asthma-COPD Overlap Syndrome Patients Research Articles

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.

Diagnostic Utility of Fractional Exhaled Nitric Oxide Findings in Patients of Asthma, COPD and Asthma and COPD Overlap

Asthma, COPD and COOP Overlap Syndromeare among the most prevalent chronic disorders affecting thegeneral population. The study was intended to understand thediagnostic utility of Fractional Exhaled Nitric Oxide (FeNO)testing in Asthma, COPD and Asthma COPD Overlap syndromepatients.

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.
 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.
 Conclusion: The case highlights the need for considering the ACOS separately as a risk and calls for a specific roadmap for perioperative management.
 
 
 Asthma-COPD Overlap Syndrome patients appear to be at high risk of PPCs
 There is a lack of evidence-based guidance and literature to tailor the management of such patients to reduce the perioperative risks for PPCs
 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.

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<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<0.05), SpO2 after 6MWT (p<0.001), dyspnea scale (p<0.001) and fatigue scale (p<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

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.

Comparison of therapeutic response between asthma,COPD, and ACOS patients by evaluation of spirometric findings

Asthma and Chronic obstructive pulmonary disease (COPD ) both are a common public health problem that affects a large portion of population. Nearly 20% of patients with obstructive lung disease have features of both asthma and COPD called ACOS that GOLD_GINA guidelines defines as persistent airflow limitation with several features of asthma and several features of COPD. Yet there is a little data available about diagnosis and treatment of this entity and current study aimed to compare therapeutic response between asthma, COPD and Asthma-COPD overlap syndrome (ACOS) subjects through spirometric data. In the present cross-sectional study, 30 known patients with mild to moderate asthma, 30 known patients with mild to moderate COPD and 30 known patients with mild to moderate ACOS according to GOLD_GINA guidelines were enrolled. We assessed post bronchodilator the ratio of the forced expiratory volume in the first one second to the forced vital capacity of the lungs (fev1) and the forced expiratory volume in the first one second to the forced vital capacity of the lungs (fev1/fvc) in all patients. Then they took standard treatment for 2 months and after this period spirometry was repeated. Spirometric data's changes was compared between the three groups by SPSS26 statistical software. Fev1 changes in response to treatment did not differ significantly between three groups (p > 0.05) but fev1/fvc changes differed significantly and this parameter in asthma was more than ACOS and in COPD was least. (In asthma, spirometric symbolized therapeutic response is more significant than ACOS, and in ACOS, it is more important than COPD in terms of fev1/fvc changes) and there was not any difference between the three groups regarding to FEV1 changes.

The Prevalence of Asthma-COPD Overlap Syndrome in Patients with Obstructive Airway Disease in Kerman, Iran

Background: The coexistence of asthma and chronic obstructive pulmonary disease (COPD) is recognized as asthma–COPD overlap syndrome (ACOS). This study aimed to investigate the prevalence of ACOS and the characteristics of the affected patients in terms of chronic pulmonary airway diseases in the southeastern Iran, Kerman.Methods: This cross-sectional study was conducted in Kerman province, Iran, from March 2017 to March 2018. 295 patients with a history of chronic pulmonary airway diseases including asthma and COPD were enrolled through convenience sampling. Spirometry was performed and forced expiratory volume (FEV1), forced vital capacity (FVC), and FEV1/FVC were calculated. The physician made the final diagnosis according to GOLD/GINA criteria. Chi-square, Fisher’s exact test, t-test, and Mann–Whitney U test were used to compare variables through SPSS version 23.Results: The ACOS prevalence was 36.9% (95% CI: 31.5- 42.7). Asthma patients were younger than ACOS patients (P = 0.001) and they had higher levels of FEV1 (P = 0.02), FEF (P ≤ 0.001), and FEV1/FVC (P ≤ 0.001) before receiving bronchodilator in comparison to ACOS patients. However, COPD patients were older than the ACOS patients (P ≤ 0.001). The lung function in ACOS patients before and after receiving bronchodilators was higher for FEV1 and FVC in COPD patients.Conclusion: The prevalence of ACOS was considerable. The present study showed that gender, age, and BMI could be associated with ACOS. The risk factors underlying ACOS and their impact on the patient’s life quality and treatment costs can be investigated by future studies.

