asthma-COPD Overlap Syndrome Research Articles

Global Lung Initiative as Diagnostic Criteria in Asthma-COPD Overlap Syndrome: Prevalence and Disease Characterization in a Real-Life Asthma Cohort.

Global Lung Initiative as Diagnostic Criteria in Asthma-COPD Overlap Syndrome: Prevalence and Disease Characterization in a Real-Life Asthma Cohort.

Asthma COPD Overlap Syndrome

Asthma COPD Overlap Syndrome

An integrated metabo-lipidomics profile of induced sputum for the identification of novel biomarkers in the differential diagnosis of asthma and COPD

BackgroundDue to their complexity and to the presence of common clinical features, differentiation between asthma and chronic obstructive pulmonary disease (COPD) can be a challenging task, complicated in such cases also by asthma–COPD overlap syndrome. The distinct immune/inflammatory and structural substrates of COPD and asthma are responsible for significant differences in the responses to standard pharmacologic treatments. Therefore, an accurate diagnosis is of central relevance to assure the appropriate therapeutic intervention in order to achieve safe and effective patient care. Induced sputum (IS) accurately mirrors inflammation in the airways, providing a more direct picture of lung cell metabolism in comparison to those specimen that reflect analytes in the systemic circulation.MethodsAn integrated untargeted metabolomics and lipidomics analysis was performed in IS of asthmatic (n = 15) and COPD (n = 22) patients based on Ultra-High-Pressure Liquid Chromatography-Mass Spectrometry (UHPLC-MS) and UHPLC–tandem MS (UHPLC-MS/MS). Partial Least Squares-Discriminant Analysis (PLS-DA) was applied to resulting dataset. The analysis of main enriched metabolic pathways and the association of the preliminary metabolites/lipids pattern identified to clinical parameters of asthma/COPD differentiation were explored. Multivariate ROC analysis was performed in order to determine the discriminatory power and the reliability of the putative biomarkers for diagnosis between COPD and asthma.ResultsPLS-DA indicated a clear separation between COPD and asthmatic patients. Among the 15 selected candidate biomarkers based on Variable Importance in Projection scores, putrescine showed the highest score. A differential IS bio-signature of 22 metabolites and lipids was found, which showed statistically significant variations between asthma and COPD. Of these 22 compounds, 18 were decreased and 4 increased in COPD compared to asthmatic patients. The IS levels of Phosphatidylethanolamine (PE) (34:1), Phosphatidylglycerol (PG) (18:1;18:2) and spermine were significantly higher in asthmatic subjects compared to COPD.ConclusionsThis is the first pilot study to analyse the IS metabolomics/lipidomics signatures relevant in discriminating asthma vs COPD. The role of polyamines, of 6-Hydroxykynurenic acid and of d-rhamnose as well as of other important players related to the alteration of glycerophospholipid, aminoacid/biotin and energy metabolism provided the construction of a diagnostic model that, if validated on a larger prospective cohort, might be used to rapidly and accurately discriminate asthma from COPD.Graphical

Chronic ozone exposure in mice mimics clinical asthma-COPD overlap syndrome and is attenuated by tiotropium

Chronic ozone exposure in mice mimics clinical asthma-COPD overlap syndrome and is attenuated by tiotropium

Evaluation of the clinical, demographic and inflammatory characteristics of a Spanish cohort of patients with asthma-COPD overlap syndrome.

Evaluation of the clinical, demographic and inflammatory characteristics of a Spanish cohort of patients with asthma-COPD overlap syndrome.

