in AwS-IRAO (p = 0.0242). Visual analysis showed a higher prevalence of emphysema (p = 0.0001) and higher emphysema score (p < 0.0001) in AwS-IRAO compared to AwNS-IRAO and distribution of emphysema was different between groups. Correlations between radiological features and lung function were stronger in AwS-IRAO. In a subgroup analysis, we found a correlation between airway neutrophilia and emphysematous features in AwS-IRAO and between eosinophilia and both airway wall thickness and emphysematous changes in AwNS-IRAO. CONCLUSIONS Although bronchial structural changes were relatively similar in smoking and nonsmoking patients with asthma and IRAO, emphysematous changes were more predominant in smokers. However, neutrophils in AwS-IRAO and eosinophils in AwNS-IRAO were associated with lung and airway structural changes.
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Affiliation(s)
- Louis-Philippe Boulet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Québec, Canada,
| | - Marie-Eve Boulay
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Québec, Canada
| | - Harvey O Coxson
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cameron J Hague
- Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joanne Milot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Québec, Canada
| | - Johane Lepage
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Québec, Canada
| | - François Maltais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Québec, Canada
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Cho E, Wu JKY, Birriel DC, Matelski J, Nadj R, DeHaas E, Huang Q, Yang K, Xu T, Cheung AB, Woo LN, Day L, Cypel M, Tikkanen J, Ryan C, Chow CW. Airway Oscillometry Detects Spirometric-Silent Episodes of Acute Cellular Rejection. Am J Respir Crit Care Med 2020; 201:1536-1544. [PMID: 32135068 DOI: 10.1164/rccm.201908-1539oc] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Acute cellular rejection (ACR) is common during the initial 3 months after lung transplant. Patients are monitored with spirometry and routine surveillance transbronchial biopsies. However, many centers monitor patients with spirometry only because of the risks and insensitivity of transbronchial biopsy for detecting ACR. Airway oscillometry is a lung function test that detects peripheral airway inhomogeneity with greater sensitivity than spirometry. Little is known about the role of oscillometry in patient monitoring after a transplant.Objectives: To characterize oscillometry measurements in biopsy-proven clinically significant (grade ≥2 ACR) in the first 3 months after a transplant.Methods: We enrolled 156 of the 209 double lung transplant recipients between December 2017 and March 2019. Weekly outpatient oscillometry and spirometry and surveillance biopsies at Weeks 6 and 12 were conducted at our center.Measurements and Main Results: Of the 138 patients followed for 3 or more months, 15 patients had 16 episodes of grade 2 ACR (AR2) and 44 patients had 64 episodes of grade 0 ACR (AR0) rejection associated with stable and/or improving spirometry. In 15/16 episodes of AR2, spirometry was stable or improving in the weeks leading to transbronchial biopsy. However, oscillometry was markedly abnormal and significantly different from AR0 (P < 0.05), particularly in integrated area of reactance and the resistance between 5 and 19 Hz, the indices of peripheral airway obstruction. By 2 weeks after biopsy, after treatment for AR2, oscillometry in the AR2 group improved and was similar to the AR0 group.Conclusions: Oscillometry identified physiological changes associated with AR2 that were not discernible by spirometry and is useful for graft monitoring after a lung transplant.
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Affiliation(s)
- Elizabeth Cho
- Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Joyce K Y Wu
- Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Pulmonary Function Laboratory
| | - Daniella Cunha Birriel
- Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto Lung Transplant Programme, Multi-Organ Transplant Unit
| | | | - Richard Nadj
- Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Emily DeHaas
- Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Qian Huang
- Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kelsey Yang
- Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tong Xu
- Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Aloysius B Cheung
- Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lindsay N Woo
- Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Day
- Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Pulmonary Function Laboratory
| | - Marcelo Cypel
- Toronto Lung Transplant Programme, Multi-Organ Transplant Unit.,Division of Thoracic Surgery, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Jussi Tikkanen
- Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto Lung Transplant Programme, Multi-Organ Transplant Unit
| | - Clodagh Ryan
- Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Pulmonary Function Laboratory
| | - Chung-Wai Chow
- Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto Lung Transplant Programme, Multi-Organ Transplant Unit
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Wang J, Wang W, Lin H, Huan C, Jiang S, Lin D, Cao N, Ren H. Role of pulmonary function and FeNO detection in early screening of patients with ACO. Exp Ther Med 2020; 20:830-837. [PMID: 32742326 PMCID: PMC7388375 DOI: 10.3892/etm.2020.8762] [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: 07/11/2019] [Accepted: 02/12/2020] [Indexed: 12/02/2022] Open
Abstract
Measurement of fractional exhaled nitric oxide (FeNO) is a quantitative and non-invasive approach to examine airway inflammation, which is a powerful aid in diagnosing chronic disorders of airways like asthma. Diagnostic value of FeNO and relevant indices on pulmonary function in the patients with asthma and chronic obstructive pulmonary disease (COPD) was evaluated. A total of 164 patients [58 asthma, 49 COPD and 57 asthma-COPD overlap (ACO)] were randomly recruited. FeNO, pulmonary ventilation function, and bronchial diastolic function were performed. Eight indicators including FeNO, vital capacity percentage (VC%), forced vital capacity percentage (FVC%), forced expiratory volume in one second percentage (FEV1%), forced expiratory volume in one second to forced vital capacity percentage (FEV1/FVC%), maximum independent ventilation volume percentage (MVV%), the increased percentage of FEV1 after bronchial diastolic test, the increased absolute value of FEV1 after bronchial diastolic test were examined. Significant difference in VC%, FVC%, FEV1%, FEV1/FVC%, MVV%, the increased absolute value of FEV1 after bronchial diastolic test and FeNO were significantly different between patients with asthma and patients with COPD (P<0.05). There were significant differences of VC%, FVC%, FEV1%, FEV1/FVC%, MVV% and the increased percentage of FEV1 after bronchial diastolic test in cases of patients with asthma compared to ACO patients (P<0.05). There was no statistical significance on VC%, FVC%, FEV1%, FEV1/FVC%, MVV% between COPD patients and ACO patients (P>0.05). However, more importantly, the increased percentage of FEV1 after bronchial diastolic test, the increased absolute value of FEV1 after bronchial diastolic test and the alterations on FeNO were found significantly different in ACO group compared with COPD alone (P<0.05). We compared the results from pulmonary ventilation function, bronchial diastolic function examination as well as FeNO detection among 3 groups of asthma, COPD and ACO. The examination of pulmonary ventilation function and bronchial diastolic function combined with FeNO detection is helpful in the early screening of ACO.