Impact of Vitamin D supplementation on Heart Rate Variability in Vitamin D deficient Asthma COPD Overlap Syndrome patients: A Randomized Controlled Trial

Background:Vitamin D3 deficiency is common in Asthma COPD overlap syndrome (ACO) and administration of vitamin D3 increased heart rate variability in healthy subjects.
 Objective: This randomized clinical trial aimed to investigate the therapeutic effect of vitamin D3administration on time domain measures of heart rate variability in 51 male vitamin D3(<30- 10ng/ml) deficient ACO patients.
 Methods: Patients were given either vitaminD3 capsule or placebo per week orally for 3 months and serum vitamin D3 level and time domain parameters of heart rate variability were assessed before and after the intervention. For statistical analysis, independent and paired sample t test was used.
 Results: Before intervention, vitamin D3 level and time domain parameters of heart rate variability were similar in all patients but these outcome measures significantly increased in vitamin D3 treated but not in placebo treated patients after 3 months.
 Conclusion:In conclusion, vitaminD3therapy is effective to improve heart rate variability in vitamin D3 deficient Asthma COPD overlap syndrome.
 J Bangladesh Soc Physiol. 2020, December; 15(2): 98-107

Study of clinical, radiological, and pulmonary function characteristics of patients having asthma-chronic obstructive pulmonary disease overlap syndrome

Background: Asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome defined as a syndrome characterized by persistent airflow limitation with several features usually associated with asthma and several features usually associated with COPD. This overlap makes the difference between COPD and asthma with persistent airflow limitation difficult, especially in smokers and elderly people. Objective: The objective of the study was to study the clinical features, radiological and pulmonary function characteristics of patients having asthma-COPD overlap syndrome. Materials and Methods: A cross-sectional study carried out at the Department of Respiratory Medicine, Government Medical College, Baroda, attached to SSG Hospital, Vadodara. A total of 100 patients enrolled which were clinically diagnosed with chronic airway obstruction as defined in the GOLD/GINA asthma-COPD overlap syndrome (ACOS) guidelines. Results: In this study, a total of 100 patients were enrolled, out them 76 patients were male and 24 patients were female. Fifty-three patients were from urban area and 47 patients from rural area. Most patients belong to age ranging from 40 to 86. Ninety-nine patients had a breathlessness and it was the most common symptom followed by chronic cough in 93 patients, sputum production in 70 patients, wheezing in 70 patients, running nose in 65 patients, and chest tightness in 46 patients. In smoking history, 25 patients were current smoker, 49 patients were ex-smoker, and 26 patients had never smoked in their life. In pulmonary function test, 26 patients had a normal test, 13 patients had obstructive abnormality with no significant bronchodilator reversibility, 54 patients had a obstructive abnormality with significant bronchodilator reversibility, and 7 patients had a restrictive abnormality. Conclusion: Clinically diagnosed ACOS patients were mostly males, belong to middle age groups, had breathlessness, wheezing, chronic cough with sputum production, and rhinitis and sneezing as the major symptoms. The pulmonary function tests revealed majority of the patients having obstructive pattern in pulmonary function test (spirometry). Furthermore, a majority of these patients had significant positive bronchodilatory response.

THE PREVALENCE AND PATIENT CHARACTERISTICS OF ASTHMA-COPD OVERLAP SYNDROME AMONG CHRONIC AIRFLOW LIMITATIONS PATIENTS: HOSPITAL-BASED STUDY

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: Distinguishing asthma from COPD can be problematic, particularly in smokers and older adults. Asthma-COPD overlap syndrome (ACOS) is identified by the clinical features that it shares with both asthma and COPD. In epidemiological studies, reported prevalence rates for ACOS have wide range between 15-20% reflects the different criteria that have been used by different investigator for diagnosing ACOS. Moreover, there is still no data about ACOS prevalence in Indonesia. Therefore, we aimed to determine prevalence and patient characteristics of ACOS among chronic airflow limitations patients in Indonesia. METHODS: This hospital-based cross sectional study conducted in asthma and COPD patients. Patients were male or female, 40 years or older and able to perform a spirometry and bronchodilator test. ACOS diagnosis was made using modified GINA/GOLD 2017 criteria which at least three clinical features that support asthma and COPD. RESULTS: This study showed that ACOS prevalence from 60 subjects was 58.3%. Characteristic patients identified as having ACOS had mean age of 61.5±10.2 year, median Brinkman index 0.5, mean BMI of 24.9±3.8% kg/m2 and the most common symptoms were shortness of breath (88.7%) and wheezing (77.1%). Spirometry result showed better lung function with variability was 10.1% and increase in forced expiratory volume in 1 second (FEV1) 158.3±97.2 ml after bronchodilator test. Chest radiograph from ACOS patient showed 48.6% had severe hyperinflamation. CONCLUSIONS: The prevalence of ACOS was high in hospital based using GINA/GOLD criteria among asthma and COPD patients. To manage ACOS patients effectively it is necessary to identify it accurately. CLINICAL IMPLICATIONS: This results may have an clinical implication on the early identification of ACOS and to manage patients for the most appropriate therapy. DISCLOSURES: No relevant relationships by Triya Damayanti, source=Web Response No relevant relationships by Rania Imaniar, source=Web Response no disclosure on file for Faisal Yunus