Asthma–COPD overlap syndrome among smoker subjects with asthma: A cross-sectional study

This study aimed to assess the prevalence of asthma–chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) in asthmatic outpatients with smoking exposure (smokers or ex-smokers with ≥10 pack-year history) and to evaluate quality of life (QoL) and adherence among the study sample. This cross-sectional study was conducted at outpatient respiratory clinics in governmental hospitals in Jordan. Asthmatic outpatients were interviewed to assess their spirometric readings, patients’ adherence, and patients’ QoL [using the Mini Asthma QoL questionnaire (MiniAQLQ)]. The prevalence of ACOS was found to be 33% among asthmatic smoker patients in the outpatient setting (n = 65 out of 200 subjects with asthma-diagnosed patients recruited into the study). For subjects with ACOS, 47.7% of them were older than 60 years old. Smoking history for more than 30 years was prevalent among most subjects with ACOS (67.7%). The MiniAQLQ average score was found to be low (mean ± SD = 3.23 ± 1.01, score out of 7) and similarly for patients’ adherence to their treatment modalities (mean ±SD = 1.76 ± 1.2, score out of 6). A significant positive relationship between adherence to treatment and QoL was found among subjects with ACOS (correlation coefficient = 0.171, p-value = 0.018). In conclusion, a moderate prevalence of ACOS was estimated among asthmatic smoker patients. Low levels of QoL and adherence to treatment were significantly correlated.

Lactobacillus rhamnosus Modulates Lung Inflammation and Mitigates Gut Dysbiosis in a Murine Model of Asthma-COPD Overlap Syndrome.

The asthma-COPD overlap syndrome (ACOS) presents lung inflammation similar to both asthma and chronic obstructive pulmonary disease (COPD). Due to the immune response between the lung and gut, it is possible that ACOS individuals present gut dysbiosis. Due to therapeutic limitations in ACOS, Lactobacillus rhamnosus (Lr) have received attention once Lr has been effective in asthma and COPD. However, there is no data about the Lr effect on both lung inflammation and gut dysbiosis in ACOS. Thus, our study investigated the Lr effect on lung inflammation, bronchoconstriction, airway remodeling, and gut dysbiosis in the murine ACOS model. Treated mice with Lr were exposed to HDM and cigarette smoke to induce ACOS. Sixty days after ACOS induction, mice were euthanized. Lung inflammation was evaluated in leukocytes in bronchoalveolar lavage fluid (BALF), airway remodeling, cytokine secretion, and transcription factor expression in the lung. The gut microbiota was assayed by 16S mRNA sequencing from a fecal sample. Leukocyte population, bronchial hyperreactivity, pro-inflammatory cytokines, and airway remodeling were attenuated in Lr-treated ACOS mice. Likewise, IL-4, IL-5, and IL-13, STAT6 and GATA3, as well as IL-17, IL-21, IL-22, STAT3, and RORɣt were reduced after Lr. In addition, IL-2, IL-12, IFN-γ, STAT1, and T-bet as well as IL-10, TGF-β, STAT5, and Foxp3 were restored after the Lr. Firmicutes was reduced, while Deferribacteres was increased after Lr. Likewise, Lr decreased Staphylococcus and increased Mucispirillum in ACOS mice. Lr improves fecal bacterial β-diversity. Our findings show for the first time the Lr effect on lung inflammation and gut dysbiosis in murine ACOS.

Overcoming the Digital Divide for Older Patients With Respiratory Disease: Focus Group Study.

