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Morimoto C, Matsumoto H, Nomura N, Sunadome H, Nagasaki T, Sato S, Sato A, Oguma T, Ito I, Kogo M, Tomii K, Tajiri T, Ohashi K, Tsukahara T, Hirai T. Sputum microbiota and inflammatory subtypes in asthma, COPD, and its overlap. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100194. [PMID: 38155860 PMCID: PMC10753087 DOI: 10.1016/j.jacig.2023.100194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 12/30/2023]
Abstract
Background Airway microbiota in asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) remains unknown. Objective This study with ACO-enriched population aimed to clarify airway microbiota in ACO and in mixed granulocytic inflammation, often detected in ACO and chronic airway diseases. Methods This is an observational cross-sectional study. Patients with asthma with airflow limitation, ACO, and COPD were enrolled. Blood tests, pulmonary function, exhaled nitric oxide, and sputum tests were conducted. Sputum microbiota was evaluated using the 16S rRNA gene sequencing technique. Results A total of 112 patients (13 asthma, 67 ACO, and 32 COPD) were examined. There were no significant differences in α-diversity among the 3 diseases. The relative abundances of phylum Bacteroidetes, class Bacteroidia, and genus Porphyromonas were associated with decreased eosinophilic inflammation, and were significantly lower in ACO than in COPD. In a comparison of sputum inflammatory subtypes, the proportion of Haemophilus was numerically highest in the mixed granulocytic subtype, followed by the neutrophilic subtype. Likewise, the proportion of Haemophilus was the highest in the intermediate-high (2%-8%) sputum eosinophil group and lowest in the severe (≥8%) eosinophil group. Clinically, Haemophilus proportion was associated with sputum symptoms. Finally, the proportion of Streptococcus was associated with higher blood eosinophil counts and most severe airflow limitation. Conclusions Bacteroidia and Porphyromonas abundances in sputum are associated with the eosinophil-low phenotype, and ACO may be characterized by a decrease in these taxa. A mild elevation in sputum eosinophil does not preclude the presence of Haemophilus, which should be noted in the management of obstructive airway diseases.
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Affiliation(s)
- Chie Morimoto
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hisako Matsumoto
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Respiratory Medicine and Allergology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Natsuko Nomura
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hironobu Sunadome
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tadao Nagasaki
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Susumu Sato
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Atsuyasu Sato
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tsuyoshi Oguma
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Isao Ito
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mariko Kogo
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Keisuke Tomii
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tomoko Tajiri
- Department of Respiratory Medicine, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Kai Ohashi
- Kyoto Institute of Nutrition & Pathology, Inc, Kyoto, Japan
| | | | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Dey S, Lu W, Haug G, Chia C, Larby J, Weber HC, Gaikwad AV, Bhattarai P, Shahzad AM, Pathinayake PS, Wark PAB, Eapen MS, Sohal SS. Airway inflammatory changes in the lungs of patients with asthma-COPD overlap (ACO): a bronchoscopy endobronchial biopsy study. Respir Res 2023; 24:221. [PMID: 37700291 PMCID: PMC10498556 DOI: 10.1186/s12931-023-02527-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 08/31/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Although asthma and chronic obstructive pulmonary disease (COPD) are two distinct chronic airway inflammatory diseases, they often co-exist in a patient and the condition is referred to as asthma-COPD overlap (ACO). Lack of evidence regarding the inflammatory cells in ACO airways has led to their poor prognosis and treatment. The objective of this endobronchial biopsy (EBB) study was to enumerate inflammatory cellular changes in the airway wall of ACO compared with asthma, COPD current smokers (CS) and ex-smokers (ES), normal lung function smokers (NLFS), and non-smoker controls (HC). METHODS EBB tissues from 74 patients were immunohistochemically stained for macrophages, mast cells, eosinophils, neutrophils, CD8+ T-cells and CD4+ T-cells. The microscopic images of stained tissues were evaluated in the epithelium, reticular basement membrane (RBM) cells/mm RBM length, and lamina propria (LP) cells/mm2 up to a depth of 120 µM using the image analysis software Image-Pro Plus 7.0. The observer was blinded to the images and disease diagnosis. Statistical analysis was performed using GraphPad Prism v9. RESULTS The tissue macrophages in ACO were substantially higher in the epithelium and RBM than in HC (P < 0.001 for both), COPD-ES (P < 0.001 for both), and -CS (P < 0.05 and < 0.0001, respectively). The ACO LP macrophages were significantly higher in number than COPD-CS (P < 0.05). The mast cell numbers in ACO were lower than in NLFS (P < 0.05) in the epithelium, lower than COPD (P < 0.05) and NLFS (P < 0.001) in RBM; and lower than HC (P < 0.05) in LP. We noted lower eosinophils in ACO LP than HC (P < 0.05) and the lowest neutrophils in both ACO and asthma. Furthermore, CD8+ T-cell numbers increased in the ACO RBM than HC (P < 0.05), COPD-ES (P < 0.05), and NLFS (P < 0.01); however, they were similar in number in epithelium and LP across groups. CD4+ T-cells remained lower in number across all regions and groups. CONCLUSION These results suggest that the ACO airway tissue inflammatory cellular profile differed from the contributing diseases of asthma and COPD with a predominance of macrophages.