Pulmonary mycosis in asthma-chronic obstructive pulmonary disease overlap syndrome

Background: Chronic obstructive pulmonary disease (COPD) and asthma are the two most commonly seen obstructive airway disorders, affecting millions of people across the world. Asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) includes the patients having features of both COPD and asthma. Objectives: The objectives of the study were to evaluate spectrum of fungal infection in sputum/induced sputum/bronchoalveolar lavage (BAL) samples of ACOS patients. Materials and Methods: Our prospective study conducted on 80 patients diagnosed ACOS, in exacerbation, of either sex attending the Department of Respiratory Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, after taking permission from the ethical committee. Sputum or induced sputum or BAL sample was collected in sterile vials and sent to the microbiology department for the examination for fungal species. In microbiology, sputum/BAL samples were subjected to direct microscopic examination using KOH and cultured on Sabouraud Dextrose Agar. The culture was observed daily until 21 days for any fungal growth. Results: Out of 80 patients of ACOS, 43 were males and 37 were females. Culture results were positive for fungal species in 33 patients out of 80 patients (41.2%). Different species of fungi were cultured such as Candida (22.6%), Aspergillus flavus (5%), Aspergillus fumigatus (2.5%), Aspergillus niger (2.5%), Penicillium non-marneffei (3.8%), Trichosporon spp. (3.8%), and Geotrichum spp. (1.3%). Conclusion: Our observations show that a wide spectrum of fungal species is prevalent in respiratory tract in ACOS patients. Determination of pulmonary mycosis in ACOS is required to detect, and treat the coinfection with fungus well in time and decrease morbidity and mortality due to ACOS.

Overlapping of Asthma and Chronic Obstructive Pulmonary Disease: A Literature Review

: Asthma and chronic obstructive pulmonary disease (COPD) are the most common chronic respiratory diseases with significant morbidity in the world. Although these diseases have different characteristics, some patients share symptoms and clinical findings of both diseases, so-called asthma-COPD overlap syndrome (ACOS). Although there is no gold standard for the diagnosis of ACOS, it is usually defined as an increased variability of airflow in the respiratory tract. Patients with ACOS are identified with distinct phenotypes such as the increased reversibility of airflow obstruction, eosinophilic bronchial and systemic inflammation, and the increased reaction to inhaled corticosteroids compared to COPD patients. The evidence indicates that ACOS patients are likely to have more dyspnea and cough, more serious symptoms, more hospital admissions, and higher mortality rate. Despite these complex conditions, ACOS patients have been eliminated from clinical trials of asthma and COPD and there is little evidence about their clinical decisions. The current study was conducted to review the epidemiology, clinical symptoms, diagnosis, and treatment of ACOS as the first stage of correct diagnosis and appropriate management of this syndrome in databases such as PubMed, Elsevier, Google Scholar, SID, Magiran, Google search engine, and so on.