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Affiliation(s)
- Jing Wang
- Department of Respiration, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Wenting Wang
- Department of Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Huan Lin
- Department of Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Cheng Huan
- Department of Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Shujuan Jiang
- Department of Respiration, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Dianjie Lin
- Department of Respiration, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Naiqing Cao
- Department of Allergy, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Hongsheng Ren
- Department of Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
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Yasuo M, Kitaguchi Y, Tokoro Y, Kosaka M, Wada Y, Kinjo T, Ushiki A, Yamamoto H, Hanaoka M. Differences Between Central Airway Obstruction and Chronic Obstructive Pulmonary Disease Detected with the Forced Oscillation Technique. Int J Chron Obstruct Pulmon Dis 2020; 15:1425-1434. [PMID: 32606651 PMCID: PMC7310967 DOI: 10.2147/copd.s246126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 05/24/2020] [Indexed: 12/13/2022] Open
Abstract
Background Obstructive ventilatory disturbances occur in both chronic obstructive pulmonary disease (COPD), a typical disease representative of peripheral airway obstruction, and central airway obstruction (CAO). Pulmonary function tests (PFTs), which depend on patient effort, are traditionally used to evaluate lung function. The forced oscillation technique (FOT) is an effort-independent method for examining lung function during tidal breathing. The FOT is used universally to assess respiratory function in patients with COPD. Several studies have measured FOT to assess ventilatory disturbances in CAO. The results showed that FOT measurements in patients with CAO were similar to those reported in patients with COPD. However, no studies have compared FOT measurements directly between CAO and COPD. The aim of this study was to identify differences in ventilatory disturbances between peripheral and central airway obstructions in COPD and CAO, before patients received pharmacological therapy or bronchoscopic interventions, respectively. Patients and Methods We retrospectively included 16 patients with CAO (10 cases of tracheal obstruction and 6 cases of bronchial obstruction) and 75 treatment-naïve patients with COPD (60 cases in Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage II and 15 cases in GOLD stage III) that were admitted from December 2013 to May 2017. Prior to treatment, patients were examined with the FOT and PFTs. Results All parameters measured with the FOT in the inspiratory phase were significantly worse in patients with CAO than in patients with COPD. The PFTs showed that the CAO group had a significantly lower peak expiratory flow rate. In the airway wall thickening phenotype of COPD, a difference between the inspiratory and expiratory phases of the resonance frequency (ΔFres) was the best indicator for distinguishing between peripheral and central airway obstructions. Conclusion This study compared differences between CAO and COPD (mainly GOLD stage II). We found that the FOT measurement, ΔFres, was the optimal indicator of the difference between the airway wall thickening COPD phenotype and CAO. Thus, the difference might be due to mechanical changes that occur in COPD with airway wall thickening.
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Affiliation(s)
- Masanori Yasuo
- The First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshiaki Kitaguchi
- The First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yayoi Tokoro
- The First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Makoto Kosaka
- The First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yosuke Wada
- The First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takumi Kinjo
- The First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Atsuhito Ushiki
- The First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroshi Yamamoto
- The First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masayuki Hanaoka
- The First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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From infancy to adulthood-Developmental changes in pulmonary quantitative computed tomography parameters. PLoS One 2020; 15:e0233622. [PMID: 32469974 PMCID: PMC7259551 DOI: 10.1371/journal.pone.0233622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 05/08/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose Quantified computed tomography (qCT) is known for correlations with airflow obstruction and fibrotic changes of the lung. However, as qCT studies often focus on diseased and elderly subjects, current literature lacks physiological qCT values during body development. We evaluated chest CT examinations of a healthy cohort, reaching from infancy to adulthood, to determine physiological qCT values and changes during body development. Method Dose-optimized chest CT examinations performed over the last 3 years using a dual-source CT were retrospectively analysed. Exclusion criteria were age >30 years and any known or newly diagnosed lung pathology. Lung volume, mean lung density, full-width-at-half-maximum and low attenuated volume (LAV) were semi-automated quantified in 151 patients. qCT values between different age groups as well as unenhanced (Group 1) and contrast-enhanced (Group 2) protocols were compared. Models for projection of age-dependant changes in qCT values were fitted. Results Significant differences in qCT parameters were found between the age groups from 0 to 15 years (p < 0.05). All parameters except LAV merge into a plateau level above this age as shown by polynomial models (r2 between 0.85 and 0.67). In group 2, this plateau phase is shifted back around five years. Except for the volume, significant differences in all qCT values were found between group 1 and 2 (p < 0.01). Conclusion qCT parameters underly a specific age-dependant dynamic. Except for LAV, qCT parameters reach a plateau around adolescence. Contrast-enhanced protocols seem to shift this plateau backwards.
