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Sebastião BF, Hortelão RM, Granadas SS, Faria JM, Pinto JR, Henriques HR. Air quality self-management in asthmatic patients with COPD: An integrative review for developing nursing interventions to prevent exacerbations. Int J Nurs Sci 2024; 11:46-56. [PMID: 38352284 PMCID: PMC10859576 DOI: 10.1016/j.ijnss.2023.12.003] [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: 08/24/2023] [Revised: 11/16/2023] [Accepted: 12/07/2023] [Indexed: 02/16/2024] Open
Abstract
Objectives Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) patients experience a lower quality of life, frequent exacerbations, and worse pulmonary function. Environmental management is essential in a complex chronic condition, as pollutant exposure can worsen symptoms and increase morbidity and mortality. We aimed to identify evidence that informs nursing interventions in promoting self-management of air quality in asthmatic people with COPD. Methods We conducted an integrative review in March of 2023. We searched the databases CINAHL, MEDLINE, Academic Search Complete, Cochrane Database of Systematic Reviews (CDSR), Scopus, Web of Science, Joanna Briggs Institute (JBI) Evidence-Based Practice Database, and Google Scholar. We included articles whose participants were adults with asthma, COPD, or both; the intervention was air quality management and the outcome of any exacerbations. We excluded editorials, letters, commentaries, opinion papers, position papers, study protocols, conference abstracts, and reviews. Data extraction and synthesis were performed, categorizing interventions according to nursing actions. Methodological quality assessment was conducted using the JBI Critical Appraisal Checklist tools. The review protocol was registered at Open Science Framework (https://doi.org/10.17605/OSF.IO/5Y4KW). Results We included five articles from different countries. The interventions promoting air quality self-management for individuals with asthma and COPD included vigilance interventions (health professional regular visits, assessment of symptoms), monitoring interventions (measurement of indoor and outdoor trigger factors), and educational interventions (air quality alerts, allergen avoidance). Policy interventions such as smoke-free policies and comprehensive strategies to improve air quality were also identified. These areas of focus represent critical components of nurses' interventions and can integrate the fundamental patterns of knowing in nursing. Although the studies reveal heterogeneous interventions and the methodological quality is variable, these interventions showed potential for preventing exacerbations, reducing emergency department visits, and minimizing hospitalizations. Conclusions The study emphasizes the need for a comprehensive approach involving nurses in multidisciplinary teams to air quality self-management. They can use these results to inform their interventions and ways of knowing, benefiting individuals with asthma and COPD. Further research is needed to expand the evidence base and refine these interventions.
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Affiliation(s)
- Bruna F. Sebastião
- Nursing School of Lisbon, Lisbon, Portugal
- Hospital Center of Central Lisbon, Portugal
| | - Raquel M. Hortelão
- Nursing School of Lisbon, Lisbon, Portugal
- CUF Tejo Hospital, Lisbon, Portugal
| | - Sara S. Granadas
- Nursing School of Lisbon, Lisbon, Portugal
- University Hospital Center of Northern Lisbon, Lisbon, Portugal
| | - José M. Faria
- Nursing School of Lisbon, Lisbon, Portugal
- Hospital Center of Central Lisbon, Portugal
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Lisbon, Portugal
| | - Joana R. Pinto
- Nursing School of Lisbon, Lisbon, Portugal
- Hospital Center of Central Lisbon, Portugal
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Lisbon, Portugal
| | - Helga Rafael Henriques
- Nursing School of Lisbon, Lisbon, Portugal
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Lisbon, Portugal
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Camargo LDN, Righetti RF, de Almeida FM, dos Santos TM, Fukuzaki S, Martins NAB, Barbeiro MC, Saraiva-Romanholo BM, Lopes FDTQDS, Leick EA, Prado CM, Tibério IDFLC. Modulating asthma-COPD overlap responses with IL-17 inhibition. Front Immunol 2023; 14:1271342. [PMID: 37965351 PMCID: PMC10641519 DOI: 10.3389/fimmu.2023.1271342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/16/2023] [Indexed: 11/16/2023] Open
Abstract