Value of Exhaled Nitric Oxide (FeNO) And Eosinophilia During the Exacerbations of Chronic Obstructive Pulmonary Disease Requiring Hospital Admission

The aim of this study was to analyze whether FeNO levels in acute exacerbation of COPD (AECOPD) with hospital admission have better diagnostic value than eosinophilia in blood, and to evaluate its usefulness in predicting a better clinical response. An observational prospective study of patients with AECOPD was carried out. FeNO determinations were made on arrival at the emergency room (ER), at discharge and during stability 3–6 months after discharge. Co-morbidities, bronchodilators, inhaled (IGC) and systemic (SGC) glucocorticoids, eosinophils, systemic inflammation markers (procalcitonin, C-reactive protein), eosinophil cationic protein, and total IgE were collected. Fifty consecutive patients (92% men, mean age 75 ± 6 years) were included in this study. Phenotypes were 26% Asthma-COPD Overlap Syndrome (ACOS), 42% chronic bronchitis (CB) and 32% emphysema. ACOS patients showed significantly higher levels of FeNO (73 ppb) and eosinophils (508 cells/mm3) than the rest (CB: 23 ppb, 184 cells/mm3, emphysema: 27 ppb, 159 cells/mm3; p < 0.05). A significant correlation between FeNO levels measured in ER and eosinophils was observed (r = 0.7; p < 0.001), but not at discharge or in stable phase. No significant association was found with parameters of systemic inflammation and mean stay. In conclusion, the determination of FeNO in AECOPD does not offer advantages over the evaluation of eosinophilia. These parameters rise at arrival in ER, descend at discharge, and remain unchanged in the stable phase. Both present similar diagnostic utility and are able to better identify the ACOS phenotype, which helps select a population that could benefit from a glucocorticoids therapy.

The relationship of depression in asthma-chronic obstructive pulmonary disease overlap syndrome.

PurposeTo clarify the relationship between asthma–chronic obstructive pulmonary disease overlap syndrome (ACOS) and depression.MethodsWe identified 10,911 patients who received an ACOS diagnosis and concurrent treatment between January 2000 and December 2009. Subjects without ACOS were included in the non-ACOS cohort (n = 10,911). Cox proportional hazard regression analysis was performed to compare the risk of depression between the ACOS and non-ACOS cohorts.ResultsThe risk of depression was higher in the ACOS cohort than in the non-ACOS cohort (adjusted hazard ratios (aHRs) = 1.67, 95% confidence interval [CI] = 1.48–1.88). In the ACOS cohort, the aHRs for depression were [2.44 (95% CI = 1.45–4.11); 2.36 (95% CI = 1.58–3.52)] in patients [aged 20–39 years; without comorbidity]. In the ACOS cohort, the aHRs for depression were 1.70 (95% CI = 1.51–1.93) and 1.84 (95% CI = 1.55–2.19) in patients without inhaled corticosteroids (ICSs) and oral steroids (OSs) use, respectively. Moreover, the aHRs for the risk of depression were 1.16 (95% CI = 0.95–1.41) and 1.12 (95% CI = 0.96–1.29) in patients with ICSs and OSs use, respectively.ConclusionThe risk of depression is higher in ACOS patients, even in those without comorbidities or in young adults. The events of the depression were not significant difference in patients receiving the ICSs/OSs between the ACOS and the non-ACOS cohorts.

Clinical implications of blood eosinophil count in patients with non-asthma-COPD overlap syndrome COPD.

BackgroundRecent studies that assessed the relevance of the blood eosinophil count as a biomarker in patients with COPD may have overestimated it because they included patients with asthma–COPD overlap syndrome (ACOS). We investigated the clinical implications of the blood eosinophil count in patients with non-ACOS COPD.Patients and methodsFrom a Korean COPD Subtype Study (KOCOSS) cohort, we selected patients with non-ACOS COPD after excluding ACOS patients according to Spanish criteria. Clinical characteristics and the incidence of moderate-to-severe exacerbation were compared among the four groups stratified according to the quartiles of blood eosinophil percent and count.ResultsOf the KOCOSS cohort of 1,132 patients with COPD, 467 non-ACOS COPD patients (41.2%) with data of blood eosinophil count remained after excluding those with ACOS based on the Spanish definition. There was no difference in clinical characteristics among groups classified according to the quartiles of eosinophil percent and count. On multivariate logistic regression, eosinophil quartiles in percent and absolute count were not associated with the incidence of moderate-to-severe acute exacerbations of COPD (AECOPD). The eosinophil count did not affect the risk of AECOPD or forced expiratory volume in 1 second (FEV1) changes according to exposure to inhaled corticosteroid (ICS). However, by increasing the cutoff value for the eosinophil count from 200/μL to 600/μL, the odds ratio for risk of exacerbation increased serially from 0.82 to 2.96 on trend analysis.ConclusionIn patients with non-ACOS COPD, the blood eosinophil count and percent were not associated with FEV1 changes, quality of life (QoL), AECOPD frequency, or response to ICS. The clinical implication of the blood eosinophil count should not be overestimated in patients with non-ACOS COPD.

