asthma-COPD Overlap Group Research Articles

Suboptimal peak inspiratory flow rate: a noticeable risk factor for inhaler concordance in patients with chronic airway diseases

BackgroundInhaler concordance and the peak inspiratory flow rate (PIFR) are important determinants of treatment effects in patients with chronic airway diseases. Adequate PIFR is required for driving aerosol medication into...

Modulating asthma-COPD overlap responses with IL-17 inhibition.

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). 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. 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). 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.

0571 Associations Between Sleep Problems and Cardiovascular Disease and All-Cause Mortality in Asthma-COPD Overlap

Abstract Introduction Sleep problems (i.e., short and long sleep duration and sleep disorders) are common in persons with either asthma or chronic obstructive pulmonary disease (COPD) and have been linked to increased cardiovascular risk and mortality. This study determined whether sleep problems are associated with increased cardiovascular disease (CVD) prevalence and all-cause mortality in adults with asthma-COPD overlap (ACO). Methods Cross-sectional analysis of the 2007-2012 National Health and Nutrition Examination Survey (NHANES) and 2015 National Death Index. Participants (n=7616) were stratified into four groups, using self-report and spirometry data: asthma (n=483), COPD (n=1006), ACO (n=398), and those without asthma or COPD (controls; n=5729). Sleep duration hours were categorized as short (≤5), normal (6-8), and long (≥9). Self-report of physician diagnosis of a sleep disorder (Yes/No) and cardiovascular disease (angina, congestive heart failure, coronary heart disease, hypertension or myocardial infarction) were collected. Logistic and Cox regression models adjusted for covariates were employed. Results Prevalence of sleep disorders in ACO (24.7%) was roughly two times higher than rates in the asthma (10.7%) and COPD (13.5%) groups and 5 times higher than controls (4.6%). The ACO group had a higher proportion of short sleepers (27.6%) compared to COPD (19.2%) and controls (11.7%) and higher proportion of long sleepers (6.9%) compared to COPD (5.5%). Short sleepers had higher odds for CVD (OR=1.70, 95% CI, 1.34–2.15) compared to normal sleepers. Relative to ACO with normal sleep, long sleepers in the other groups had lower odds for CVD (all P-values &amp;lt;0.05). Both short and long sleepers in the control (HR=0.19, 95% CI 0.07–0.47, and HR=0.07, 95% CI 0.02–0.35, respectively) or COPD (HR=0.38, 95% C, 0.19–0.77, and HR=0.24, 95% CI 0.12–0.51, respectively) groups had lower hazards of all-cause mortality compared to ACO with normal sleep. The influence of presence of sleep disorders on CVD and mortality did not vary between groups. Conclusion Associations between sleep duration and increased risk of CVD and all-cause mortality were stronger in ACO as compared to COPD and controls. Persons with ACO may represent a high-risk group that should be targeted for assessment and treatment of sleep problems. Support (If Any)

Impact of asthma, chronic obstructive pulmonary disease (COPD), and asthma-COPD overlap on the prognosis of coronavirus disease 2019.

BackgroundThe effects of asthma, chronic obstructive pulmonary disease (COPD), or asthma-COPD overlap (ACO) on coronavirus disease 2019 (COVID-19) remain unclear.ObjectiveWe aimed to investigate the effects of chronic obstructive airway diseases such as asthma, COPD, and ACO on COVID-19.MethodsIn total, 5625 hospitalized patients with COVID-19 were divided into asthma, COPD, ACO, and control groups. A multivariate logistic regression analysis was performed to identify factors affecting the COVID-19 mortality rate. To find out whether chronic obstructive airway diseases such as asthma, COPD, and ACO affect COVID-19 mortality, 1:4 matching was performed, except for the ACO group alone due to a small number of patients.ResultsThe mortality rates of asthma, COPD, and ACO groups were about 2.3, 4.8, and 5.5 times higher than that of the control group, respectively. Although not statistically significant, the survival probability tended to decrease (asthma, COPD, and combined groups of asthma and ACO, hazard ratio [HR]: 1.84, 1.31, and 1.89, respectively). The survival probability of the combined groups of COPD, ACO, and asthma and the combined groups of COPD and ACO was significantly lower than that of the matched control group (HR: 3.00 and 1.99, respectively).ConclusionCompared to patients with COVID-19 without chronic obstructive airway disease, patients with these comorbidities are more likely to require oxygen and mechanical ventilators and have a higher mortality rate, which can be considered when classifying and monitoring patients in the era of COVID-19. Therefore, further studies are needed to evaluate the effect of chronic obstructive airway disease, especially ACO, on COVID-19 mortality.