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Affiliation(s)
- Surajit Dey
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Locked Bag, 1322, Newnham Drive, Launceston, TAS, 7248, Australia
| | - Wenying Lu
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Locked Bag, 1322, Newnham Drive, Launceston, TAS, 7248, Australia
- Launceston Respiratory and Sleep Centre, Launceston, TAS, 7250, Australia
| | - Greg Haug
- Department of Respiratory Medicine, Launceston General Hospital, Launceston, TAS, 7250, Australia
| | - Collin Chia
- Launceston Respiratory and Sleep Centre, Launceston, TAS, 7250, Australia
- Department of Respiratory Medicine, Launceston General Hospital, Launceston, TAS, 7250, Australia
| | - Josie Larby
- Department of Respiratory Medicine, Launceston General Hospital, Launceston, TAS, 7250, Australia
| | - Heinrich C Weber
- Department of Respiratory Medicine, Tasmanian Health Services (THS), North-West Hospital, Burnie, TAS, Australia
| | - Archana Vijay Gaikwad
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Locked Bag, 1322, Newnham Drive, Launceston, TAS, 7248, Australia
| | - Prem Bhattarai
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Locked Bag, 1322, Newnham Drive, Launceston, TAS, 7248, Australia
- Launceston Respiratory and Sleep Centre, Launceston, TAS, 7250, Australia
| | - Affan Mahmood Shahzad
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Locked Bag, 1322, Newnham Drive, Launceston, TAS, 7248, Australia
| | - Prabuddha S Pathinayake
- Immune Health Program, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, Australia
| | - Peter A B Wark
- Immune Health Program, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, Australia
| | - Mathew Suji Eapen
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Locked Bag, 1322, Newnham Drive, Launceston, TAS, 7248, Australia
| | - Sukhwinder Singh Sohal
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Locked Bag, 1322, Newnham Drive, Launceston, TAS, 7248, Australia.
- Launceston Respiratory and Sleep Centre, Launceston, TAS, 7250, Australia.
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Sreenivasan PK, Prasad K. Increase in the level of oral neutrophils with gingival inflammation - A population survey. Saudi Dent J 2022; 34:795-801. [PMID: 36570581 PMCID: PMC9767864 DOI: 10.1016/j.sdentj.2022.11.004] [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: 05/07/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives Host responses to oral inflammation include a continuous and substantive response with the influx of polymorphonuclear leukocytes (PMN). PMN, referred to as first responders, migrate rapidly from the circulatory system through the connective tissue to mitigate stimuli and localize in the saliva. This study examined the relationship between the well-established clinical indices of gingivitis and dental plaque and the PMN level. Materials and Methods This study enrolled adults aged 18-75 years, who provided voluntary informed consent. Oral rinse samples were collected from 159 participants to estimate the PMN levels prior to the full-mouth assessment for gingivitis and dental plaque using the respective clinical indices. Results The gingival index and dental plaque index scores were in the range of 0.098-2.71 and 0.73-4.78, respectively. Regardless of the age and gender, higher number of PMN was observed with higher gingival index and dental plaque index scores. Our analyses indicated a significant correlation between the oral PMN level and gingival index with a correlation coefficient of 0.66 (p < 0.0001). Similarly, the correlation between the PMN level and dental plaque index was statistically significant with a correlation coefficient of 0.57 (p < 0.0001). Regression analysis identified a significant relationship between the PMN level and clinical indices (p < 0.0005). Conclusions Increase in the PMN levels with increasing clinical scores (gingival and dental plaque indices) reflect the oral inflammatory burden, irrespective of age or gender. These observations warrant future studies on participants stratified by health status and research directed toward examining the effects of interventions.
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Affiliation(s)
- Prem K. Sreenivasan
- HITLAB, 3960 Broadway, New York, NY 10032, USA,Department of Oral Biology, Rutgers School of Dental Medicine, Newark, NJ 07103, USA,Corresponding author at: HITLAB, 3960 Broadway, New York, NY 10032, USA.
| | - K.V.V.Kakarla Prasad
- Department of Public Health Dentistry, SDM College of Dental Sciences and Hospital, Affiliated to SDM University, Dharwad 580009, India
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Peng J, Wang M, Wu Y, Shen Y, Chen L. Clinical Indicators for Asthma-COPD Overlap: A Systematic Review and Meta-Analysis. Int J Chron Obstruct Pulmon Dis 2022; 17:2567-2575. [PMID: 36259043 PMCID: PMC9572492 DOI: 10.2147/copd.s374079] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/24/2022] [Indexed: 11/05/2022] Open
Abstract
Background Some clinical indicators have been reported to be useful in differentiating asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) from pure asthma/COPD, but the results were inconsistent. This study aims to evaluate the diagnostic value of these indicators for ACO. Methods Databases of PubMed, EMBASE, Ovid and Web of Science were retrieved. Pooled standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated in random-effects models. Results 48 eligible studies were included. The pooled results indicated, compared with pure asthma, ACO patients had lower levels of forced expiratory volume in the first second (FEV1)% predicted (pred) (SMD=−1.09, 95% CI −1.3 to −0.87), diffusion lung capacity for carbon monoxide (DLCO)% pred (SMD=−0.83, 95% CI −1.24 to −0.42), fractional exhaled nitric oxide (FeNO) (SMD=−0.23, 95% CI −0.36 to −0.11), and higher levels of induced sputum neutrophil (SMD = 0.51, 95% CI 0.21 to 0.81), circulating YKL-40 (SMD = 0.96, 95% CI 0.27 to 1.64). However, relative to COPD alone, ACO patients had higher levels of FEV1% pred (SMD = 0.15, 95% CI 0.05 to 0.26), DLCO% pred (SMD = 0.38, 95% CI 0.16 to 0.6), FeNO (SMD = 0.59, 95% CI 0.40 to 0.78), serum total immunoglobulin (Ig)E (SMD = 0.42, 95% CI 0.1 to 0.75), blood eosinophil (SMD = 0.44, 95% CI 0.29 to 0.59), induced sputum eosinophil (SMD = 0.62, 95% CI 0.42 to 0.83), and lower levels of induced sputum neutrophil (SMD=−0.48, 95% CI −0.7 to −0.27), circulating YKL-40 (SMD=−1.09, 95% CI −1.92 to −0.26). Conclusion Compared with pure asthma/COPD, ACO patients have different levels of FEV1% pred, DLCO% pred, FeNO, serum total IgE, blood eosinophil, induced sputum eosinophil/neutrophil, and circulating YKL-40, which could be helpful to establish a clinical diagnosis of ACO.