Background IL-17 is a modulator of the inflammatory response and is implicated in lung remodeling in both asthma and chronic obstructive pulmonary disease (COPD). Well as and probably in patients with asthma-COPD overlap (ACO). Methods In this study, we evaluated the response of the airways and alveolar septa to anti-IL-17 treatment in an ACO model. Fifty-six male BALB/c mice were sensitized with ovalbumin (OVA group), received porcine pancreatic elastase (PPE group), or both (ACO group). Mice were then treated with either anti-IL-17 monoclonal antibody or saline. We evaluated hyperresponsiveness, bronchoalveolar lavage fluid (BALF) cell counts, and mean alveolar diameter. We quantified inflammatory, response, extracellular matrix remodeling, oxidative stress markers, and signaling pathway markers. Results Anti-IL-17 treatment in the ACO anti-IL-17 group reduced the maximum response of respiratory system Rrs, Ers, Raw, Gtis, this when compared to the ACO group (p<0.05). There was a reduction in the total number of inflammatory cells, neutrophils, and macrophages in the BALF in the ACO anti-IL-17 group compared to the ACO group (p<0.05). There was attenuated dendritic cells, CD4+, CD8+, FOXP3, IL-1β, IL-2, IL-6, IL-13, IL-17, IL-33 in ACO anti-IL-17 group in airway and alveolar septum compared to the ACO group (p<0.05). We observed a reduction of MMP-9, MMP-12, TIMP-1, TGF-β, collagen type I in ACO anti-IL-17 group in airway and alveolar septum compared to the ACO group (p < 0.05). We also observed a reduction of iNOS and 8-iso-PGF2α in the airways and in the alveolar septum was reduced in the ACO anti-IL-17group compared to the ACO group (p < 0.05). Regarding the signaling pathways, NF-kB, ROCK-1, and ROCK-2 in the airway and alveolar septum were attenuated in the ACO anti-IL-17 group when compared to the ACO group (p<0.05). Conclusions Our results suggest that inhibiting IL-17 modulates cell-associated cytokine production in lung tissue, extracellular matrix remodeling, and oxidative stress in ACO through the modulation of NF-kB and FOXP3.
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Affiliation(s)
- Leandro do Nascimento Camargo
- Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
- Serviço de Reabilitação, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Renato Fraga Righetti
- Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
- Serviço de Reabilitação, Hospital Sírio-Libanês, São Paulo, Brazil
| | | | - Tabata Maruyama dos Santos
- Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
- Serviço de Reabilitação, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Silvia Fukuzaki
- Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | - Carla Máximo Prado
- Department of Bioscience, Federal University of São Paulo, Santos, São Paulo, Brazil
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Barbosa JAS, da Silva LLS, João JMLG, de Campos EC, Fukuzaki S, Camargo LDN, dos Santos TM, dos Santos HT, Bezerra SKM, Saraiva-Romanholo BM, Lopes FDTQDS, Bonturi CR, Oliva MLV, Leick EA, Righetti RF, Tibério IDFLC. Investigating the Effects of a New Peptide, Derived from the Enterolobium contortisiliquum Proteinase Inhibitor (EcTI), on Inflammation, Remodeling, and Oxidative Stress in an Experimental Mouse Model of Asthma-Chronic Obstructive Pulmonary Disease Overlap (ACO). Int J Mol Sci 2023; 24:14710. [PMID: 37834157 PMCID: PMC10573003 DOI: 10.3390/ijms241914710] [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: 08/31/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
The synthesized peptide derived from Enterolobium contortisiliquum (pep3-EcTI) has been associated with potent anti-inflammatory and antioxidant effects, and it may be a potential new treatment for asthma-COPD overlap-ACO). Purpose: To investigate the primary sequence effects of pep3-EcTI in an experimental ACO. BALB/c mice were divided into eight groups: SAL (saline), OVA (ovalbumin), ELA (elastase), ACO (ovalbumin + elastase), ACO-pep3-EcTI (treated with inhibitor), ACO-DX (treated with dexamethasone), ACO-DX-pep3-EcTI (treated with dexamethasone and inhibitor), and SAL-pep3-EcTI (saline group treated with inhibitor). We evaluated the hyperresponsiveness to methacholine, exhaled nitric oxide, bronchoalveolar lavage fluid (BALF), mean linear intercept (Lm), inflammatory markers, tumor necrosis factor (TNF-α), interferon (IFN)), matrix metalloproteinases (MMPs), growth factor (TGF-β), collagen fibers, the oxidative stress marker inducible nitric oxide synthase (iNOS), transcription factors, and the signaling pathway NF-κB in the airways (AW) and alveolar septa (AS). Statistical analysis was conducted using one-way ANOVA and t-tests, significant when p < 0.05. ACO caused alterations in the airways and alveolar septa. Compared with SAL, ACO-pep3-EcTI reversed the changes in the percentage of resistance of the respiratory system (%Rrs), the elastance of the respiratory system (%Ers), tissue resistance (%Gtis), tissue elastance (%Htis), airway resistance (%Raw), Lm, exhaled nitric oxide (ENO), lymphocytes, IL-4, IL-5, IL-6, IL-10, IL-13, IL-17, TNF-α, INF-γ, MMP-12, transforming growth factor (TGF)-β, collagen fibers, and iNOS. ACO-DX reversed the changes in %Rrs, %Ers, %Gtis, %Htis, %Raw, total cells, eosinophils, neutrophils, lymphocytes, macrophages, IL-1β, IL-6, IL-10, IL-13, IL-17, TNF-α, INF-γ, MMP-12, TGF-β, collagen fibers, and iNOS. ACO-DX-pep3-EcTI reversed the changes, as was also observed for the pep3-EcTI and the ACO-DX-pep3-EcTI. Significance: The pep3-EcTI was revealed to be a promising strategy for the treatment of ACO, asthma, and COPD.