Role of Aspergillus fumigatus sensitization in Patients with Asthma- COPD Overlap compared to asthma patients

Abstract Background Distinguishing asthma from COPD can be difficult especially among old age and smokers. Some patients have common features of asthma and COPD.1 (GINA, 2018). Hence, the definition of asthma COPD overlap (ACO) was developed. ACO is a considerable risk factor for healthcare utilization versus the general population, the asthma population and the COPD population.2(Minchul Kim et al., 2019). Fungal sensitization increase severity of asthma. Aim of the study To compare the prevalence of aspergillus fumigatus sensitization among ACO patients versus asthmatic patients and healthy normal control. Patients and Methods 90 individuals were included; 30 diagnosed as bronchial asthma (According to GINA 2018), 30 ACO patients and 30 healthy normal control. All are group matched to age and sex and selected from the allergy and chest outpatient clinics at Ain shams University hospitals. Total IgE, skin test for Aspergillus and spirometry were done to all participants. Results Aspergillus sensitization was more prevalent among ACO group compared to asthma group however, all control individuals were negative to aspergillus. FEV1 was significantly lower among ACO and asthma groups when compared to control. FEV1 increased significantly in the three groups after albuterol inhalation. Conclusion sensitization to Aspergillus was more among ACO patients compared to Asthma and control groups.

The Value of Impulse Oscillometric Parameters and Quantitative HRCT Parameters in Differentiating Asthma-COPD Overlap from COPD.

PurposeTo evaluate the value of impulse oscillometry (IOS) and quantitative HRCT parameters for differentiating asthma–COPD overlap (ACO) in COPD patients.Patients and MethodsWe enrolled 44 controls and 66 COPD patients, divided into the pure COPD group (n=40) and the ACO group (n=26). Spearman correlation analysis was utilized to assess the relationship between the quantitative HRCT and IOS parameters. A binary logistic regression analysis was performed to analyze the associations between the different variables and the risk of ACO. Receiver operating characteristic (ROC) curves were employed to identify the optimal cutoff and assess the diagnostic value of relative volume change −856 HU to −950 HU (RVC−856 to −950), decrease in the resistance from 5 Hz to 20 Hz (R5-R20) and their combination in predicting ACO. Bootstrapping validation was used to evaluate the internal validation. The concordance index (C-index) and calibration plot were calculated to assess the discrimination and calibration of the prediction model.ResultsBinary logistic regression analysis indicated that RVC−856 to −950 and the IOS parameters (R5-R20, R5, X5) were independently correlated with a higher risk of developing ACO after adjusting for age, sex, body mass index (BMI), history of smoking, exacerbation and atopy or allergic rhinitis. A correlation analysis showed a good correlation between the pulmonary function parameters and RVC−856 to −950, with a weaker correlation with the % area of low attenuation (LAA%) in ACO patients. Combining RVC−856 to −950 and R5-R20 to predict ACO, the AUC was 0.909, and the optimal cutoff value was >-0.62 for RVC−856 to −950 and >0.09 for R5-R20. Good calibration and favorable discrimination were displayed with a higher C-index.ConclusionMore serious small airway impairment exists in ACO patients. The combination of RVC−856 to −950 and R5-R20 could be applied to differentiate ACO from COPD patients.

Aspergillus fumigatus sensitization among asthma COPD overlap patients

Recently, many researchers are interested in studying asthma COPD overlap (ACO) group features. Sensitization to Aspergillus has been linked to increased severity of asthma; however, limited data is available about fungal sensitization in ACO group. This study was designed to determine the prevalence of Aspergillus fumigatus (A. fumigatus) sensitization among ACO patients in comparison to asthma patients. This cross-sectional study included 30 patients with ACO, and compared them to 30 asthmatic patients, as regards sensitization to A. fumigatus. Sensitization was diagnosed using skin prick test and specific IgE. Blood eosinophil count, total IgE and pulmonary functions results were also recorded. Thirteen patients with ACO (43.3%) were sensitized to A. fumigatus compared to 8 asthmatic cases (26.7%), P value 0.17. Blood eosinophil count and total IgE were significantly higher among ACO patients compared to asthma group (P values 0.003, 0.007 respectively). Blood eosinophil count was significantly higher among A. fumigatus sensitized ACO patients (400 cells/L) compared to 320 cells/L in non-sensitized ACO subgroup (P value 0.01). Otherwise, they were comparable regarding pulmonary functions and total IgE. In conclusion, Sensitization to A. fumigatus is higher among patients with ACO than that in patients with asthma but without a statistical significance. Moreover, Sensitized ACO patients showed significantly higher blood eosinophil count than non-sensitized ones.