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DYNAMICS OF FUNCTIONAL CONDITION AND QUALITY OF LIFE IN PATIENTS WITH ASTHMA-COPD OVERLAP AND CONCOMITANT ARTERIAL HYPERTENSION AGAINST THE BACKGROUND OF COMPLEX THERAPY. EUREKA: HEALTH SCIENCES 2020. [DOI: 10.21303/2504-5679.2020.001135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Patients with ACO have significant poorer health-related quality of life and more severe functional limitations compared to asthma and COPD alone. Most commonly, chronic respiratory disease is associated with cardiovascular disease, such as arterial hypertension. However, the impact of concomitant cardiac diseases on the quality of life and functional status of patients with ACO remains poorly understood.
The aim of the work was to study dynamics of functional condition and quality of life in with ACO and concomitant AH against the background of complex therapy.
Materials and methods. We selected for participating in the study 100 patients with ACO and concomitant AH. Examination of the patients included: clinical methods, spirometry, and questinaries – mMRS, CAT, SGRQ, performing 6MWT.
Results. After 16 weeks of treatment there were no changes in lung functional status in patients on standard treatment, at the same time, in group of patients who had an active rehabilitation program, there was a significant improvement in the bronchial response to the action of bronchodilators, although other indicators of the functional status of the lungs didn't show significant changes. Patients who additionally used an active rehabilitation program had a significant improvement in clinical symptoms, shortness of breath, and quality of life according to CAT, mMRC, and SGRQ scores, respectively. There was also a significant increase in distance during the 6MWT in this group of patients.
Conclusions. Conducting an active rehabilitation program (physical rehabilitation in combination with an educational program and self-management) in group of patients with ACO and concomitant AH, who are on standard medical treatment, significantly improves the bronchial response to the action of bronchodilators, decreases clinical manifestations, shortness of breath and improve quality of life and exercise tolerance, according to CAT, mMRC, SGRQ and 6MWT questionnaires, respectively.
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Anazawa R, Kawata N, Matsuura Y, Ikari J, Tada Y, Suzuki M, Takayanagi S, Matsuoka S, Matsushita S, Tatsumi K. Longitudinal changes in structural lung abnormalities using MDCT in chronic obstructive pulmonary disease with asthma-like features. PLoS One 2019; 14:e0227141. [PMID: 31887184 PMCID: PMC6936827 DOI: 10.1371/journal.pone.0227141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 12/12/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Some patients with chronic obstructive pulmonary disease (COPD) have asthma-like features. However, there have been few reports on the structural lung abnormalities found in this patient population. Multi-detector computed tomography (MDCT) can detect emphysematous low-attenuation areas (LAA) within the lung, airway thickness (wall area percentage, WA%), and the loss of pulmonary vasculature as the percentage of small pulmonary vessels with cross-sectional area (CSA) less than 5 mm2 (%CSA<5). We analyzed differences in structural lung changes over time between patients with COPD and those with COPD with asthma-like features using these CT parameters. MATERIAL AND METHODS We performed pulmonary function tests (PFTs), MDCT, and a COPD assessment test (CAT) in 50 patients with COPD and 29 patients with COPD with asthma-like features at the time of enrollment and two years later. We analyzed changes in clinical parameters and CT indices over time and evaluated differences in structural changes between groups. RESULTS The CAT score and FEV1 did not significantly change during the follow-up period in either group. Emphysematous LAA regions significantly increased in both groups. The %CSA<5 showed a small but significant increase in COPD patients, but a significant decrease in patients with COPD with asthma-like features. The WA% at the distal bronchi was significantly decreased in COPD, but did not significantly change in COPD with asthma -like features. CONCLUSION Emphysematous LAA increased in patients with COPD with and without asthma-like features. The %CSA<5 and WA% at the distal bronchi did not change in parallel with LAA. Furthermore, changes in %CSA<5 were significantly different between patients with COPD and those with COPD with asthma-like features. Patients with COPD with asthma-like features may have different longitudinal structural changes than those seen in COPD patients.