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Affiliation(s)
- Junjie Peng
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People’s Republic of China
| | - Min Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People’s Republic of China
| | - Yanqiu Wu
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People’s Republic of China
| | - Yongchun Shen
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People’s Republic of China
| | - Lei Chen
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People’s Republic of China,Correspondence: Lei Chen; Yongchun Shen, Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People’s Republic of China, Email ;
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6
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Shabaan AY, Daabis RG, Abdelhady AM, Ibrahim DH. Prevalence of asthma—chronic obstructive pulmonary disease overlap in patients with airflow limitation. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2021. [DOI: 10.1186/s43168-021-00055-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Asthma-COPD overlap (ACO) according to GINA and GOLD is not a single disease and is described by persistent airflow limitation with several features usually associated with asthma and several features usually associated with COPD. Some different protocols were proposed to diagnose ACO, besides those reported in GINA and GOLD guidelines. Despite the discrepancy between all the proposed diagnostic protocols, the diagnosis of ACO is still worthy as it may lead to a more appropriate treatment plan. In Egypt, prevalence of ACO is hardly estimated due to lack of database of patients. Our aim of work was to detect the prevalence of ACO in patients diagnosed as having a chronic airflow limiting disease.
Results
In asthma group (75 patients), 53.3% (40 patients) were diagnosed as ACO with 3 statistically significant favoring diagnostic criteria; post-BDR test FEV1/FVC < 70%, longer disease duration, and sputum neutrophilia ≥ 57%. While in COPD group (75 patients), 42.7% (32 patients) were diagnosed as ACO with four statistically significant favoring diagnostic criteria; higher BDR, presence of personal history of either asthma or atopy and sputum eosinophils > 1%.
Conclusions
ACO has an underestimated prevalence among those diagnosed with either asthma or COPD. More consensus guidelines are needed to focus on the more effective and the more practical criteria to diagnose such hidden disease.
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7
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Dey S, Eapen MS, Chia C, Gaikwad AV, Wark PAB, Sohal SS. Pathogenesis, clinical features of asthma COPD overlap (ACO), and therapeutic modalities. Am J Physiol Lung Cell Mol Physiol 2021; 322:L64-L83. [PMID: 34668439 DOI: 10.1152/ajplung.00121.2021] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Both asthma and COPD are heterogeneous diseases identified by characteristic symptoms and functional abnormalities, with airway obstruction common in both diseases. Asthma COPD overlap (ACO) does not define a single disease but is a descriptive term for clinical use that includes several overlapping clinical phenotypes of chronic airways disease with different underlying mechanisms. This literature review was initiated to describe published studies, identify gaps in knowledge, and propose future research goals regarding the disease pathology of ACO, especially the airway remodelling changes and inflammation aspects. Airway remodelling occurs in asthma and COPD, but there are differences in the structures affected and the prime anatomic site at which they occur. Reticular basement membrane thickening and cellular infiltration with eosinophils and T-helper (CD4+) lymphocytes are prominent features of asthma. Epithelial squamous metaplasia, airway wall fibrosis, emphysema, bronchoalveolar lavage (BAL) neutrophilia and (CD8+) T-cytotoxic lymphocyte infiltrations in the airway wall are features of COPD. There is no universally accepted definition of ACO, nor are there clearly defined pathological characteristics to differentiate from asthma and COPD. Understanding etiological concepts within the purview of inflammation and airway remodelling changes in ACO would allow better management of these patients.