Role of blood neutrophil to lymphocyte ratio and serum total IgE in diagnosis of asthma-COPD overlap among patients with COPD

Background: Some clinical and spirometric features are common to both COPD and asthma-COPD overlap (ACO), causing difficulties in distinguishing these airway diseases from each other. Since, both of them are characterized by airway inflammation, any inflammatory biomarker as blood neutrophil to lymphocyte ratio and serum total IgE can be used for this purpose.&#x0D; Objectives: To assess the role of blood neutrophil to lymphocyte ratio and serum total IgE in the diagnosis of ACO among patients with COPD.&#x0D; Methods: This cross sectional study was conducted in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University, Dhaka from March 2019 to February 2020. For this, 63 male stable patients (age 40 to 80 years) of COPD were enrolled and 51 of them were finally selected according to exclusion criteria. Then these 51 COPD patients were divided into ACO and COPD-alone groups, based on criteria from the joint document by the Global Initiative for Asthma (GINA) and the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Blood neutrophil to lymphocyte ratio (NLR) and serum total IgE of all patients were measured by standard lab procedure. For statistical analysis, Chi-Square test, Fisher exact test, Shapiro Wilk test, Mann-Whitney U test and receiver operating characteristic (ROC) curve analysis were done, as applicable.&#x0D; Results: Among the 51 COPD patients, 26 patients were diagnosed with ACO and 25 patients were with COPD-alone. Here, NLR was significantly lower (median 2.09 vs 3.43, respectively; p&lt;0.001) in ACO patients than that of COPD-alone. In addition, NLR showed ‘very good’ (area under ROC curve 0.815) diagnostic accuracy.&#x0D; Conclusion: The present study reveals that, blood neutrophil to lymphocyte ratio, but not serum total IgE can play substantial role in diagnosis of ACO among the patients with COPD&#x0D; J Bangladesh Soc Physiol. 2020, December; 15(2): 54-60

A study with overview of asthma, COPD that overlaps among different patients with different diseases

In this present time, it is a necessity to re-evaluate the basic concept of asthma as well as COPD, that these two are separate conditions, or when out of these two conditions one evolves from the other, or whether they both exists together. Total 60 numbers of patients were included in our prospective study, those all have chronic disease of airways and were classified into three respective groups namely, i) chronic obstructive pulmonary disease, asthma–COPD overlap (ACO) [WU1] [k2] and the last one is asthma. The patients were selected from outdoor patient department of Khaja Nawaz Institute of Medical Sciences from the month of January 2020 to the month of September 2020, where the patients that suffers from chronic obstructive pulmonary disease and ACO were diagnosed carefully according to “GOLD” guidelines 2020 and the patients that suffers from asthma were carefully diagnosed according to the GINA guidelines 2020. All the patients that were selected in the study only after careful and thorough history taking, clinical examination of the patient, all the laboratory finding was done carefully, chest X-ray was done, spirometry was done before administration of bronchodilator and again spirometry was done after the administration of bronchodilator i.e. reversibility test was done, and last but not the least, examination of sputum was done that too carefully for careful eosinophil count. Total number of patients included in the study was 60 that suffers from COPD, Asthma, Asthma [WU3] COPD overlap. It included 41 (68.3%) males and 19(31.6%) females. In our prospective study out of 60 19 patients i.e. 31.9% out of total were diagnosed of having COPD, out of 60, 18 i.e. 30% have problem of asthma, and 18 patients i.e. 30% out of total were having ACO. We in our study found that all the three experimental groups show history of atopy, with 61.9% patients belong to ACO group, 17.3% belongs to COPD and 84.2% belongs to Asthma [WU4] group. When comparison between all the experimental groups were made regarding sputum eosinophil count, revealed that all the three experimental groups show positive eosinophil count with respect to 22.2% in case of ACO, 84.2% in case of asthma group and 13% in case of COPD. Out of three experimental groups, only ACO group represents the highest percentage among different patients that have disease of obstructive airways. It also reveals some of the features of disease asthma like atopy and positive sputum eosinophil count along with some features of chronic obstructive pulmonary disease with respect to old age and those people has a positive history of smoking.