Differences between asthma-COPD overlap syndrome and adult-onset asthma.

Differences between asthma-COPD overlap syndrome (ACOS) and adult-onset asthma are poorly understood. This study aimed to evaluate these differences in a clinical cohort of patients with adult-onset asthma, as a part of the Seinäjoki Adult Asthma Study (SAAS).188 patients were diagnosed with adult-onset asthma and re-evaluated 12 years after diagnosis. They were divided into three groups based on smoking history and post bronchodilator spirometry values: 1)never- and ex-smokers with <10 smoked pack-years; 2) non-obstructive (forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ≥0.7) patients with ≥10 pack-years; and 3) ACOS patients with ≥10 pack-years and FEV1/FVC <0.7.ACOS patients had lower diffusing capacity (DLCO/VA 86% predicted versus 98 or 96% predicted; p<0.001), higher blood neutrophil levels (4.50 versus 3.60 or 3.85×109 L-1; p=0.008), and higher IL-6 levels (2.88 versus 1.52 or 2.10 pg·mL-1, p<0.001) as compared to never- and ex-smokers with <10 pack-years, or non-obstructive patients with ≥10 pack-years smoking history, respectively. ACOS patients also showed reduced lung function, higher remaining bronchial reversibility and a higher number of comorbidities.This study shows distinct differences in diffusing capacity, blood neutrophil and IL-6 levels, bronchial reversibility, lung function and comorbidities between ACOS and adult-onset asthma. The present findings should be considered in the comprehensive assessment of adult asthma patients.

Sagittal-lung CT measurements in the evaluation of asthma-COPD overlap syndrome: a distinctive phenotype from COPD alone.

This study aimed at investigating the capability of sagittal-lung computed tomography (CT) measurements in differentiating chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap syndrome (ACOS). Clinical and high-resolution CT of 229 patients including 123 pure COPD patients and 106 ACOS patients were included. Sagittal-lung CT measurements in terms of bilateral lung height (LH), anterior-posterior lung diameter (APLD), diaphragm height (DH), and anterior sterno-diaphragmatic angle (ASDA), as well as inter-pulmonary septum length (IPSL) on axial images were measured both before and after bronchodilator (BD) administration. Comparisons of clinical characteristics and CT measurements between patient groups were performed. All pre-BD quantitative sagittal features measuring diaphragm flattening and hyperinflation were not significantly different between patients with COPD and patients with ACOS (P values all >0.05). Following BD administration, the ACOS patients exhibited lower left LH, bilateral APLD, and bilateral ASDA, but higher right DH, compared to pure COPD patients (P values all <0.05). Right LH, left DH and IPSL were not significantly different between patient groups. Besides, variations of all sagittal-lung CT measurements were significantly larger in patients with ACOS than in patients with pure COPD (P values all <0.001) and showed high performance in differentiating these two kinds of patient, with diagnostic sensitivities ranging from 76.4 to 97.2%, specificities ranging from 86.2 to 100.0%, and accuracies ranging from 80.9 to 90.7%. Sagittal-lung CT measurements allow for differentiating patients with ACOS from those with pure COPD. The ACOS patients had larger post-BD variations of sagittal-lung CT measurements than patients with pure COPD.

Asthma-chronic obstructive pulmonary disease overlap syndrome – Literature review and contributions towards a Portuguese consensus

IntroductionPhenotypic overlap between the two main chronic airway pulmonary diseases, asthma and chronic obstructive pulmonary disease (COPD), has been the subject of debate for decades, and recently the nomenclature of asthma-COPD overlap syndrome (ACOS) was adopted for this condition. The definition of this entity in the literature is, however, very heterogeneous, it is therefore important to define how it applies to Portugal. MethodsA literature review of ACOS was made in a first phase resulting in the drawing up of a document that was later submitted for discussion among a panel of chronic lung diseases experts, resulting in reflexions about diagnosis, treatment and clinical guidance for ACOS patients. ResultsThere was a consensus among the experts that the diagnosis of ACOS should be considered in the concomitant presence of: clinical manifestations characteristic of both asthma and COPD, persistent airway obstruction (post-bronchodilator FEV1/FVC<0.7), positive response to bronchodilator test (increase in FEV1 of ≥200mL and ≥12% from baseline) and current or past history of smoking or biomass exposure. In reaching diagnosis, the presence of peripheral eosinophilia (>300eosinophils/μL or >5% of leukocytes) and previous history of atopy should also be considered. The recommended first line pharmacological treatment in these patients is the ICS/LABA association; if symptomatic control is not achieved or in case of clinical severity, triple therapy with ICS/LABA/LAMA may be used. An effective control of the exposure to risk factors, vaccination, respiratory rehabilitation and treatment of comorbidities is also important. ConclusionsThe creation of initial guidelines on ACOS, which can be applied in the Portuguese context, has an important role in the generation of a broad nationwide consensus. This will give, in the near future, a far better clinical, functional and epidemiological characterization of ACOS patients, with the ultimate goal of achieving better therapeutic guidance.