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Affiliation(s)
- Surajit Dey
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Mathew Suji Eapen
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Collin Chia
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia.,Department of Respiratory Medicine, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Archana Vijay Gaikwad
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Peter A B Wark
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, Australia.,Department of Respiratory and Sleep Medicine John Hunter Hospital, New Lambton Heights, Australia
| | - Sukhwinder Singh Sohal
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
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Odimba U, Senthilselvan A, Farrell J, Gao Z. Current Knowledge of Asthma-COPD Overlap (ACO) Genetic Risk Factors, Characteristics, and Prognosis. COPD 2021; 18:585-595. [PMID: 34555990 DOI: 10.1080/15412555.2021.1980870] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Asthma-COPD overlap (ACO) is a newly identified phenotype of chronic obstructive airway diseases with shared asthma and COPD features. Patients with ACO are poorly defined, and some evidence suggests that they have worse health outcomes and greater disease burden than patients with COPD or asthma. Generally, there is no evidence-based and universal definition for ACO; several consensus documents have provided various descriptions of the phenotype. In addition, the mechanisms underlying the development of ACO are not fully understood. Whether ACO is a distinct clinical entity with its particular discrete genetic determinant different from asthma and COPD alone or an intermediate phenotype with overlapping genetic markers within asthma and COPD spectrum of obstructive airway disease remains unproven. This review summarizes the current knowledge of the genetic risk factors, characteristics, and prognosis of ACO.
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Affiliation(s)
- Ugochukwu Odimba
- Clinical Epidemiology Unit, Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | | | - Jamie Farrell
- Clinical Epidemiology Unit, Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.,Faculty of Medicine, Health Sciences Centre (Respirology Department), Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Zhiwei Gao
- Clinical Epidemiology Unit, Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
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Calverley PMA, Walker PP. ACO (Asthma-COPD Overlap) Is Independent from COPD: The Case in Favour. Diagnostics (Basel) 2021; 11:1189. [PMID: 34208874 PMCID: PMC8304638 DOI: 10.3390/diagnostics11071189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 11/24/2022] Open
Abstract
Over the last decade interest has been shown in people with symptomatic lung disease who have features both of COPD and asthma. In this review we examine how COPD and asthma are defined and examine clinical characteristics of people defined by researchers as having asthma-COPD overlap (ACO). We look at pathological and physiological features along with symptoms and consider the impact of each diagnosis upon therapeutic management. We highlight challenges in the diagnosis and management of airway disease and the various phenotypes that could be part of ACO, in so doing suggesting ways for the clinician to manage patients with features of both asthma and COPD.
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Affiliation(s)
| | - Paul Phillip Walker
- Liverpool University Hospitals Foundation NHS, University of Liverpool, Liverpool L9 7AL, UK
- Department of Respiratory Medicine, Aintree Hospital, Lower Lane, Liverpool L9 7AL, UK
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Tejwani V, Moughames E, Suresh K, Tang SE, Mair LG, Romero K, Putcha N, Alexis NE, Woo H, D’Alessio FR, Hansel NN. Black Carbon Content in Airway Macrophages is Associated with Reduced CD80 Expression and Increased Exacerbations in Former Smokers With COPD. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2021; 8:91-99. [PMID: 33156984 PMCID: PMC8047619 DOI: 10.15326/jcopdf.2020.0170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/18/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is characterized by recurrent exacerbations. Macrophages play a critical role in immune response and tissue repair in COPD. Airway macrophages (AM) are exposed to environmental exposures which are retained in the cytoplasmic material. Both biomass and particulate matter have been linked to higher AM black carbon. It is unknown if AM black carbon is associated with COPD morbidity and macrophage phenotype. METHODS Former smokers with COPD were enrolled and sputum induction was performed to obtain airway macrophages. Macrophages underwent black carbon quantification and flow cytometry phenotyping. Health information was obtained the same day as sputum induction and prospective exacerbations were assessed by monthly telephone calls. RESULTS We studied 30 former smokers with COPD who had a mean age of 67 years and mean forced expiratory volume in 1 second (FEV1)% predicted of 60.8%. Higher AM black carbon content was associated with increased total exacerbations and severe exacerbations and reduced CD80 expression. CONCLUSION AM black carbon association with respiratory morbidity is largely unexplored and this is the first study to identify association with prospective exacerbations. Macrophages expressed reduced CD80, a surface marker providing costimulatory signals required for development of antigen-specific immune responses. Our findings suggest that reduced CD80 expression is the pathophysiologic mechanism for the association of AM black carbon content and increased exacerbations. Therefore, beyond solely serving as a marker for increased exposures, AM black carbon content may be a predictor of future exacerbations given a macrophage less equipped to respond to an acute infectious exposure.