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Affiliation(s)
- Rie Anazawa
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Naoko Kawata
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Yukiko Matsuura
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Jun Ikari
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Yuji Tada
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Masaki Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Shin Takayanagi
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Shin Matsuoka
- Department of Radiology, St. Marianna University School of Medicine, Sugao, Miyamae-ku, Kawasaki-shi, Kanagawa, Japan
| | - Shoichiro Matsushita
- Department of Radiology, St. Marianna University School of Medicine, Sugao, Miyamae-ku, Kawasaki-shi, Kanagawa, Japan
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba, Japan
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Yamamura K, Hara J, Kobayashi T, Ohkura N, Abo M, Akasaki K, Nomura S, Yuasa M, Saeki K, Terada N, Matsuoka H, Tambo Y, Nishikawa S, Sone T, Kimura H, Kasahara K. The prevalence and clinical features of asthma-COPD overlap (ACO) definitively diagnosed according to the Japanese Respiratory Society Guidelines for the Management of ACO 2018. THE JOURNAL OF MEDICAL INVESTIGATION 2019; 66:157-164. [PMID: 31064931 DOI: 10.2152/jmi.66.157] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background Asthma-COPD overlap (ACO) is a disease that shares clinical features of both asthma and COPD. The purpose of this study is to investigate the prevalence and clinical features of ACO. Methods We retrospectively reviewed data for 170 patients with persistent airflow limitation and diagnosed them according to "The Japanese Respiratory Society Guidelines for the Management of ACO 2018". Results Of the 170 patients, 111 were diagnosed as follows : COPD (74 patients, 66.6%), ACO (34 patients, 30.6%), and asthma (3 patients, 2.8%). There was no significant difference in clinical features between ACO and COPD patients. The following pulmonary function tests were significantly lower in ACO than in COPD patients : forced expiratory volume in 1 second/forced vital capacity, peak expiratory flow, maximal mid-expiratory flow, and the maximum expiratory flow at 50%and75%. The following respiratory impedance parameters were significantly higher in ACO than in COPD patients : respiratory resistance (Rrs) at 5 Hz (R5), Rrsat 20 Hz (R20), R5-R20, and low-frequency reactance area. Conclusions About 30% of patients with persistent airflow limitation were diagnosed with ACO. ACO patients had lower lung function and higher respiratory impedance compared with COPD patients. J. Med. Invest. 66 : 157-164, February, 2019.
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Affiliation(s)
- Kenta Yamamura
- Department of Respiratory Medicine, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University
| | - Johsuke Hara
- Department of Respiratory Medicine, Kanazawa University Hospital
| | | | - Noriyuki Ohkura
- Department of Respiratory Medicine, Kanazawa University Hospital
| | - Miki Abo
- Department of Respiratory Medicine, Kanazawa University Hospital
| | - Kyota Akasaki
- Department of Respiratory Medicine, Kanazawa University Hospital
| | - Syunichi Nomura
- Department of Respiratory Medicine, Kanazawa University Hospital
| | - Mizuki Yuasa
- Department of Respiratory Medicine, Kanazawa University Hospital
| | - Keigo Saeki
- Department of Respiratory Medicine, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University
| | - Nanao Terada
- Department of Respiratory Medicine, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University
| | - Hiroki Matsuoka
- Department of Respiratory Medicine, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University
| | - Yuichi Tambo
- Department of Respiratory Medicine, Kanazawa University Hospital
| | - Shingo Nishikawa
- Department of Respiratory Medicine, Kanazawa University Hospital
| | - Takashi Sone
- Department of Regional Respiratory Symptomatology, Kanazawa University Graduate School of Medical Science
| | - Hideharu Kimura
- Department of Respiratory Medicine, Kanazawa University Hospital
| | - Kazuo Kasahara
- Department of Respiratory Medicine, Kanazawa University Hospital
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Fayed HK, Abd-Elkareem YG, Samaha WA, Abdalshakour MS. Functional and radiological characteristics of asthma combined chronic obstructive pulmonary disease overlap. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2019. [DOI: 10.4103/ejb.ejb_14_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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25
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Boulet LP, Boulay MÈ, Dérival JL, Milot J, Lepage J, Bilodeau L, Maltais F. Asthma-COPD Overlap Phenotypes and Smoking :Comparative features of asthma in smoking or non-smoking patients with an incomplete reversibility of airway obstruction. COPD 2018; 15:130-138. [PMID: 29683758 DOI: 10.1080/15412555.2017.1395834] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The development of COPD features, such as an incomplete reversibility of airway obstruction (IRAO), in smoking or non-smoking asthmatic patients, a condition often named Asthma-COPD Overlap (ACO), has been recognized for decades. However, there is a need to know more about the sub-phenotypes of this condition according to smoking. This study aimed at comparing the clinical, physiological and inflammatory features of smoking and non-smoking asthmatic patients exhibiting IRAO. In this cross-sectional study, patients with an IRAO with (ACO, ≥20 pack-years) or without (NS-IRAO, <5 pack-years) significant smoking history completed questionnaires about asthma control (ACQ, score 0-6, 6 = better score) and quality of life (AQLQ, score 1-7, 1 = better score) and performed expiratory flows, lung volume and carbon monoxide diffusion capacity measurements. Blood sampling and induced sputum were obtained for systemic and lower airway inflammation assessment. A total of 115 asthmatic patients were included (75 ACO: age 61 ± 10 years, 60% women and 40 NS-IRAO: age 64 ± 9 years, 38% women). ACO patients had worse asthma control scores (1.8 ± 0.9 vs 1.4 ± 0.9, P = 0.02) and poorer asthma quality of life (5.3 ± 1.0 vs 5.9 ± 1.0, P = 0.003). In addition, ACO had higher residual volume (145 ± 45 vs 121 ± 29% predicted, P = 0.008) and a lower carbon monoxide diffusing capacity corrected for alveolar volume (90 ± 22 vs 108 ± 20% predicted, P = 0.0008). No significant differences were observed in systemic or lower airway inflammation. In conclusion, in smokers and non-smokers, the presence of IRAO in asthmatics is associated with different phenotypes that reflect the addition of smoking-induced changes to asthma physiopathology.