The need for and adoption of eHealth programs are growing worldwide. However, access can be limited among patients with low socioeconomic backgrounds, often resulting in a so-called "digital divide" due to a mismatch between eHealth and target populations that can gain benefit. This digital divide can result in unsuccessful eHealth implementations, which is of critical importance to health care. This study evaluated the opinions of elderly patients with asthma and chronic obstructive pulmonary disease (COPD) about an existing pharmacy-based personalized patient web portal that provides medication overview and information on associated diagnoses. The aim was to obtain insights on the common barriers of elderly people when using health-related websites, which can help to improve accessibility. This was a cross-sectional qualitative study of a patient panel of the Groningen Research Institute for Asthma and COPD in primary care. Participants were required to be older than 55 years, be Dutch speaking, have no prior experience with the study website, and be diagnosed with a chronic respiratory illness. Two focus groups were created, and they completed a 45-minute session for testing the website and a 120-minute session for semistructured interviews. The focus group sessions were recorded, transcribed verbatim, and analyzed by content analysis. We enrolled 11 patients (9 women) with a mean age of 66 (SD 9) years. Of these, 5 had asthma, 3 had COPD, 2 had asthma-COPD overlap syndrome, and 1 had bronchiectasis. Participants were generally positive about the website, especially the areas providing disease-related information and the medication overview. They appreciated that the website would enable them to share this information with other health care providers. However, some difficulties were reported with navigation, such as opening a new tab, and others reported that the layout of the website was difficult either because of visual impairments or problems with navigation. It was also felt that monitoring would only be relevant if it is also checked by health care professionals as part of a treatment plan. Participants mentioned few privacy or safety concerns. It is feasible to develop websites for elderly patients; however, developers must take the specific needs and limitations of elderly people into account (eg, navigation problems, poor vision, or poor hand-eye coordination). The provision of information appears to be the most important aspect of the website, and as such, we should endeavor to ensure that the layout and navigation remain basic and accessible. Patients are only motivated to use self-management applications if they are an integrated part of their treatment. The usability of the website can be improved by including older people during development and by implementing design features that can improve accessibility in this group.

Feasibility of Tiotropium Bromide Treatment in Patients with Asthma-COPD Overlap Syndrome and its Effect on Lung Function

Objective: To explore the feasibility of tiotropium bromide therapy and its effect on the lung function of patients with asthma-COPD overlap syndrome (ACOS). Method: The 58 subjects selected in this study were all ACOS patients admitted to our hospital (Hohhot First Hospital) from October 2020 to October 2022. They were grouped according to the random number table method and divided into a control group (29 cases) and an observation group (29 cases). The control group received routine treatment plus salmeterol-fluticasone powder inhalation treatment, and the observation group received tiotropium bromide treatment. The relevant indicators of the two groups were compared. Results: The total clinical effective rate of the observation group was significantly higher than that of the control group. Besides, the forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) levels, and ACT scores of the two groups increased after treatment, with the observation group having better results than the control group. The residual volume-total lung capacity ratio (RV/TLC), acute exacerbation frequency, and CAT scores all decreased, with the observation group showing smaller values than the control group. The difference between the results of both groups were significant (P < 0.05) Conclusion: Tiotropium bromide has a significant clinical effect in the treatment of ACOS patients and can effectively improve the lung function of patients.

Сlinical features of asthma-COPD overlap syndrome with comorbid type 2 diabetes mellitus

Background. Comorbidity profiles are a common subject of research in patients with asthma-COPD (chronic obstructive pulmonary disease) overlap (ACO), but in case of concurrent type 2 diabetes mellitus (T2DM), there is a lack of targeted research on the quality of life, clinical course, and lung function. The aim of the study was to clarify the clinical features of asthma-COPD overlap in combination with T2DM. Materials and methods. Sixty-nine patients were examined: 24 with ACO and T2DM (group 1), 21 with asthma and T2DM (group 2), and 24 with COPD and T2DM (group 3). A diagnosis of ACO was made according to GINA and GOLD 2017 guidelines. Quality of life was assessed using the CAT, ACQ, and SGRQ, and the severity of dyspnea was assessed using the mMRC scale, disease severity and prognosis using the BODE index. Spirometry with bronchodilation test, 6-minute walk test, and bioimpedance analysis were performed. Results. Patients in the main group had a higher total SGRQ score than those in group 3 (by 33 %, p = 0.001). Higher ACQ and total SGRQ scores indicate a trend toward worse asthma control and lower quality of life in patients with ACO and T2DM compared to the asthma + T2DM group (p = 0.056 and p = 0.054, respectively). Body mass index was higher than in patients with COPD and T2DM (by 16.3 %, p = 0.001). Higher serum glucose levels were found in patients with ACO and T2DM than in those with COPD and T2DM (by 18.3 %, p = 0.028). The FEV1 in the ACO and T2DM group was lower than in the asthma + T2DM group (by 18.7 %, p = 0.027), and the SVC was lower by 33 % (p = 0.021). There was a tendency to a lower result in the 6-minute walk test in the main group compared to patients from group 3 (p = 0.0548), and a higher frequency of exacerbations per year compared to groups 2 (p = 0.08) and 3 (p = 0.06). Conclusions. Patients with asthma-COPD overlap and concurrent type 2 diabetes mellitus have worse quality of life, lower FEV1 and SVC, submaximal exercise tolerance, higher fasting glucose levels, and a tendency towards increased exacerbation frequency.