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Affiliation(s)
- Jéssica Anastácia Silva Barbosa
- Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo 01246-903, Brazil; (J.A.S.B.); (L.L.S.d.S.); (J.M.L.G.J.); (E.C.d.C.); (S.F.); (L.d.N.C.); (T.M.d.S.); (H.T.d.S.); (S.K.M.B.); (B.M.S.-R.); (F.D.T.Q.d.S.L.); (E.A.L.); (R.F.R.)
- Hospital Sírio Libanês, São Paulo 01308-050, Brazil
| | - Luana Laura Sales da Silva
- Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo 01246-903, Brazil; (J.A.S.B.); (L.L.S.d.S.); (J.M.L.G.J.); (E.C.d.C.); (S.F.); (L.d.N.C.); (T.M.d.S.); (H.T.d.S.); (S.K.M.B.); (B.M.S.-R.); (F.D.T.Q.d.S.L.); (E.A.L.); (R.F.R.)
| | - Juliana Morelli Lopes Gonçalves João
- Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo 01246-903, Brazil; (J.A.S.B.); (L.L.S.d.S.); (J.M.L.G.J.); (E.C.d.C.); (S.F.); (L.d.N.C.); (T.M.d.S.); (H.T.d.S.); (S.K.M.B.); (B.M.S.-R.); (F.D.T.Q.d.S.L.); (E.A.L.); (R.F.R.)
- Hospital Sírio Libanês, São Paulo 01308-050, Brazil
| | - Elaine Cristina de Campos
- Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo 01246-903, Brazil; (J.A.S.B.); (L.L.S.d.S.); (J.M.L.G.J.); (E.C.d.C.); (S.F.); (L.d.N.C.); (T.M.d.S.); (H.T.d.S.); (S.K.M.B.); (B.M.S.-R.); (F.D.T.Q.d.S.L.); (E.A.L.); (R.F.R.)
- Hospital Sírio Libanês, São Paulo 01308-050, Brazil
| | - Silvia Fukuzaki
- Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo 01246-903, Brazil; (J.A.S.B.); (L.L.S.d.S.); (J.M.L.G.J.); (E.C.d.C.); (S.F.); (L.d.N.C.); (T.M.d.S.); (H.T.d.S.); (S.K.M.B.); (B.M.S.-R.); (F.D.T.Q.d.S.L.); (E.A.L.); (R.F.R.)
| | - Leandro do Nascimento Camargo
- Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo 01246-903, Brazil; (J.A.S.B.); (L.L.S.d.S.); (J.M.L.G.J.); (E.C.d.C.); (S.F.); (L.d.N.C.); (T.M.d.S.); (H.T.d.S.); (S.K.M.B.); (B.M.S.-R.); (F.D.T.Q.d.S.L.); (E.A.L.); (R.F.R.)
- Hospital Sírio Libanês, São Paulo 01308-050, Brazil
| | - Tabata Maruyama dos Santos
- Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo 01246-903, Brazil; (J.A.S.B.); (L.L.S.d.S.); (J.M.L.G.J.); (E.C.d.C.); (S.F.); (L.d.N.C.); (T.M.d.S.); (H.T.d.S.); (S.K.M.B.); (B.M.S.-R.); (F.D.T.Q.d.S.L.); (E.A.L.); (R.F.R.)