Clinical, functional and laboratory characteristics of patients with asthma-COPD overlap

Objective: to access some clinical, functional and laboratory features of patients with asthma-COPD overlap (ACO).Material and methods. Our study involved 120 patients and two ACO groups were created: asthmatic smokers - Group I and COPD patients with high degree of reversibility of airflow limitation and eosinophilic COPD (eosinophil blood count ≥2% and 200 cell/ml) - Group II. All the other COPD subjects – Group III. The spirometry testing were performed using computer spirograph «BTL-08SpiroPro» (Great Britain). Weight and body composition variables were measured with a body composition monitor (BC-601 Tanita, Japan). Blood eosinophils and total IgE levels were estimated. «Microsoft Excel», «Statistica» were used for mathematical and statistical analysis.Results. There were 28,3% of participants classified as ACO. The combination of long-acting beta-agonist and inhaled corticosteroids usage rate was higher among asthmatic smokers (2,3 and 1,8 times higher than in Group II and Group III respectively), as well as short acting beta-agonist and oral corticosteroid usage rates (1,7 and 2,3 times higher in Group I compared to Group II). The peripheral blood eosinophil and serum IgE levels were 1,8 and 3,3 times higher (p&lt;0,05) in Group II than in Group I and III. FEVI was higher in Group I by 7,6% and in Group II by 11,8% than in COPD. It has been demonstrated that among Group II subjects there was higher BMI( by 28,8% and 22,2% (p&lt;0,05)), the body fat percentage ( by 19,7% and 41,3% (р&lt;0,05)), the visceral fat level (by 16,7% and 20,3%(р&lt;0,05)) and the muscle mass(by 10,8% and 15,5%(р&lt;0,05)) than in asthmatic smokers and COPD patients respectively.Conclusion. The prevalence of ACO (asthmatic smokers, eosinophilic COPD and COPD with high degree of reversibility) among the examined subjects was 28,3%. COPD patients with high degree of reversibility and eosinophilic inflammation are characterized by higher blood eosinophil and total serum IgE levels, higher FEV1, amount of visceral fat, body fat percentage and especially muscle muss.

COPD Comorbidities Predict High Mortality – Asthma-COPD-Overlap Has Better Prognosis

The purpose of this study was to investigate the characteristics and survival of patients with COPD and asthma-COPD overlap (ACO) and how these patient groups differ from each other. We examined the impact of different comorbidities, multimorbidity, lung function and other factors have on survival in COPD and ACO patients. We also examined the causes of death to determine how many patients die of other than respiratory diseases. This retrospective study includes 214 patients with an exacerbation of COPD requiring hospitalisation during the year of 2005. The patients were followed up until the end of year 2015. The survival of ACO patients was significantly higher than COPD patients (4.7 vs. 1.7 years, p = 0.001). Poor lung function predicted worse survival in both patient groups, but the prognosis was still better in ACO patients with both FEV1 over and under 50% of predicted (median survival 8.4 years vs. 5.8 years, p < 0.001) compared to COPD (4.9 and 3.1 years, respectively). In this study setting, the negative effect of having three or more comorbidities on survival was significant in both groups. We didn’t see major differences in the profiles of comorbidity patterns, in the underlying cause of deaths or in the pulmonary functions between ACO and COPD groups at the beginning of follow-up. Patients with a BMI over 25 seemed to have a trend for better survival (p = 0.055), but no differences were found between ACO and COPD groups.

Role of pulmonary function and FeNO detection in early screening of patients with ACO.