Effect of budesonide formoterol combined with tiotropium bromide on pulmonary function and inflammatory factors in patients with asthma-COPD overlap syndrome.

To investigate the clinical efficacy of combining budesonide formoterol with tiotropium bromide for treating asthma-chronic obstructive pulmonary disease overlap syndrome (AOCS). The data of 104 patients with AOCS admitted to our hospital from December 2019 to December 2020 were assessed, randomly and divided into an experimental group (comprising 52 patients, receiving drug combination therapy) and a conventional group (comprising 52 patients, receiving drug therapy alone). Patients' clinical efficacy, pulmonary function, fractioned exhaled nitric oxide (FeNO), immune function, endothelial function, serum lipid peroxidation injury indexes, adverse reactions, and quality of life scores were compared. Prior to treatment, no significant differences were observed in various pulmonary function indicators, FeNO, immune function, endothelial function, and lipid peroxidation injury indexes between the two groups (P > 0.05). However, after treatment, all observation indexes in both groups improved to different levels, with the experimental group -demonstrating -significantly superior improvement, compared to the conventional group (P < 0.05). We also observed that adverse reactions in the experimental group were significantly lower than in the conventional group (P < 0.05). The combination of budesonide formoterol to tiotropium bromide in treating asthma-COPD overlap syndrome may significantly improve pulmonary function, endothelial function, and immune status of patients and encourage the recovery of serum lipid peroxidation injury; therefore, this may deserve widespread adoption and application.

Evaluation of human neutrophil gelatinase-associated lipocalin level in asthma-COPD overlap syndrome of elderly patients

Aims: Human neutrophil gelatinase-associated lipocalin (NGAL) is a protein considered as a noninvasive prognostic biomarker in Asthma-COPD overlap syndrome (ACO). In this study we aimed to show the usability of NGAL as a biomarker in ACO characterized with airway inflammation in over 65 years old. Methods: Three patient groups (Group I: COPD, n: 50, Group II: Asthma, n:50, Group III: ACO, n:50) and a healhty non smoker group (Group IV, n:50) are taken into study. The serum NGAL levels of groups are compared. In Group I, II, III the level of serum NGAL is compared with the age, duration of smoking (pocket/year), number of attack per year, respiratory function values, serum C reaktive protein (CRP, mg/dL), serum IgE (IU/mL) and blood neutrophil-to-lymphocyte rate and atopy. Results: In patients having ACO when the maximum level of serum exist, it is observed that serum NGAL level is increased as the number of attacks is increased (p&lt;0.002). On the other hand in the patients having ACO there was also positive correlation between NLR and serum NGAL level (p&lt;0.05). Conclusion: The increase in serum NGAL levels in chronic inflammatory lung diseases suggests that serum NGAL levels can be used as a biomarker to assess inflammation severity

Perioperative Management of Patients with Asthma-COPD Overlap Syndrome - Where Do We Stand? A Case Report-Based Discussion