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Affiliation(s)
- Louis-Philippe Boulet
- a Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval , Québec , Canada
| | - Marie-Ève Boulay
- a Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval , Québec , Canada
| | - Jude-Lyne Dérival
- a Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval , Québec , Canada
| | - Joanne Milot
- a Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval , Québec , Canada
| | - Johane Lepage
- a Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval , Québec , Canada
| | - Lara Bilodeau
- a Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval , Québec , Canada
| | - François Maltais
- a Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval , Québec , Canada
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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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Yasuo M, Kitaguchi Y, Kinota F, Kosaka M, Urushihata K, Ushiki A, Yamamoto H, Kawakami S, Hanaoka M. Usefulness of the forced oscillation technique in assessing the therapeutic result of tracheobronchial central airway obstruction. Respir Investig 2018; 56:222-229. [PMID: 29773293 DOI: 10.1016/j.resinv.2018.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/07/2017] [Accepted: 01/21/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pulmonary function tests (PFTs) comprise the traditional method for detecting central airway obstruction (CAO) and evaluating therapeutic effects, but are effort-dependent. By contrast, the forced oscillation technique (FOT) is performed during tidal breathing in an effort-independent mode and is universally used to assess respiratory function in patients with chronic obstructive pulmonary disease (COPD) and asthma. We used the FOT to measure airway resistance and reactance in patients with CAO before and after interventional bronchoscopy and compared the results to data obtained using PFTs. METHODS Twelve patients with CAO were recruited from December 2013 to July 2016. The FOT, PFTs, chest computed tomography (CT), COPD Assessment Test (CAT), and the modified Medical Research Council (mMRC) dyspnea scale were employed before and after interventional bronchoscopy. The minimum airway cross-sectional area (MACSA) was calculated using a CT image calculator. RESULTS Of the 12 patients, 6 had tracheal obstruction and 6 had bronchial obstruction. All FOT measurements, except ΔX5, were significantly improved after interventional bronchoscopy in all cases. The significance of the improvement was greater with the FOT than PFTs. The MACSA, CAT, and mMRC dyspnea scale scores also significantly improved in all cases. Furthermore, only alteration of resistance at 20 Hz (R20) significantly correlated with the alteration of the MACSA after intervention. No significant correlations were found for PFTs. CONCLUSIONS The FOT is suitable and convenient for assessing therapeutic results in patients with tracheobronchial CAO. The alteration of R20 is useful for estimating the airway dilation of CAO after interventional bronchoscopy.
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Affiliation(s)
- Masanori Yasuo
- The First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Yoshiaki Kitaguchi
- The First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Fumiya Kinota
- The First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Makoto Kosaka
- The First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Kazuhisa Urushihata
- The First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Atsuhito Ushiki
- The First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Hiroshi Yamamoto
- The First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Satoshi Kawakami
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Masayuki Hanaoka
- The First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
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Yeh JJ, Wei YF, Lin CL, Hsu WH. Effect of the asthma-chronic obstructive pulmonary disease syndrome on the stroke, Parkinson's disease, and dementia: a national cohort study. Oncotarget 2017; 9:12418-12431. [PMID: 29552322 PMCID: PMC5844758 DOI: 10.18632/oncotarget.23811] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 11/10/2017] [Indexed: 12/13/2022] Open
Abstract
Background To evaluate the association of asthma–chronic obstructive pulmonary disease syndrome (ACOS) with neurodegenerative diseases (stroke, Parkinson's disease and dementia) and the role of the steroids in the neurodegenerative diseases among the ACOS cohort. Materials and Methods Comparison of the ACOS cohort (N = 10,260) with the non-ACOS cohort (n = 20,513) based on the patients aged ≧40 years in the National Health Insurance Research Database from January 1, 2000 to December 31, 2010. These patients follow up to diagnosis of neurodegenerative diseases or the December 31, 2011; using multivariable Cox proportional hazards models. Results After adjustment for potential confounders, the [adjusted hazard ratio (aHR), 95% confidence interval (CI)] in the ACOS cohort were [1.39, 1.28–1.50] [1.56, 1.34–1.81] and [1.43, 1.29–1.59] for stroke, Parkinson's disease, dementia; respectively. The [aHR, 95% CI] for ACOS cohort with (inhaler corticosteroids ≧0.13 gram/ oral steroids ≧0.08gram) were with less risk (all aHR<1, p values <0.05) for these 3 neurodegenerative diseases except Parkinson's disease with inhaler corticosteroids >0.43 gram. The risk of stroke and dementia were the lower in patients with < 250 μg/d of a fluticasone equivalent inhaler corticosteroids (aHR = 0.53, 95% CI = 0.35–0.79; aHR = 0.53, 95% CI = 0.31–0.90, respectively). Conclusions The ACOS cohort had a higher risk of the neurodegenerative diseases. The lower dose of the inhaler corticosteroids with cumulative dose ≧0.13 gram have the less risk of stroke and dementia.