Measurement of fractional exhaled nitric oxide (FeNO) is a quantitative and non-invasive approach to examine airway inflammation, which is a powerful aid in diagnosing chronic disorders of airways like asthma. Diagnostic value of FeNO and relevant indices on pulmonary function in the patients with asthma and chronic obstructive pulmonary disease (COPD) was evaluated. A total of 164 patients [58 asthma, 49 COPD and 57 asthma-COPD overlap (ACO)] were randomly recruited. FeNO, pulmonary ventilation function, and bronchial diastolic function were performed. Eight indicators including FeNO, vital capacity percentage (VC%), forced vital capacity percentage (FVC%), forced expiratory volume in one second percentage (FEV1%), forced expiratory volume in one second to forced vital capacity percentage (FEV1/FVC%), maximum independent ventilation volume percentage (MVV%), the increased percentage of FEV1 after bronchial diastolic test, the increased absolute value of FEV1 after bronchial diastolic test were examined. Significant difference in VC%, FVC%, FEV1%, FEV1/FVC%, MVV%, the increased absolute value of FEV1 after bronchial diastolic test and FeNO were significantly different between patients with asthma and patients with COPD (P<0.05). There were significant differences of VC%, FVC%, FEV1%, FEV1/FVC%, MVV% and the increased percentage of FEV1 after bronchial diastolic test in cases of patients with asthma compared to ACO patients (P<0.05). There was no statistical significance on VC%, FVC%, FEV1%, FEV1/FVC%, MVV% between COPD patients and ACO patients (P>0.05). However, more importantly, the increased percentage of FEV1 after bronchial diastolic test, the increased absolute value of FEV1 after bronchial diastolic test and the alterations on FeNO were found significantly different in ACO group compared with COPD alone (P<0.05). We compared the results from pulmonary ventilation function, bronchial diastolic function examination as well as FeNO detection among 3 groups of asthma, COPD and ACO. The examination of pulmonary ventilation function and bronchial diastolic function combined with FeNO detection is helpful in the early screening of ACO.

Effects of PM10 on mortality in pure COPD and asthma-COPD overlap: difference in exposure duration, gender, and smoking status

We investigated the effects of particulate matter (PM) on mortality in patients diagnosed with asthma-COPD overlap (ACO) or ‘pure COPD’. Subjects from the National Health Insurance Service–National Sample Cohort of Korea, who were aged 40 years or above and had newly diagnosed COPD since 2009 were selected. Finally, 6,313 patients were enrolled and divided into ‘pure COPD’ and ACO groups. Average PM10 exposure data were obtained using Kriging interpolation from 2001 to 2013. Hazard ratios(HR) were estimated using a time-varying Cox regression model. Exposure to PM10 for 1, 3, and 6 months was associated with an increase in non-accidental mortality in the entire COPD group, especially the ACO group. When a stratified analysis of 3-month exposure was performed by sex, the highest HR was found in women with ACO (HR = 1.153; 95% confidence intervals [CI]: 1.121, 1.185). A stratified analysis according to smoking status showed that ACO patients had the highest HR among never smokers (HR = 1.151; 95% CI; 1.124, 1.178). Average exposure to PM10 was associated with non-accidental mortality in patients with COPD, especially those diagnosed with ACO. In addition, the adverse effects of PM10 exposure are more severe in women and never-smokers.

Evaluation of the Characteristics of Asthma in Severe and Extremely Severe COPD.

BackgroundBiotherapy for asthma may be useful in patients suffering from chronic obstructive pulmonary disease (COPD) with asthma characteristics. Therefore, the evaluation and close monitoring of asthma characteristics in severe and extremely severe COPD can guide treatment decisions to improve prognosis.MethodsStable patients suffering from COPD and having a forced expiratory volume in 1 s (FEV1%) of ≤50% (GOLD 3–4) in the First Affiliated Hospital of Sun Yat-Sen University from December 2014 to June 2018 were retrospectively enrolled in this study and evaluated in terms of their asthma characteristics (blood eosinophil counts, fractional exhaled NO [FeNO] values, and reversibility).ResultsA total of 178 patients with an average age of 65.62±9.28 years were enrolled in this study. A total of 85 patients had an improvement of ≥12% in FEV1%, and 61 of these patients had an absolute increase of >200 mL. Of 122 patients, 68 had blood eosinophil counts of ≥150 cells/μl, whereas 27 showed blood eosinophil counts ≥300 cells/μl. The blood eosinophil of ≥2% was found in 66/122 (54.10%) patients, whereas ≥3% was found in 51/122 (41.80%) patients. A total of 46 of 58 patients had an increased serum IgE level of ≥30 IU/mL, and 32 patients had an IgE of ≥100 IU/mL. The FeNO value of ≥25 ACO (ppb) was found in 51/155 (32.90%) patients. Furthermore, 43 patients had asthma–COPD overlap (ACO), and the FeNO values in the ACO group was 26.13±14.91 ppb, which was significantly higher than that in the COPD alone group (20.99±9.16 ppb; P=0.016). A total of 12 patients with ACO had a negative response after bronchodilation. In the COPD alone group, 34 patients had an absolute increase of >200 mL, whereas 55 of the 95 patients had blood eosinophil counts of ≥150 cells/μl. The blood eosinophilia of ≥2% was found in 54/95 (56.84%) patients. A total of 36 of 45 patients had an increased serum IgE level of ≥30 IU/mL. The FeNO value of 34/123 (27.64%) patients was ≥25 ppb.ConclusionThe characteristics of asthma are common findings in patients with severe and extremely severe COPD. Biomarkers should be actively used to evaluate the characteristics of asthma in these patients. If the characteristics of asthma exist, then anti-IgE or anti-IL-5 therapy should be considered to reduce exacerbation.