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Affiliation(s)
- Vickram Tejwani
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Eric Moughames
- Johns Hopkins Bayview Medical Center, Baltimore, Maryland, United States
| | - Karthik Suresh
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Shih-En Tang
- Division of Pulmonary and Critical Care Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - Laura G. Mair
- Johns Hopkins Bayview Medical Center, Baltimore, Maryland, United States
| | - Karina Romero
- Johns Hopkins Bayview Medical Center, Baltimore, Maryland, United States
| | - Nirupama Putcha
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Neil E. Alexis
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Han Woo
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Franco R. D’Alessio
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
- **These authors share senior authorship
| | - Nadia N. Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
- **These authors share senior authorship
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Lee H, Kim S, Kim B, Lee Y, Lee HY, Ban G, Kim M, Kim J, Kwon J, Park S, Jung J, Park SY, Park CS, Rhee CK, Lee T, Lee J, Kim SR, Park J, Park H, Yoo KH, Oh Y, Koh Y, Lee B, Jang A, Cho S, Park H, Park C, Cho YS, Yoon HJ. Characteristics of Specialist-Diagnosed Asthma-COPD Overlap in Severe Asthma: Observations from the Korean Severe Asthma Registry (KoSAR). Allergy 2021; 76:223-232. [PMID: 33411398 DOI: 10.1111/all.14483] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/30/2020] [Accepted: 05/18/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND While the clinical characteristics and outcomes of asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) have been frequently compared with those of COPD or asthma, the prevalence and features of ACO in patients with severe asthma are unclear. OBJECTIVES Evaluation of the prevalence and clinical features of ACO using the Korean severe asthma registry. METHODS At the time of registration, ACO was determined in patients with severe asthma by attending specialists. Patients were classified into ACO and non-ACO groups, and the demographic and clinical characteristics of these two groups were compared. RESULTS Of 482 patients with severe asthma, 23.7% had ACO. Patients in the ACO group were more likely to be male (P < .001), older (P < .001), and ex- or current smokers (P < .001) compared with those in the non-ACO group. Patients in the ACO group had lower mean forced expiratory volume in 1 second (P < .001) and blood eosinophil percentage (P = .006), but higher blood neutrophil percentage (P = .027) than those in the non-ACO group. The ACO group used more inhaled long-acting muscarinic antagonist (P < .001), methylxanthine (P = .001), or sustained systemic corticosteroid (P = .002). In addition, unscheduled emergency department visits due to exacerbation were more frequent in the ACO group (P = .006). CONCLUSION Among patients with severe asthma, those with ACO were older, predominantly male, and were more likely to have a smoking history than those with asthma only. Patients with ACO used more systemic corticosteroid and had more frequent exacerbations related to emergency department visits than those with severe asthma only.
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Affiliation(s)
- Hyun Lee
- Department of Internal Medicine Hanyang University College of Medicine Seoul Korea
| | - Sang‐Heon Kim
- Department of Internal Medicine Hanyang University College of Medicine Seoul Korea
| | - Byung‐Keun Kim
- Department of Internal Medicine Korea University Medical Center Anam Hospital Seoul Korea
| | - Youngsoo Lee
- Department of Allergy and Clinical Immunology Ajou University School of Medicine Suwon Korea
| | - Hwa Young Lee
- Division of Pulmonary, Allergy and Critical Care Medicine Department of Internal Medicine Seoul St Mary’s HospitalCollege of MedicineThe Catholic University of Korea Seoul Korea
| | - Ga‐Young Ban
- Department of Pulmonary, Allergy and Critical Care Medicine Kangdong Sacred Heart HospitalHallym University College of Medicine Seoul Korea
| | - Min‐Hye Kim
- Department of Internal Medicine College of Medicine, Ewha Womans University Seoul Korea
| | - Joo‐Hee Kim
- Department of Internal Medicine Hallym University College of Medicine Anyang Korea
| | - Jae‐Woo Kwon
- Department of Internal Medicine Kangwon National University School of Medicine Chuncheon Korea
| | - So‐Young Park
- Division of Pulmonary, Allergy and Critical Care Medicine Department of Internal Medicine Konkuk University School of Medicine Seoul Korea
| | - Jae‐Woo Jung
- Department of Internal Medicine Chung‐Ang University College of Medicine Seoul Korea
| | - So Young Park
- Department of Internal Medicine Eulji University School of Medicine Seoul Korea
| | - Chan Sun Park
- Department of Internal Medicine Inje UniversityHaeundae Paik Hospital Busan Korea
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine Department of Internal Medicine Seoul St Mary’s HospitalCollege of MedicineThe Catholic University of Korea Seoul Korea
| | - Taehoon Lee
- Department of Internal Medicine Ulsan University HospitalUniversity of Ulsan College of Medicine Ulsan Korea
| | - Jae‐Hyun Lee
- Department of Internal Medicine Yonsei University College of Medicine Seoul Korea
| | - So Ri Kim
- Division of Respiratory Medicine and Allergy Department of Internal Medicine Chonbuk National University Medical School Jeonju Korea
| | - Jong‐Sook Park
- Department of Internal Medicine Soonchunhyang University College of Medicine Bucheon Korea
| | - Heung‐Woo Park
- Department of Internal Medicine Seoul National University College of Medicine Seoul Korea
| | - Kwang Ha Yoo
- Division of Pulmonary, Allergy and Critical Care Medicine Department of Internal Medicine Konkuk University School of Medicine Seoul Korea
| | - Yeon‐Mok Oh
- Department of Internal Medicine University of Ulsan College of Medicine Seoul Korea
| | - Young‐Il Koh