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Affiliation(s)
- Jun-Jun Yeh
- Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.,Chia Nan University of Pharmacy and Science, Tainan, Taiwan.,Meiho University, Pingtung, Taiwan.,Pingtung Christian Hospital, Pingtung, Taiwan
| | - Yu-Feng Wei
- Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Wu-Huei Hsu
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
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Yeh JJ, Wei YF, Lin CL, Hsu WH. Association of asthma-chronic obstructive pulmonary disease overlap syndrome with coronary artery disease, cardiac dysrhythmia and heart failure: a population-based retrospective cohort study. BMJ Open 2017; 7:e017657. [PMID: 28982831 PMCID: PMC5640024 DOI: 10.1136/bmjopen-2017-017657] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Patients with asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) and cardiovascular diseases (CVDs) share common risk factors. However, the association between ACOS and the incidence of CVDs has not been reported. This study investigated the relationship between CVDs and ACOS in the general population. SETTING Data were obtained from Taiwan's National Health Insurance Research Database for the period 2000 to 2010. PARTICIPANTS The ACOS cohort comprised patients (n=5814) who had received a diagnosis of asthma and COPD. The non-ACOS cohort comprised patients who had not received a diagnosis of asthma or COPD and were matched to the ACOS cohort (2:1) by age, sex and index date (n=11 625). PRIMARY AND SECONDARY OUTCOME MEASURES The cumulative incidence of CVDs-coronary artery disease (CAD), cardiac dysrhythmia (CD) and heart failure (HF)-was calculated. Cox proportional regression analysis was employed to examine the relationship between ACOS and CVDs. RESULTS After adjustment for multiple confounding factors-age, sex, comorbidities and medications-patients with ACOS were associated with a significantly higher risk of CVDs; the adjusted HRs (aHRs; 95% CI) for CAD, CD and HF were 1.62 (1.50 to 1.76), 1.44 (1.30 to 1.61) and 1.94 (1.73 to 2.19), respectively, whereas those of beta-blockers treatment for CAD, CD and HF were 1.19 (0.92 to 1.53), 0.90 (0.56 to 1.45) and 0.82 (0.49 to 1.38). The aHR of atenolol treatment for CD was 1.72 (1.01 to 2.93). The aHRs (95% CIs) of ACOS without acute exacerbation of COPD (AE-COPD) for CAD, CD and HF were 1.85 (1.70 to 2.01), 1.57 (1.40 to 1.77) and 2.07 (1.82 to 2.35), respectively. CONCLUSION ACOS was associated with higher CVD risk, even without the presence of previous comorbidities or AE-COPD. No significant differences in CVD events were observed in the ACOS cohort using beta-blockers, except for those using atenolol for treating CD.
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Grants
- This study is supported in part by Taiwan Ministry of Health and Welfare Clinical Trial Center (MOHW106-TDU-B-212-113004), China Medical University Hospital, Academia Sinica Taiwan Biobank Stroke Biosignature Project (BM10601010036), Taiwan Clinical Trial Consortium for Stroke (MOST 106-2321-B-039-005), Tseng-Lien Lin Foundation, Taichung, Taiwan, Taiwan Brain Disease Foundation, Taipei, Taiwan, and Katsuzo and Kiyo AoshimaMemorial Funds, Japan. The funders had no role in study design, data coll
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Affiliation(s)
- Jun-Jun Yeh
- Department of Chest Medicine, Family Medicine and Geriatric Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
- Meiho University, Pingtung, Taiwan
- Chia Nan University of Pharmacy and Science, Tainan, Taiwan
- Heng Chun Christian Hospital, Pingtung, Taiwan
| | - Yu-Feng Wei
- Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Wu-Huei Hsu
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan
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Okuda M, Tanaka N, Naito K, Kumada T, Fukuda K, Kato Y, Kido Y, Okuda Y, Nohara R. Evaluation by various methods of the physiological mechanism of a high-flow nasal cannula (HFNC) in healthy volunteers. BMJ Open Respir Res 2017; 4:e000200. [PMID: 29071075 PMCID: PMC5647476 DOI: 10.1136/bmjresp-2017-000200] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/20/2017] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Several reports have described the usefulness of a high-flow nasal cannula (HFNC). However, the physiological mechanisms of this system are unclear. In the current study, various methods were used to investigate the physiological mechanisms of an HFNC in healthy volunteers. METHODS The physiological mechanisms of the constant-flow and constant-pressure models of HFNC were studied in 10 healthy volunteers by the oesophageal balloon method, the electrical impedance method and the forced oscillation technique (FOT). RESULTS The tidal volume (TV) increased markedly during HFNC (off, 30 L/min, 50 L/min: 685.6±236.5 mL, 929.8±434.7 mL, 968.8±451.1 mL). The end-inspiratory oesophageal pressure (EIOP) was not significantly different, but there was a tendency for it to decrease. HFNC 30 L/min and 50 L/min, the increment in TV and the difference in EIOP showed strong negative correlations (p=0.0025, 0.003). The end-expiratory oesophageal pressure (EEOP) increased. The respiratory system reactance at 5 Hz (X5) by FOT decreased significantly. There was a flow rate-dependent EEOP increase, and the positive end-expiratory pressure (PEEP) effect of HFNC was confirmed. There was a correlation between the difference in X5 and the difference in EEOP during HFNC 30 L/min and 50 L/min, with correlation coefficients of 0.534 and 0.404 (p=0.112, 0.281). The amount of change in EEOP and the fluctuation in X5 were positively correlated. CONCLUSIONS The PEEP effect of HFNC was confirmed by the electrical impedance method and FOT. The increment in TV and the difference in EIOP of HFNC showed strong negative correlations.