Prevalence of self-reported sleep problems amongst adults with obstructive airway disease in the NHANES cohort in the United States.

Sleep and respiratory problems are common in adults in the USA. However, sleep problems often remain undiagnosed in patients with obstructive airway diseases (OADs). This study was designed to examine the association between sleep problems and different categories of OAD amongst US adults. We conducted an observational, cross-sectional study using a nationally representative sample of the US civilian non-institutionalized population from 2007 to 2008 National Health and Nutritional Examination Survey (NHANES). A total of 3204 study participants aged ≥35years were stratified into four groups, using a self-reported history of asthma and data from spirometry: asthma-COPD overlap (ACO) (n = 70, 2.2%), asthma (n = 168, 5.2%), chronic obstructive pulmonary disease (COPD) (n = 412, 12.8%), and those without any OAD (normal) (n = 2554, 79.7%). After characterizing the baseline demographics and health status of the four groups, multivariate logistic regression analysis was performed to estimate the likelihood of sleep problems in adults after adjusting for age, gender, body mass index, smoking, alcohol, obstructive sleep apnea syndrome (OSAS), depression, and diabetes. The index sample was the normal group. Sleep problems were defined as any complaints which affect or involve sleep. The participants with COPD were older (62.0 ± 11.7years) as compared to ACO (59.1 ± 11.3years), asthma (53.6 ± 11.3), and normal groups (53.8 ± 12.1) (p < 0.0001). Comparing baseline characteristics between the four groups, there were significant associations between OAD status and sleep problems including inadequate sleep, sleep-onset insomnia, snoring, frequent trouble sleeping, nocturnal arousals, early morning awakenings, fatigue, daytime sleepiness, use of prescription medication for sleep, leg jerks, leg cramps, difficulty in concentration, and difficulty in remembering things when tired. The multivariate logistic regression models evaluating the prevalence of sleep problems in individual OADs showed a stronger association between asthma and sleep problems as compared to COPD and ACO and sleep disorders. All OADs are associated with a higher prevalence of sleep problems. There is a stronger association between asthma and sleep problems as compared to COPD and ACO. We speculate that the nocturnal burden of asthma contributes to sleep problems. Our results suggest that adults with OAD should be aggressively screened for sleep problems.

Differences in the risk of mood disorders in patients with asthma-COPD overlap and in patients with COPD alone: a nationwide population-based retrospective cohort study in Korea