- Department of Internal Medicine Chonnam National University Medical School Gwangju Korea
| | - Byung‐Jae Lee
- Department of Medicine Sungkyunkwan University School of Medicine Seoul Korea
| | - An‐Soo Jang
- Department of Internal Medicine Soonchunhyang University College of Medicine Bucheon Korea
| | - Sang‐Heon Cho
- Department of Internal Medicine Seoul National University College of Medicine Seoul Korea
| | - Hae‐Sim Park
- Department of Allergy and Clinical Immunology Ajou University School of Medicine Suwon Korea
| | - Choon‐Sik Park
- Department of Internal Medicine Soonchunhyang University College of Medicine Bucheon Korea
| | - You Sook Cho
- Department of Internal Medicine University of Ulsan College of Medicine Seoul Korea
| | - Ho Joo Yoon
- Department of Internal Medicine Hanyang University College of Medicine Seoul Korea
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12
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Zhu T, Li S, Wang J, Liu C, Gao L, Zeng Y, Mao R, Cui B, Ji H, Chen Z. Induced sputum metabolomic profiles and oxidative stress are associated with chronic obstructive pulmonary disease (COPD) severity: potential use for predictive, preventive, and personalized medicine. EPMA J 2020; 11:645-659. [PMID: 33235638 PMCID: PMC7680486 DOI: 10.1007/s13167-020-00227-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 10/19/2020] [Indexed: 02/07/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a highly heterogeneous disease, and metabolomics plays a hub role in predictive, preventive, and personalized medicine (PPPM) related to COPD. This study thus aimed to reveal the role of induced sputum metabolomics in predicting COPD severity. In this pilot study, a total of 20 COPD patients were included. The induced sputum metabolites were assayed using a liquid chromatography-mass spectrometry (LC-MS/MS) system. Five oxidative stress products (myeloperoxidase (MPO), superoxide dismutase (SOD), glutathione (GSH), neutrophil elastase (NE), and 8-iso-PGF2α) in induced sputum were measured by ELISA, and the metabolomic profiles were distinguished by principal component analysis (PCA) and orthogonal projections to latent structures discriminant analysis (OPLS-DA). The Kyoto Encyclopedia of Genes and Genomes (KEGG) was used for pathway enrichment analysis, and a significant difference in induced sputum metabolomics was observed between moderate and severe COPD. The KEGG analysis revealed that the glycerophospholipid metabolism pathway was downregulated in severe COPD. Due to the critical role of glycerophospholipid metabolism in oxidative stress, significant negative correlations were discovered between glycerophospholipid metabolites and three oxidative stress products (SOD, MPO, and 8-iso-PGF2α). The diagnostic values of SOD, MPO, and 8-iso-PGF2α in induced sputum were found to exhibit high sensitivities and specificities in the prediction of COPD severity. Collectively, this study provides the first identification of the association between induced sputum metabolomic profiles and COPD severity, indicating the potential value of metabolomics in PPPM for COPD management. The study also reveals the correlation between glycerophospholipid metabolites and oxidative stress products and their value for predicting COPD severity. Supplementary Information The online version contains supplementary material available at 10.1007/s13167-020-00227-w.
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Affiliation(s)
- Tao Zhu
- Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010 China
| | - Shanqun Li
- Department of Respiratory and Critical Care Medicine, Zhongshan Hospital of Fudan University, Shanghai, 20032 China
| | - Jiajia Wang
- Rheumatology Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010 China
| | - Chunfang Liu
- Department of Respiratory and Critical Care Medicine, Zhongshan Hospital of Fudan University, Shanghai, 20032 China
| | - Lei Gao
- Department of Respiratory and Critical Care Medicine, Zhongshan Hospital of Fudan University, Shanghai, 20032 China
| | - Yuzhen Zeng
- Department of Respiratory and Critical Care Medicine, Zhongshan Hospital of Fudan University, Shanghai, 20032 China
| | - Ruolin Mao
- Department of Respiratory and Critical Care Medicine, Zhongshan Hospital of Fudan University, Shanghai, 20032 China
| | - Bo Cui
- Department of Respiratory and Critical Care Medicine, Zhongshan Hospital of Fudan University, Shanghai, 20032 China
| | - Hong Ji
- California National Primate Research Center, and Department of Anatomy, Physiology & Cell Biology, School of Veterinary Medicine, University of California, Davis, CA 95616 USA
| | - Zhihong Chen
- Department of Respiratory and Critical Care Medicine, Zhongshan Hospital of Fudan University, Shanghai, 20032 China
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13
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Sharma S, Khurana S, Federman AD, Wisnivesky J, Holguin F. Asthma-Chronic Obstructive Pulmonary Disease Overlap. Immunol Allergy Clin North Am 2020; 40:565-573. [PMID: 33012320 DOI: 10.1016/j.iac.2020.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) defines a subgroup of patients with asthma who have persistent airflow obstruction or patients with COPD who may exhibit variable airflow limitation and/or evidence of type 2 inflammation. Additional investigations are needed to determine whether ACO represents a distinct disorder with unique underlying pathophysiology, whether ACO patients should be managed differently from those with asthma or COPD, and whether the diagnosis affects long-term outcomes. This article presents the data about the clinical features of ACO, the current information regarding the underlying pathophysiology of the syndrome, and current understanding of therapeutic options.
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Affiliation(s)
- Sunita Sharma
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, 12700 East 19th Avenue, MS C272, Aurora, CO 80045-2563, USA.