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Affiliation(s)
- Miyuki Okuda
- Federation of National Public Service Personnel Mutual Aid Association Hirakata Kohsai Hospital, Hirakata, Osaka, Japan
| | - Nobuya Tanaka
- Federation of National Public Service Personnel Mutual Aid Association Hirakata Kohsai Hospital, Hirakata, Osaka, Japan
| | | | | | - Koji Fukuda
- Federation of National Public Service Personnel Mutual Aid Association Hirakata Kohsai Hospital, Hirakata, Osaka, Japan
| | - Yuto Kato
- Federation of National Public Service Personnel Mutual Aid Association Hirakata Kohsai Hospital, Hirakata, Osaka, Japan
| | - Yuto Kido
- Federation of National Public Service Personnel Mutual Aid Association Hirakata Kohsai Hospital, Hirakata, Osaka, Japan
| | | | - Ryuji Nohara
- Federation of National Public Service Personnel Mutual Aid Association Hirakata Kohsai Hospital, Hirakata, Osaka, Japan
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Ding B, Small M. Treatment trends in patients with asthma-COPD overlap syndrome in a COPD cohort: findings from a real-world survey. Int J Chron Obstruct Pulmon Dis 2017; 12:1753-1763. [PMID: 28670116 PMCID: PMC5479265 DOI: 10.2147/copd.s136314] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Asthma and chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) is an increasingly recognized phenotype. Few randomized clinical trials have been conducted in patients with ACOS; therefore, scientific evidence concerning ACOS is scarce and a therapeutic approach remains unclear. The aim of this study was to evaluate current treatment trends for patients with ACOS, identified as those with a dual definition of asthma and COPD, in a real-world COPD cohort. METHODS Data were analyzed from patients with asthma and COPD in the USA, France, Germany, Italy, Spain, and the UK who participated in the 2012 and 2013 Adelphi Respiratory Disease Specific Programmes (DSPs). Patients with ACOS were identified in the COPD population; these patients had a physician-confirmed, concomitant asthma diagnosis. Physicians completed a patient record form providing information on patient and disease characteristics including prescribed respiratory treatment. Pairwise comparisons were made between the ACOS, asthma, and COPD populations using χ2 tests. RESULTS In total, 9,042 patients with asthma-only, 7,119 patients with COPD-only, and 523 patients with ACOS (a dual diagnosis of asthma and COPD) participated in the study. The most commonly prescribed regimens were inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) + long-acting muscarinic antagonist (LAMA); (ACOS 30%, asthma 1.4%, and COPD 32%), ICS/LABA (19%, 41.5%, and 17%, respectively), and LAMA (6%, 0.4%, and 19%, respectively); 18% of patients with ACOS were not prescribed an ICS. Patients with ACOS had a significantly higher incidence of gastroesophageal reflux disease, diabetes, and obesity and experienced more exacerbations in the past year than those with COPD or asthma. CONCLUSIONS The majority of patients with ACOS, as defined in this research, were prescribed similar treatment to those with COPD. There is a need, however, for better treatment for patients with ACOS, as indicated by symptoms and exacerbation levels. A clearer therapeutic approach for patients with ACOS is required.
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Affiliation(s)
- Bo Ding
- AstraZeneca Gothenburg, Mölndal, Sweden
| | - Mark Small
- Adelphi Real World, Bollington, Macclesfield, UK
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Miravitlles M. Diagnosis of asthma-COPD overlap: the five commandments. Eur Respir J 2017; 49:49/5/1700506. [PMID: 28461307 DOI: 10.1183/13993003.00506-2017] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 04/10/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Marc Miravitlles
- Pneumology Dept, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
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Tommola M, Ilmarinen P, Tuomisto LE, Lehtimäki L, Haanpää J, Niemelä O, Kankaanranta H. Differences between asthma-COPD overlap syndrome and adult-onset asthma. Eur Respir J 2017; 49:49/5/1602383. [PMID: 28461298 DOI: 10.1183/13993003.02383-2016] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/25/2017] [Indexed: 12/12/2022]
Abstract
Differences between asthma-COPD overlap syndrome (ACOS) and adult-onset asthma are poorly understood. This study aimed to evaluate these differences in a clinical cohort of patients with adult-onset asthma, as a part of the Seinäjoki Adult Asthma Study (SAAS).188 patients were diagnosed with adult-onset asthma and re-evaluated 12 years after diagnosis. They were divided into three groups based on smoking history and post bronchodilator spirometry values: 1) never- and ex-smokers with <10 smoked pack-years; 2) non-obstructive (forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ≥0.7) patients with ≥10 pack-years; and 3) ACOS patients with ≥10 pack-years and FEV1/FVC <0.7.ACOS patients had lower diffusing capacity (DLCO/VA 86% predicted versus 98 or 96% predicted; p<0.001), higher blood neutrophil levels (4.50 versus 3.60 or 3.85×109 L-1; p=0.008), and higher IL-6 levels (2.88 versus 1.52 or 2.10 pg·mL-1, p<0.001) as compared to never- and ex-smokers with <10 pack-years, or non-obstructive patients with ≥10 pack-years smoking history, respectively. ACOS patients also showed reduced lung function, higher remaining bronchial reversibility and a higher number of comorbidities.This study shows distinct differences in diffusing capacity, blood neutrophil and IL-6 levels, bronchial reversibility, lung function and comorbidities between ACOS and adult-onset asthma. The present findings should be considered in the comprehensive assessment of adult asthma patients.