BackgroundAlthough feelings of anxiety and depression are common in patients with chronic obstructive pulmonary disease (COPD), little is known about the estimates of their incidence in patients with asthma-COPD overlap (ACO), which has been described and acknowledged as a distinct clinical entity. We aimed to estimate the risk of depression and anxiety among patients with ACO and compare it with the risk among those with COPD alone in the general population.MethodsWe conducted a nationwide population-based retrospective cohort study using the Korean National Sample Cohort database between 1 January, 2002, and 31 December, 2013. Patients who were diagnosed with COPD (International Classification of Diseases, 10th revision [ICD-10] codes J42-J44) at least twice and prescribed COPD medications at least once between 2003 and 2011 were classified into two categories: patients who were diagnosed with asthma (ICD-10 codes J45-J46) more than twice and at least once prescribed asthma medications comprised the ACO group, and the remaining COPD patients comprised the COPD alone group. Patients who had been diagnosed with depression or anxiety within a year before the index date were excluded. We defined the outcome as time to first diagnosis with depression and anxiety. Matched Cox regression models were used to compare the risk of depression and anxiety among patients with ACO and patients with COPD alone after propensity score matching with a 1:1 ratio.ResultsAfter propensity score estimation and matching in a 1:1 ratio, the cohort used in the analysis included 15,644 patients. The risk of depression during the entire study period was higher for patients with ACO than for patients with COPD alone (adjusted hazard ratio, 1.10; 95% confidence interval, 1.03–1.18; P value = 0.0039), with an elevated risk in patients aged 40–64 years (1.21; 1.10–1.34; 0.0001) and in women (1.18; 1.07–1.29; 0.0005). The risk of anxiety was higher for patients with ACO than for patients with COPD alone (1.06; 1.01–1.12; 0.0272), with a higher risk in patients aged 40–64 years (1.08; 1.00–1.17; 0.0392); however, the risk was not significant when stratified by sex.ConclusionsThis population-based study revealed a higher incidence of depression and anxiety in patients with ACO than in patients with COPD alone.

Clinical and laboratory characteristics of patients with cardiopulmonary comorbidence

Comorbidity of bronchial obstructive diseases and arterial hypertension (AH) is an important medico-social problem due to the increased incidence, the severity of complications, the tendency to increase mortality and disability of patients. However, the clinical characteristics and role of the major markers of inflammation in the pathogenesis of conditions such as chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap (ACO) against AH and their impact on the course of the disease remain poorly understood.The aim of the study is to study the main clinical and laboratory parameters of patients with ACO and COPD with concomitant AH compared with each other and patients with isolated AH and with ACO without AH.Materials and methods. To participate in the study, we selected 100 patients with ACO on the background of AH, 30 patients with ACO without AH, 30 patients with COPD on the background of AH, 30 patients with AH. Examination of patients included: clinical methods - analysis of complaints and anamnesis of patients, standard clinical examination with measurement of blood pressure and heart rate, anthropometric study with the determination of body mass index (BMI), spirometric study with a test for reversibility of bronchial obstruction, the concentration of interleukin 6 (IL-6), interleukin 8 (IL-8), tumor necrosis factor α (TNF-α) and C-reactive proteine (CRP) in serum were determined by enzyme immunoassay.Results. Patients of the surveyed groups did not differ significantly in age and gender composition. There were no significant differences in smoking status and major indicators of respiratory function in the ACO and COPD groups, unlike the AH group. However, the FEV1 increase after bronchodilator inhalation was significantly higher in the ACO groups than in the COPD group and only AH. No significant differences were found between the study groups on TNF-α. At the same time, the group of patients with ACO on the background of AH was significantly different from the group of only ACO, COPD with AH and only AH in terms of CRP and IL-6; for IL-8 there was a significant difference compared with the groups with ACO and COPD with AH, and there were no significant differences with the AH group.Conclusions. The less prolonged exposure of the smoking factor with the background of bronchial asthma leads to pronounced changes in respiratory function, similar to changes in COPD with greater exposure to smoking. ACO patients have a better reversal of bronchial obstruction in response to bronchodilators than patients with COPD, which may indicate a potential better response of this group of patients to bronchodilator treatment. The course of ACO on the background of AH is accompanied by more pronounced chronic inflammation

Correlation between expressions of myeloperoxidase and eosinophil cationic protein in sputum and clinical features of asthma-chronic obstructive pulmonary disease overlap

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. 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. No significant difference was observed in the CAT scores between ACO group and COPD group (P&gt; 0.05). Compared with the asthma group, the patients with ACO had significantly lower ACT scores and lower FEV1, PEF and MMF25/75 (P &lt; 0.05). The patients with ACO had significantly higher FVC and sputum eosinophil ratio than those with COPD (P &lt; 0.05), and a higher sputum neutrophil ratio than those with asthma (P &lt; 0.01). In ACO group, the MPO level in sputum was significantly higher than that in the asthma group (P &lt; 0.05), while sputum ECP level was significantly higher than that in both the asthma group and COPD group (P &lt; 0.05 or 0.01). In ACO group, sputum MPO level was positively correlated with sputum neutrophil ratio (r=0.8358, P &lt; 0.01) but was not correlated with CAT score or FEV1 (P&gt; 0.05); sputum ECP level was positively correlated with sputum eosinophil ratio (r=0.4666, P &lt; 0.05) and was inversely correlated with ACT score (r=-0.4966, P &lt; 0.05) and FEV1 (r=-0.4610, P &lt; 0.05). 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.