Background: Postoperative pulmonary complications (PPCs) are associated with a significant morbidity and mortality; prevention and management strategies depend greatly on the patients’ comorbid conditions. Chronic Obstructive Pulmonary Disease (COPD) is a well-known risk factor for PPCs, but controlled Asthma does not appear to be so. On the other hand, the role of Asthma-COPD Overlap Syndrome (ACOS) as a risk for PPCs is yet to be studied. While there is a guidance for the perioperative risk reduction and management of COPD and Asthma, specific guidance for ACOS is also lacking. As a consequence, physicians tailor their management by considering both the components.&#x0D; Case presentation: We present a case of a 74-year-old man with ACOS, diagnosed with invasive bladder carcinoma. He was taken for laparoscopic radical cystectomy and ileal conduit. Although he had an uneventful surgery, we lost him on the seventh postoperative day due to multiple complications, including PPCs.&#x0D; Conclusion: The case highlights the need for considering the ACOS separately as a risk and calls for a specific roadmap for perioperative management.&#x0D; &#x0D; &#x0D; Asthma-COPD Overlap Syndrome patients appear to be at high risk of PPCs&#x0D; There is a lack of evidence-based guidance and literature to tailor the management of such patients to reduce the perioperative risks for PPCs&#x0D; It is high time to delineate the ACOS patients from Asthma and COPD, study them in context to PPCs and perioperative outcome so that specific guidance can be developed.&#x0D;

Fluticasone Furoate/Vilanterol Use Trends and Characteristics in Patients With Obstructive Airway Disease: A Real-World Study of 10,374 Patients From India.

Introduction Obstructive Airway Diseases (OADs) are the leading cause of death among chronic respiratory diseases worldwide, and novel therapies are direly needed. Fluticasone furoate/vilanterol (FF/Vi) (100/25 µg) is the first once-daily ICS/uLABA marketed in India for COPD since 2021. Considering its limited real-world experience in OAD patients in Indian clinical settings, a large drug utilization study (DUS) was planned. Methodology We conducted a cross-sectional, observational DUS at 1900 outpatient clinics in India from October 2021 to March 2022. Prescription data and medical history of patients who were prescribed the FF/Vi combination werecollected. Results It was observed that FF/Vi was prescribed in an almost equal number of patients with COPD (44.2%) and asthma (42.9%). The majority of the patients (74%) were switched from previous ICS/LABA to this ICS/uLABA, while 26% of patients were treatment naïve.The average CAT score was 19.5±7.8 (43.2% GOLD Group C and 32.2% GOLD Group B) in COPD patients, while the average ACQ-5 score was 2.6±1.3 (33.1% GINA Step 3, 29.5% GINA Step 2) in asthmatic patients. Most of the patients (63.9%) had raised biomarkers (Blood eosinophil count >300 cells/μl). Prior history of exacerbation was present in 65% of patients with annual exacerbation rates of 1.2 in COPD, 1.1 in asthma, and 1.2 in asthma-COPD overlap syndrome (ACOS). Leukotriene inhibitors (42%) and LAMAs (30.8%) were common add-on medications. Conclusion We observed a trend towards a shift to once-daily ICS/uLABA (FF/Vi) by physicians, especially in symptomatic and exacerbating OAD patients with underlying comorbidities.

Vitamin D3 supplementation on lung functions and exercise tolerance in D3 deficient asthma COPD overlap syndrome patients - A randomized controlled trial