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Affiliation(s)
- Minna Tommola
- Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Pinja Ilmarinen
- Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Leena E Tuomisto
- Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Jussi Haanpää
- Dept of Clinical Physiology, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Onni Niemelä
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Dept of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Hannu Kankaanranta
- Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
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Araújo D, Padrão E, Morais-Almeida M, Cardoso J, Pavão F, Leite RB, Caldas AC, Marques A. Asthma-chronic obstructive pulmonary disease overlap syndrome - Literature review and contributions towards a Portuguese consensus. REVISTA PORTUGUESA DE PNEUMOLOGIA 2017; 23:90-99. [PMID: 28089081 DOI: 10.1016/j.rppnen.2016.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 11/05/2016] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Phenotypic overlap between the two main chronic airway pulmonary diseases, asthma and chronic obstructive pulmonary disease (COPD), has been the subject of debate for decades, and recently the nomenclature of asthma-COPD overlap syndrome (ACOS) was adopted for this condition. The definition of this entity in the literature is, however, very heterogeneous, it is therefore important to define how it applies to Portugal. METHODS A literature review of ACOS was made in a first phase resulting in the drawing up of a document that was later submitted for discussion among a panel of chronic lung diseases experts, resulting in reflexions about diagnosis, treatment and clinical guidance for ACOS patients. RESULTS There was a consensus among the experts that the diagnosis of ACOS should be considered in the concomitant presence of: clinical manifestations characteristic of both asthma and COPD, persistent airway obstruction (post-bronchodilator FEV1/FVC<0.7), positive response to bronchodilator test (increase in FEV1 of ≥200mL and ≥12% from baseline) and current or past history of smoking or biomass exposure. In reaching diagnosis, the presence of peripheral eosinophilia (>300eosinophils/μL or >5% of leukocytes) and previous history of atopy should also be considered. The recommended first line pharmacological treatment in these patients is the ICS/LABA association; if symptomatic control is not achieved or in case of clinical severity, triple therapy with ICS/LABA/LAMA may be used. An effective control of the exposure to risk factors, vaccination, respiratory rehabilitation and treatment of comorbidities is also important. CONCLUSIONS The creation of initial guidelines on ACOS, which can be applied in the Portuguese context, has an important role in the generation of a broad nationwide consensus. This will give, in the near future, a far better clinical, functional and epidemiological characterization of ACOS patients, with the ultimate goal of achieving better therapeutic guidance.
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Affiliation(s)
- D Araújo
- Institute of Health Sciences, Universidade Católica Portuguesa, Portugal; Pulmonology Department, Centro Hospitalar de São João, Porto, Portugal
| | - E Padrão
- Institute of Health Sciences, Universidade Católica Portuguesa, Portugal; Pulmonology Department, Centro Hospitalar de São João, Porto, Portugal.
| | - M Morais-Almeida
- Coordinator of Allergy Center of CUF Hospitals, Lisbon, Portugal
| | - J Cardoso
- Pulmonology Department, Centro Hospitalar de Lisboa Central, Lisboa, Portugal; Nova Medical School, Lisbon, Portugal
| | - F Pavão
- Institute of Health Sciences, Universidade Católica Portuguesa, Portugal
| | - R B Leite
- Institute of Health Sciences, Universidade Católica Portuguesa, Portugal; Faculty of Health, Medicine and Life Sciences, Maastricht University, Portugal
| | - A C Caldas
- Institute of Health Sciences, Universidade Católica Portuguesa, Portugal
| | - A Marques
- Pulmonology Department, Centro Hospitalar de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Portugal
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Rogliani P, Ora J, Puxeddu E, Cazzola M. Airflow obstruction: is it asthma or is it COPD? Int J Chron Obstruct Pulmon Dis 2016; 11:3007-3013. [PMID: 27942210 PMCID: PMC5137932 DOI: 10.2147/copd.s54927] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Despite the availability of guideline recommendations, diagnostic confusion between COPD and asthma appears common, and often it is very difficult to decide whether the obstruction is caused by asthma or COPD in a patient with airway obstruction. However, there are well-defined features that help in differentiating asthma from COPD in the presence of fixed airflow obstruction. Nonetheless, the presentations of asthma and COPD can converge and mimic each other, making it difficult to give these patients a diagnosis of either condition. The association of asthma and COPD in the same patient has been designated mixed asthma–COPD phenotype or overlap syndrome. However, since the absence of a clear definition and the inclusion of patients with different characteristics under this umbrella term, it may not facilitate treatment decisions, especially in the absence of clinical trials addressing this heterogeneous population. We are realizing that neither asthma nor COPD are single diseases, but rather syndromes consisting of several endotypes and phenotypes, consequently comprising a spectrum of diseases that must be recognized and adequately treated with targeted therapy. Therefore, we must treat patients by personalizing therapy on the basis of those treatable traits present in each subject.
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Affiliation(s)
- Paola Rogliani
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Josuel Ora
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Ermanno Puxeddu
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Mario Cazzola
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
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