- Hospital Sírio Libanês, São Paulo 01308-050, Brazil
| | - Henrique Tibucheski dos Santos
- Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo 01246-903, Brazil; (J.A.S.B.); (L.L.S.d.S.); (J.M.L.G.J.); (E.C.d.C.); (S.F.); (L.d.N.C.); (T.M.d.S.); (H.T.d.S.); (S.K.M.B.); (B.M.S.-R.); (F.D.T.Q.d.S.L.); (E.A.L.); (R.F.R.)
| | - Suellen Karoline Moreira Bezerra
- Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo 01246-903, Brazil; (J.A.S.B.); (L.L.S.d.S.); (J.M.L.G.J.); (E.C.d.C.); (S.F.); (L.d.N.C.); (T.M.d.S.); (H.T.d.S.); (S.K.M.B.); (B.M.S.-R.); (F.D.T.Q.d.S.L.); (E.A.L.); (R.F.R.)
| | - Beatriz Mangueira Saraiva-Romanholo
- Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo 01246-903, Brazil; (J.A.S.B.); (L.L.S.d.S.); (J.M.L.G.J.); (E.C.d.C.); (S.F.); (L.d.N.C.); (T.M.d.S.); (H.T.d.S.); (S.K.M.B.); (B.M.S.-R.); (F.D.T.Q.d.S.L.); (E.A.L.); (R.F.R.)
- Department of Medicine, University City of São Paulo, São Paulo 03071-000, Brazil
| | - Fernanda Degobbi Tenório Quirino dos Santos Lopes
- Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo 01246-903, Brazil; (J.A.S.B.); (L.L.S.d.S.); (J.M.L.G.J.); (E.C.d.C.); (S.F.); (L.d.N.C.); (T.M.d.S.); (H.T.d.S.); (S.K.M.B.); (B.M.S.-R.); (F.D.T.Q.d.S.L.); (E.A.L.); (R.F.R.)
| | - Camila Ramalho Bonturi
- Departamento de Bioquímica, Universidade Federal de São Paulo (UNIFESP), São Paulo 04039-002, Brazil; (C.R.B.); (M.L.V.O.)
| | - Maria Luiza Vilela Oliva
- Departamento de Bioquímica, Universidade Federal de São Paulo (UNIFESP), São Paulo 04039-002, Brazil; (C.R.B.); (M.L.V.O.)
| | - Edna Aparecida Leick
- Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo 01246-903, Brazil; (J.A.S.B.); (L.L.S.d.S.); (J.M.L.G.J.); (E.C.d.C.); (S.F.); (L.d.N.C.); (T.M.d.S.); (H.T.d.S.); (S.K.M.B.); (B.M.S.-R.); (F.D.T.Q.d.S.L.); (E.A.L.); (R.F.R.)
| | - Renato Fraga Righetti
- Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo 01246-903, Brazil; (J.A.S.B.); (L.L.S.d.S.); (J.M.L.G.J.); (E.C.d.C.); (S.F.); (L.d.N.C.); (T.M.d.S.); (H.T.d.S.); (S.K.M.B.); (B.M.S.-R.); (F.D.T.Q.d.S.L.); (E.A.L.); (R.F.R.)
- Hospital Sírio Libanês, São Paulo 01308-050, Brazil
| | - Iolanda de Fátima Lopes Calvo Tibério
- Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo 01246-903, Brazil; (J.A.S.B.); (L.L.S.d.S.); (J.M.L.G.J.); (E.C.d.C.); (S.F.); (L.d.N.C.); (T.M.d.S.); (H.T.d.S.); (S.K.M.B.); (B.M.S.-R.); (F.D.T.Q.d.S.L.); (E.A.L.); (R.F.R.)
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Nishimura K. Special Issue "Diagnosis, Treatment, and Management of COPD and Asthma". Diagnostics (Basel) 2023; 13:2634. [PMID: 37627892 PMCID: PMC10453548 DOI: 10.3390/diagnostics13162634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023] Open
Abstract
It has been my great pleasure to publish 17 papers in the Special Issue "Diagnosis, Treatment, and Management of COPD and Asthma" [...].
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Affiliation(s)
- Koichi Nishimura
- Visiting Researcher, National Center for Geriatrics and Gerontology, 7-430, Morioka-cho, Obu 474-8511, Japan;
- Clinic Nishimura, 4-3 Kohigashi, Kuri-cho, Ayabe 623-0222, Japan
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Alsayed AR, Abu-Samak MS, Alkhatib M. Asthma-COPD Overlap in Clinical Practice (ACO_CP 2023): Toward Precision Medicine. J Pers Med 2023; 13:677. [PMID: 37109063 PMCID: PMC10146260 DOI: 10.3390/jpm13040677] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Asthma and COPD have characteristic symptoms, yet patients with both are prevalent. Despite this, there is currently no globally accepted definition for the overlap between asthma and COPD, commonly referred to as asthma-COPD overlap (ACO). Generally, ACO is not considered a distinct disease or symptom from either clinical or mechanistic perspectives. However, identifying patients who present with both conditions is crucial for guiding clinical therapy. Similar to asthma and COPD, ACO patients are heterogeneous and presumably have multiple underlying disease processes. The variability of ACO patients led to the establishment of multiple definitions describing the condition's essential clinical, physiological, and molecular characteristics. ACO comprises numerous phenotypes, which affects the optimal medication choice and can serve as a predictor of disease prognosis. Various phenotypes of ACO have been suggested based on host factors including but not limited to demographics, symptoms, spirometric findings, smoking history, and underlying airway inflammation. This review provides a comprehensive clinical guide for ACO patients to be used in clinical practice based on the available limited data. Future longitudinal studies must evaluate the stability of ACO phenotypes over time and explore their predictive powers to facilitate a more precise and effective management approach.