Background: Vitamin D3 supplementation showed significant improvement in lung functions and exercise tolerance in both of asthma and COPD patients. Objectives: To evaluate the effects of vitamin D3 supplementation on lung functions and exercise tolerance in D3 deficient, stable patients with ACO. Methods: A double blinded randomized placebo controlled trial was carried out on 60 (sixty) D3 deficient [serum 25-hydroxycholecalciferol, 25(OH)D&lt;30 ng/ml], male, smoker, stable ACO patients of age 40 to 80 year, selected according to selection criteria. After the final selection, all the patients were randomly allocated as ‘Study’ (n=30) or ‘Control’ (n=30) and their baseline spirometric lung functions (FVC, FEV1, FEV1/FVC ratio, PEFR, FEF25-75) and exercise tolerance represented by 6Minute Walk Distance (6MWD), peripheral capillary oxygen saturation (SpO2) at rest, SpO2 after 6MWT, dyspnea scale and fatigue scale variables were measured. All the ‘Study’ patients received 80,000 IU (2 oral capsules) of vitamin D3 per week for first 13 weeks. Subsequently, according to their serum 25(OH)D or calcium, they got 40,000 IU (1 oral capsule) of D3 per 1 week or per 2 weeks or per 6 weeks or no further supplementation, for following 13 weeks. Whereas, all the ‘Control’ patients received two oral capsules of placebo weekly for consecutive 26 weeks. After 26 weeks of follow up, spirometric lung functions and exercise tolerance variables were again measured and compared with their corresponding baseline value. Data were analyzed by independent and paired sample t test, where p£0.05 was accepted as significant. Results: There was significant improvement in 6MWD (p&lt;0.05), SpO2 after 6MWT (p&lt;0.001), dyspnea scale (p&lt;0.001) and fatigue scale (p&lt;0.001), in patients with vitamin D3 supplementation in comparison to those of placebo on 26th week of follow up. However, there was no improvement in ventilatory variables in the D3 supplemented group in comparison to those of placebo group. Conclusion: The present study reveals that vitamin D3 supplementation improves exercise tolerance but not ventilatory variables in vitamin D3 deficient stable ACO patients. Further multi centered trials with different dose as well as duration schedule on both male and female ACO patients are recommended. J Bangladesh Soc Physiol. 2022, June; 17(1): 21-33

Recent miRNA Research in Asthma.

The study of microRNA in asthma has revealed a vibrant new level of gene regulation underlying asthma pathology. Several miRNAs have been shown to be important in asthma, influencing various biological mechanisms which lead to asthma pathology and symptoms. In addition, miRNAs have been proposed as biomarkers of asthma affection status, asthma severity, and asthma treatment response. We review all recent asthma-miRNA work, while also presenting comprehensive tables of all miRNA results related to asthma. We here reviewed 63 recent studies published reporting asthma and miRNA research, and an additional 14 reviews of the same. We summarized the information for both adult and childhood asthma, as well as research on miRNAs in asthma-COPD overlap syndrome (ACOs), and virus-induced asthma exacerbations. We attempted to present a comprehensive collection of recently published asthma-associated miRNAs as well as tables of all published asthma-related miRNA results.

Airway Obstruction in Primary Care Patients: Need for Implementing Spirometry Use.

(1) Background: To detect early airway obstruction in an adult primary care setting. (2) Methods: Seventeen general practitioners (GP) were involved. A total of 912 patients consulting their GPs over 40 years were recruited: 583 of them (323M) agreed to perform/undergo all the procedures: respiratory questionnaire, mMRC questionnaire, and spirometry. We identified four subgroups: physician COPD patients; physician asthma patients; asthma-COPD overlap syndrome patients; and no respiratory diagnosis subjects, on the basis of physician diagnosis. For screening purposes, an FEV1/FVC < 70% was considered a marker of airway obstruction (AO). (3) Results: Prevalence rates of COPD, A, and ACOS were 12.5%, 7.8%, and 3.6%, respectively. In the overall sample 16.3% showed airway obstruction: 26% mild, 56% moderate, 17% severe, and 1% very severe. In obstructed subjects, those reporting neither respiratory symptoms nor a physician’s respiratory diagnosis were 60% level I; 43% level II; 44% level III; and none level IV. Wheezing (p < 0.001), sputum (p = 0.01), older age (p < 0.0001), and male gender (p = 0.002) were the best predictors of airway obstruction. (4) Conclusions: A high prevalence of AO was found. In AO we found a high prevalence of subjects without respiratory symptoms or respiratory chronic diagnosis. Airway obstruction was predicted by the presence of wheezing, sputum, older age, and male gender.

Does the asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) exist? A narrative review from epidemiology and practice.