| | - Sandhya Khurana
- Division of Pulmonary and Critical Care Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mt. Sinai, 1 Gustave L. Levy Place, Box 1232, New York, NY 10029, USA
| | - Juan Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mt. Sinai, 1 Gustave L. Levy Place, Box 1232, New York, NY 10029, USA
| | - Fernando Holguin
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, 12700 East 19th Avenue, MS C272, Aurora, CO 80045-2563, USA
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14
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Mycroft K, Krenke R, Górska K. Eosinophils in COPD-Current Concepts and Clinical Implications. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:2565-2574. [PMID: 32251737 DOI: 10.1016/j.jaip.2020.03.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/03/2020] [Accepted: 03/08/2020] [Indexed: 01/20/2023]
Abstract
In recent years, heterogeneity in chronic obstructive pulmonary disease (COPD) inflammatory patterns has been recognized as a basis for more precise treatment interventions because current therapies have limited effectiveness. Eosinophilic airway inflammation in COPD has become a subject of research interest as a potential treatment target for inhaled corticosteroid therapy. However, the role of eosinophils in COPD is still unclear, and it is unknown why only some patients with COPD develop eosinophilic airway inflammation. Induced sputum analysis is the most common method of assessing the type of airway inflammation. Accessibility to sputum induction, however, is limited in clinical practice, and blood eosinophils have been proposed to serve as a surrogate marker and treatment guide. Blood eosinophil count has been shown to poorly predict sputum eosinophilia, and, moreover, it seems to be fairly unstable and affected by various factors. Nevertheless, in several trials, blood eosinophil count appeared to predict good response to inhaled corticosteroids However, biologics targeting eosinophils do not appear to be effective in COPD. In this review, we briefly summarize the current knowledge on eosinophils in COPD pathogenesis. Then, we discuss the use of blood eosinophil count in COPD in relation to the recent Global Initiative for Chronic Obstructive Pulmonary Disease recommendations, their ability to predict sputum eosinophilia, and their potential role in guiding treatment.
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Affiliation(s)
- Katarzyna Mycroft
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Rafal Krenke
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Górska
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland.
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15
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Biomarkers for chronic obstructive pulmonary disease diagnosis and progression: insights, disappointments and promise. Curr Opin Pulm Med 2020; 25:144-149. [PMID: 30520743 DOI: 10.1097/mcp.0000000000000549] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW This article reviews the status of biomarkers useful in the diagnosis and progression of chronic obstructive pulmonary disease (COPD). Biomarkers have been the focus of a great deal of COPD-related research in recent years, although useful markers in these specific arenas remain elusive. RECENT FINDINGS No biomarker other than lung function has been shown to be useful, to date, for the diagnosis of COPD. The best blood-based biomarkers for the progression of COPD may involve combinations of individual markers, such as CC16, fibrinogen and sRAGE. New imaging metrics, such as central airway collapse, pulmonary vascular changes and central airway branch variation, may be able to provide valuable prognostic and information, although these remain confined to research applications. SUMMARY Blood-based biomarkers for diagnosing and determining the progression of COPD remain disappointingly elusive. Although there have been some advances in nonblood-based markers, such as those from imaging, exhaled breath or physiologic assessment, these remain limited, for the most part, to research applications. Moving toward better markers that could be used in clinical application in the screening and diagnosis of COPD that could also provide prognostic information remains an important goal of research.
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Abstract
PURPOSE OF REVIEW Asthma and chronic obstructive pulmonary disease (COPD) are common diseases that often overlap. The term asthma-COPD overlap (ACO) has been used to define this entity but there remain several speculations on its exact definition, impact, pathophysiology, clinical features, and management. We reviewed recent publications on ACO to obtain more insight of current knowledge and outline future needs. RECENT FINDINGS Criteria for ACO vary from one publication to another and the many variable features of these patients underline the need to reconsider the evaluation and approach of patients with overlapping features based on clinical traits and underlying biological mechanisms. Epidemiological studies reveal that ACO patients have generally an increased burden of illness and healthcare use in addition to poorer quality of life (QoL) compared with asthma and higher or equal to COPD. However, their long-term outcome seems better than patients with COPD alone. Various methods have been proposed to evaluate these patients but their usefulness compared to 'classical' investigation of obstructive lung diseases remains speculative and needs further evaluation. Furthermore, there are no formal studies that examined and compared the different treatment strategies of well-characterized patients with ACO as such patients are usually excluded from clinical trials. SUMMARY ACO is a common condition with variable features and a high burden of disease. There is no consensus on its definition, diagnostic, and clinical features and more research should be done on its optimal management and long-term outcomes.
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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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Yang H, Zhang Y, Zhang J, Pan J, Wang F, Luo X, Chen F. [Correlation between expressions of myeloperoxidase and eosinophil cationic protein in sputum and clinical features of asthma-chronic obstructive pulmonary disease overlap]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2019; 38:1215-1221. [PMID: 30377121 DOI: 10.3969/j.issn.1673-4254.2018.10.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To observe the role of myeloperoxidase(MPO)and eosinophilic cationic protein(ECP)in the airway inflammation and their correlation with clinical feature in asthma-COPD overlap (ACO) patients. METHODS Twenty patients with COPD, 20 with asthma, 20 with ACO and 20 control subjects underwent pulmonary function test for measurement of forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), and maximum midexpiratory flow (MMF25/75). COPD assessment test (CAT) was used to evaluate the clinical symptoms of the patients with COPD and ACO. The asthma control test (ACT) was used to evaluate the asthma control in the patients with asthma and ACO. Induced sputum samples were collected from the subjects for analysis of neutrophil and eosinophil ratios, and enzyme-linked immunosorbent assay was used to determine the expression levels of MPO and ECP in the sputum. RESULTS No significant difference was observed in the CAT scores between ACO group and COPD group (P> 0.05). Compared with the asthma group, the patients with ACO had significantly lower ACT scores and lower FEV1, PEF and MMF25/75 (P < 0.05). The patients with ACO had significantly higher FVC and sputum eosinophil ratio than those with COPD (P < 0.05), and a higher sputum neutrophil ratio than those with asthma (P < 0.01). In ACO group, the MPO level in sputum was significantly higher than that in the asthma group (P < 0.05), while sputum ECP level was significantly higher than that in both the asthma group and COPD group (P < 0.05 or 0.01). In ACO group, sputum MPO level was positively correlated with sputum neutrophil ratio (r=0.8358, P < 0.01) but was not correlated with CAT score or FEV1 (P> 0.05); sputum ECP level was positively correlated with sputum eosinophil ratio (r=0.4666, P < 0.05) and was inversely correlated with ACT score (r=-0.4966, P < 0.05) and FEV1 (r=-0.4610, P < 0.05). CONCLUSIONS Both neutrophilic and eosinophilic inflammations occur in the airway of patients with ACO, and their sputum ECP level is negatively correlated with asthma control and obstructive airflow limitation.