Relationship between Fractional Exhaled Nitric Oxide Level and Efficacy of Inhaled Corticosteroid in Asthma-COPD Overlap Syndrome Patients with Different Disease Severity.

This study explored the relationship between the fractional exhaled nitric oxide (FeNO) level and the efficacy of inhaled corticosteroid (ICS) in asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) patients with different disease severity. A total of 127 ACOS patients with ACOS (case group) and 131 healthy people (control group) were enrolled in this study. Based on the severity of COPD, the ACOS patients were divided into: mild ACOS; moderate ACOS; severe ACOS; and extremely severe ACOS groups. We compared FeNO levels, pulmonary function parameters including percentage of forced expiratory volume in 1 second (FEV1) to predicted value (FEV1%pred), ratio of FEV1 to forced vital capacity (FEV1/FVC), inspiratory capacity to total lung capacity (IC/TLC) and residual volume to total lung capacity (RV/TLC), arterial blood gas parameters, including PH, arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2), total serum immunoglobulin E (IgE), induced sputum eosinophil (EOS), plasma surfactant protein A (SP-A), plasma soluble receptor for advanced glycation end products (sRAGE), sputum myeloperoxidase (MPO), sputum neutrophil gelatinase-associated lipocalin (NGAL) and Asthma Control Test (ACT) scores, and COPD Assessment Test (CAT) scores. Compared with pre-treatment parameters, the FeNO levels, RV/TLC, PaCO2, total serum IgE, induced sputum EOS, plasma SP-A, sputum MPO, sputum NGAL, and CAT scores were significantly decreased after 6 months of ICS treatment, while FEV1%pred, FEV1/FVC, IC/TLC, PH, PaO2, plasma sRAGE, and ACT scores were significantly increased in ACOS patients with different disease severity after 6 months of ICS treatment. This finding suggests that the FeNO level may accurately predict the efficacy of ICS in the treatment of ACOS patients.

Asthma COPD Overlap Syndrome: An Approach to A Real -World Endotype in Obstructive Lung Disease?

Although some patients with obstructive lung disease (OLD) have features of both asthma and chronic obstructive pulmonary disease (COPD), the term "asthma-COPD overlap syndrome (ACOS)" was coined only relatively recently. However, there are gaps in our knowledge of the clinical features, pathogenesis, prognosis, and management of ACOS patients. To review the literature on ACOS to determine the extent to which the clinical features, pathologic mechanisms, clinical outcomes, and current therapeutic approaches for ACOS differ from those in patients with asthma alone or COPD alone. PUBMED searches were conducted to review the demographic and clinical features, comorbidities, lung imaging characteristics, prognoses, pathologic mechanisms, and current therapeutic approaches for patients with ACOS versus asthma alone or COPD alone. Criteria that are used to diagnose ACOS vary considerably. Overall, ACOS patients have higher symptom burdens (especially dyspnea), poorer quality of life scores, and more frequent and severe exacerbations than patients with COPD alone or asthma alone. However, there are conflicting reports on the prognosis of ACOS patients. Imaging studies indicate that ACOS is predominantly an airway disease. ACOS has been linked to the presence of Th2-type immune responses in COPD airways and Th1-type immune responses in asthmatic airways. Current therapeutic options for ACOS patients include inhaled corticosteroids and bronchodilators. However, randomized clinical trials have not yet been conducted to optimize the management of ACOS patients. ACOS patients have clinical features that are now well defined, but additional studies are needed to provide novel insights into ACOS pathogenesis, and to optimize the treatment of these patients.