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Affiliation(s)
- Ahmad R Alsayed
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11937, Jordan
| | - Mahmoud S Abu-Samak
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11937, Jordan
| | - Mohammad Alkhatib
- Department of Experimental Medicine, University of Rome "Tor Vergata", 00133 Roma, Italy
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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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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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Adrish M, Anand MP, Hanania NA. Phenotypes of Asthma–Chronic Obstructive Pulmonary Disease Overlap. Immunol Allergy Clin North Am 2022; 42:645-655. [PMID: 35965051 DOI: 10.1016/j.iac.2022.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chen YC, Chang YP, Huang KT, Hsu PY, Hsiao CC, Lin MC. Unraveling the Pathogenesis of Asthma and Chronic Obstructive Pulmonary Disease Overlap: Focusing on Epigenetic Mechanisms. Cells 2022; 11:cells11111728. [PMID: 35681424 PMCID: PMC9179497 DOI: 10.3390/cells11111728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/05/2022] [Accepted: 05/21/2022] [Indexed: 12/10/2022] Open
Abstract
Asthma and COPD overlap (ACO) is characterized by patients presenting with persistent airflow limitation and features of both asthma and COPD. It is associated with a higher frequency and severity of exacerbations, a faster lung function decline, and a higher healthcare cost. Systemic inflammation in COPD and asthma is driven by type 1 T helper (Th1) and Th2 immune responses, respectively, both of which may contribute to airway remodeling in ACO. ACO-related biomarkers can be classified into four categories: neutrophil-mediated inflammation, Th2 cell responses, arachidonic acid-eicosanoids pathway, and metabolites. Gene–environment interactions are key contributors to the complexity of ACO and are regulated by epigenetic mechanisms, including DNA methylation, histone modifications, and non-coding RNAs. Thus, this review focuses on the link between epigenetics and ACO, and outlines the following: (I) inheriting epigenotypes without change with environmental stimuli, or epigenetic changes in response to long-term exposure to inhaled particles plus intermittent exposure to specific allergens; (II) epigenetic markers distinguishing ACO from COPD and asthma; (III) potential epigenetic drugs that can reverse oxidative stress, glucocorticoid insensitivity, and cell injury. Improved understanding of the epigenetic regulations holds great value to give deeper insight into the mechanisms, and clarify their implications for biomedical research in ACO.
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Affiliation(s)
- Yung-Che Chen
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (Y.-P.C.); (K.-T.H.); (P.-Y.H.)
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Correspondence: (Y.-C.C.); (C.-C.H.); (M.-C.L.); Tel.: +886-7-731-7123 (ext. 8199) (Y.-C.C. & M.-C.L.); +886-7-731-7123 (ext. 8979) (C.-C.H.)
| | - Yu-Ping Chang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (Y.-P.C.); (K.-T.H.); (P.-Y.H.)
| | - Kuo-Tung Huang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (Y.-P.C.); (K.-T.H.); (P.-Y.H.)
| | - Po-Yuan Hsu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (Y.-P.C.); (K.-T.H.); (P.-Y.H.)
| | - Chang-Chun Hsiao
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (Y.-P.C.); (K.-T.H.); (P.-Y.H.)
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Correspondence: (Y.-C.C.); (C.-C.H.); (M.-C.L.); Tel.: +886-7-731-7123 (ext. 8199) (Y.-C.C. & M.-C.L.); +886-7-731-7123 (ext. 8979) (C.-C.H.)
| | - Meng-Chih Lin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (Y.-P.C.); (K.-T.H.); (P.-Y.H.)
- Correspondence: (Y.-C.C.); (C.-C.H.); (M.-C.L.); Tel.: +886-7-731-7123 (ext. 8199) (Y.-C.C. & M.-C.L.); +886-7-731-7123 (ext. 8979) (C.-C.H.)
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