Health characteristics of patients with asthma, COPD and asthma-COPD overlap in the NHANES database.

IntroductionAsthma and COPD have overlapping characteristics. As there are limited data on whether asthma–COPD overlap (ACO) represents a distinct condition, this study aimed to determine the similarities and differences of ACO with asthma and COPD.MethodsUS population-based, cross-sectional study using National Health and Nutrition Examination Survey data (2009–2012) compared participants with ACO vs those with asthma or COPD, each as mutually exclusive disease states. Demographics, health status, disability/limitations, health care resource utilization, clinical characteristics, and peripheral blood eosinophil counts were analyzed.ResultsA total of 1,609, 479, and 299 participants with asthma, COPD, and ACO, respectively, were included. An age-matched asthma subgroup included 299 participants from the asthma group. Compared with asthma and COPD, participants with ACO had worse health status, increased disease burden, and more comorbid conditions. The ACO, vs age-matched asthma subgroup, had lower percent predicted prebronchodilator forced expiratory volume in 1 second (82.1% vs 88.0%; P=0.017). The ACO group had significantly more asthma attacks in the past year than the age-matched asthma subgroup (49.8% vs 38.4%; P<0.001). The ACO group had more participants with postbronchodilator forced expiratory volume in 1 second <80% predicted (52.1%) vs COPD (30.8%; P=0.003) and more participants with blood eosinophil counts ≥400 cells/µL (16.9%) vs COPD (9.5%; P=0.007) and the asthma subgroup (6.7%; P=0.014).ConclusionThe ACO group represents an important subset of patients with chronic respiratory disease with an increased burden of disease over asthma and COPD individually. Early identification of this population will enable appropriate therapeutic interventions in a timely manner.

Journal Club - Asthma/Chronic Obstructive Pulmonary Disease Overlap: Fact or Fiction?

With the development of biologics and the advent of “precision medicine” there is great interest in defining phenotypes and indeed endotypes that may identify responders based on clinical characteristics and/or underlying biological mechanisms. Recently, the Food and Drug Administration (FDA) voted against approval of mepolizumab for use in chronic obstructive pulmonary disease (COPD) stating that there was insufficient evidence to support mepolizumab as an add-on therapy for COPD patients guided by eosinophil levels. The FDA committee pointed to a lack of consensus over the definition and possible relevance of a so-called “eosinophilic COPD phenotype.” They pointed to the variability in blood eosinophils making it a challenge to use it as a potential marker to identify appropriate candidates for therapeutic trials. The committee recommended greater research with larger numbers and better patient characterization, including more female patients, (an important recommendation particularly given that women are known to have higher rates of airway hyper-responsiveness than men). Refining the characterization of the asthma/COPD overlap (ACO) group is key to moving forward in studying the use of biologics in this population. Recent studies have pointed to the benefits of long-acting muscarinic antagonists (LAMA) bronchodilators, originally only indicated for COPD, to be efficacious in some asthma patients (tiotropium has been approved by the FDA for asthma and COPD).1,2 Conversely, there have been several trials that have looked at the use of TH-2 pathway biologics typically reserved for asthma patients, (omalizumab,3 mepolizumab4-6and benralizumab7), in COPD patients thought to demonstrate potential overlap features (history of allergies, elevated immunoglobulin E [IgE], high eosinophil counts, asthma history, smoking history, partial reversibility). The various criteria used to define the ACO group have typically utilized some combination of these features. This is the backdrop for reviewing several recent papers that have focused on assessing the prevalence of ACO according to different ACO criteria and/or examined various potential clinical characteristics and/or biomarkers that may lead to greater discrimination in defining the potential endotypes within the ACO group. I present this particular collection of recent studies from this year mostly to demonstrate the highly variable, (and in some instances questionable), criteria for defining ACO patients. With more biologics for airway disease in the pipeline it is critical that we further refine our precision in defining the heterogeneity of the endotypes (or treatable traits) within the ACO group for better patient selection in clinical trials. Note: Abstracts are presented in their original, published format and have not been edited to match JCOPDF style.