Asthma and chronic obstructive pulmonary disease (COPD) have traditionally been approached as separate entities that must be researched and treated separately. There is growing recognition, however, that a substantial proportion of patients with obstructive lung disease have characteristics of both asthma and COPD (termed the asthma-COPD overlap syndrome (ACOS)). Lung disease experts have difficulty defining ACOS, and many still resist accepting the possibility that asthma and COPD may be linked. It is likely that practicing clinicians may be equally confused about how to identify and treat ACOS. This narrative review aims to clarify concepts of ACOS definition, argues that the best way to understand ACOS is to view the chronic lung disease process longitudinally rather than cross-sectionally, and presents evidence that ACOS can be the end result of the natural history of severe asthma. The review also points out the serious gaps in knowledge regarding therapy for ACOS and presents emerging data supporting the intracellular respiratory pathogen Chlamydia pneumoniae as a possible common etiologic agent in severe asthma and ACOS.

Effectiveness and Treatment Compliance of Salmeterol-Fluticasone Easyhaler® Among Patients with Asthma, COPD, or Asthma-COPD Overlap Syndrome: Real-World Study Findings.

For inhalation therapies to be effective, it is crucial that patients manage inhaler use correctly in their everyday life and achieve treatment compliance. We investigated the effectiveness of the salmeterol-fluticasone propionate Easyhaler® (SF EH) device-metered dry powder inhaler in a real-world setting in Hungary among adult patients with asthma, chronic obstructive pulmonary disease (COPD), or asthma-COPD overlap syndrome (ACO). A prospective, open-label, multicenter, noninterventional, investigator-sponsored study was conducted in outpatient pneumonology centers. Eligible patients were aged ≥ 18years with either a new diagnosis of asthma, COPD, or ACO, or whose disease was not controlled with preexisting medication. Data were collected at baseline and 12 + 4weeks, including the asthma control test (ACT), COPD assessment test (CAT), spirometry parameters [including forced expiratory volume for 1s (FEV1)], and physician- and patient-reported outcomes. Five hundred sixteen patients were recruited from 103 centers: 376 with asthma; 104 with COPD; and 36 with ACO. At week 12, there were significant improvements from baseline in both mean ACT score in patients with asthma (14.4 ± 4.2 versus 21.4 ± 2.8; P < 0.001) and mean CAT score in patients with COPD (24.0 ± 6.1 versus 16.0 ± 5.8; P < 0.001). Significant improvement was observed when the switch from the most frequently used previous inhalers was analyzed separately. Mean FEV1 improved from 76.0% ± 17.2 to 84.7% ± 16.1 (P < 0.001) and from 53.8% ± 15.0 to 59.9% ± 15.0 (P < 0.001) in patients with asthma or COPD, respectively. The study demonstrated improved physician-rated overall treatment compliance and patient preference for the SF EH over 3months use compared with previous inhaler treatment, with patients effectively adopting the SF EH into everyday life. Treatment with SF EH significantly improved patients' lung function parameters and disease control.

Fractional Exhaled Nitric Oxide Testing: Change in Clinical Management of Asthma, or Chronic Obstructive Pulmonary

Asthma and chronic obstructive pulmonary disease (COPD) are common airway inflammatory conditions that can present in isolation or a combination known as asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS). Due to similarities in clinical presentation, differentiating these conditions can be challenging. Fractional exhaled nitric oxide (FeNO) is an endogenous molecule that can be elevated in patients with airway inflammation, particularly asthma. The purpose of this study was to determine if FeNO levels can be used to change pharmacologic management (addition, in patients presenting with asthma, COPD, and ACOS. A retrospective chart review of 250 patients underwent FeNO testing; 93 patients were included in the final analysis with their FeNO levels and medications. Out of 76 patients, 34 were prescribed medications of interest (inhaled corticosteroids (ICS), Inhaled corticosteroids - long-acting beta-agonists (ICS-LABA), anticholinergics (AC) monotherapy or combination therapy). After the FeNO testing, the number of patients on ICS therapy doubled (8 to 16), and the number of patients on ICS -LABA increased by 69.2%. Lastly, the number of patients not on medication of interest, 57.1%, ended up on one after FeNO testing. Our results support the utility of FeNO as a viable test to manage patients with obstructive lung disease.