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Affiliation(s)
- Hongkuan Yang
- First Clinical Medical College First Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 310000, China
| | - Yan Zhang
- Department of Rheumatology First Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 310000, China
| | - Jiaying Zhang
- First Clinical Medical College First Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 310000, China
| | - Junjie Pan
- First Clinical Medical College First Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 310000, China
| | - Fang Wang
- First Clinical Medical College First Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 310000, China
| | - Xuping Luo
- First Clinical Medical College First Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 310000, China
| | - Fang Chen
- Pulmonary Function Test Room, First Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 310000, China
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19
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Singh A, Liu C, Putman B, Zeig-Owens R, Hall CB, Schwartz T, Webber MP, Cohen HW, Berger KI, Nolan A, Prezant DJ, Weiden MD. Predictors of Asthma/COPD Overlap in FDNY Firefighters With World Trade Center Dust Exposure: A Longitudinal Study. Chest 2018; 154:1301-1310. [PMID: 30028968 DOI: 10.1016/j.chest.2018.07.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/31/2018] [Accepted: 07/02/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Previously healthy firefighters with World Trade Center (WTC) dust exposure developed airway disease. Risk factors for irritant-associated asthma/COPD overlap are poorly defined. METHODS This study included 2,137 WTC-exposed firefighters who underwent a clinically indicated bronchodilator pulmonary function test (BD-PFT) between 9/11/2001 and 9/10/2017. A post-BD FEV1 increase of > 12% and 200 mL from baseline defined asthma, and a post-BD FEV1/FVC ratio < 0.7 identified COPD cases. Participants who met both criteria had asthma/COPD overlap. Eosinophil levels were measured on screening blood tests performed shortly after 9/11/2001 and prior to BD-PFT; a subgroup of participants also had serum IgE and 21 cytokines measured (n = 215). Marginal Cox regression models for multiple events assessed the associations of eosinophil levels or serum biomarkers with subsequent diagnosis, with age, race, smoking, WTC exposure, first post-9/11 FEV1/FVC ratio, and BMI included as covariates. RESULTS BD-PFT diagnosed asthma/COPD overlap in 99 subjects (4.6%), isolated-asthma in 202 (9.5%), and isolated-COPD in 215 (10.1%). Eosinophil concentration ≥ 300 cells/μL was associated with increased risk of asthma/COPD overlap (hazard ratio [HR], 1.85; 95% CI, 1.16-2.95) but not with isolated-asthma or isolated-COPD. Serum IL-4 also predicted asthma/COPD overlap (HR, 1.51 per doubling of cytokine concentration; 95% CI, 1.17-1.95). Greater IL-21 concentration was associated with both isolated-asthma and isolated-COPD (HRs of 1.73 [95% CI, 1.27-2.35] and 2.06 [95% CI, 1.31-3.23], respectively). CONCLUSIONS In WTC-exposed firefighters, elevated blood eosinophil and IL-4 levels are associated with subsequent asthma/COPD overlap. Disease-specific T-helper cell type 2 biomarkers present years before diagnosis suggest patient-intrinsic predisposition to irritant-associated asthma/COPD overlap.
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Affiliation(s)
- Ankura Singh
- Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY; Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Charles Liu
- Pulmonary, Critical Care and Sleep Medicine Division, Department of Medicine and Department of Environmental Medicine, New York University School of Medicine, New York, NY
| | - Barbara Putman
- Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY; Pulmonary, Critical Care and Sleep Medicine Division, Department of Medicine and Department of Environmental Medicine, New York University School of Medicine, New York, NY
| | - Rachel Zeig-Owens
- Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY; Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Division of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Charles B Hall
- Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Theresa Schwartz
- Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY; Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Mayris P Webber
- Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY; Division of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Hillel W Cohen
- Division of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Kenneth I Berger
- Pulmonary, Critical Care and Sleep Medicine Division, Department of Medicine and Department of Environmental Medicine, New York University School of Medicine, New York, NY
| | - Anna Nolan
- Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY; Pulmonary, Critical Care and Sleep Medicine Division, Department of Medicine and Department of Environmental Medicine, New York University School of Medicine, New York, NY
| | - David J Prezant
- Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY; Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Michael D Weiden
- Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY; Pulmonary, Critical Care and Sleep Medicine Division, Department of Medicine and Department of Environmental Medicine, New York University School of Medicine, New York, NY.
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