asthma-COPD Overlap Syndrome Research Articles

Electronic cigarette use and its association with asthma, chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap syndrome among never cigarette smokers.

INTRODUCTIONAlthough smoking is a strong risk factor for lung diseases including asthma, COPD, and asthma-COPD overlap syndrome (ACOS), studies are needed to examine the association between e-cigarettes and asthma, COPD, and ACOS. This study evaluated the association between e-cigarette use and self-reported diagnosis of asthma, COPD, and ACOS using a large nationally representative sample of adults aged ≥18 years in the United States.METHODSCross-sectional data from the Behavioral Risk Factor Surveillance System (BRFSS) from 2016 to 2018 was used to examine self-reported information on current e-cigarette use, demographic variables, and asthma and COPD status among never cigarette smokers (n=8736). Asthma and COPD were measured by self-reported diagnosis, and respondents who reported having both diagnoses were then classified as having ACOS. Of the 46079 never cigarette smokers, 4368 non-e-cigarette smokers were 1:1 propensity score-matched to e-cigarette smokers on age, sex, race/ethnicity and education level. We used multinomial logistic regression to examine association between current e-cigarette use and self-report asthma, COPD, and ACOS while controlling for marital status and employment in addition to matching variables.RESULTSCompared with never e-cigarette smokers, e-cigarette smokers had increased odds of self-reported ACOS (OR=2.27; 95% CI: 2.23–2.31), asthma (OR=1.26; 95% CI: 1.25–1.27) and COPD (OR=1.44; 95% CI: 1.42–1.46).CONCLUSIONSData from this large nationally representative sample suggest that e-cigarette use is associated with increased odds of self-reported asthma, COPD, and ACOS among never combustible cigarette smokers. The odds of ACOS were twice as high among e-cigarette users compared with never smokers of conventional cigarettes. The findings from this study suggest the need to further investigate the long-term and short-term health effects of e-cigarette use, since the age of those at risk in our study was 18–24 years.

Comparative RNA-Seq Transcriptome Analysis on Pulmonary Inflammation in a Mouse Model of Asthma-COPD Overlap Syndrome.

Asthma–chronic obstructive pulmonary disease (COPD) overlap (ACO) is a severe clinical syndrome characterized to describe patients with both asthma and COPD clinical characteristics, which has posed a serious threat to patients’ quality of life and life safety. However, there are many difficulties and uncertainties in its diagnosis and treatment in clinic; especially, its animal model has not been fully and thoroughly established, and the evaluation of therapeutic drugs is still in its infancy. Here, we used ovalbumin (OVA), lipopolysaccharide (LPS), and smoke costimulation to establish an ACO mouse model and then used RNA-seq technology to detect gene expression in mouse lung tissue. The results showed that ACO mice showed an overlap syndrome of asthma and COPD in lung histological changes and the levels of inflammatory cytokines in bronchoalveolar lavage fluid. The RNA-seq analysis results showed that 6,324 differentially expressed genes (DEGs) were screened between the ACO group and the control group, of which 2,717 (42.7%) were downregulated, and 3,607 (57.3%) were upregulated. Metascape analysis results showed that in the ACO model we established, due to the damage of the respiratory system, the accumulated diseased tissue involves lung, spleen, blood, bone marrow, thymus, etc. It has certain characteristics of pneumonia, pulmonary fibrosis, and chronic obstructive airway disease, lung tumors, rheumatoid arthritis. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analysis showed that DEGs were enriched in inflammation, immune system activation and imbalance, cell proliferation, and adhesion migration, and the upstream signaling pathways of inflammation were mainly affected by HLA-DRA, SYK, CTLA4, VAV1, NRAS, and JAK3. In short, our research established a mouse model that can better simulate the clinicopathological characteristics of ACO and suggested the foundations in elucidating the molecular mechanisms for pulmonary inflammation and fibrosis in ACO. This work may help further research and contribute substantially to prevention and clinical treatment of ACO in the future.

Deconstruyendo los fenotipos en la EPOC: un análisis de la cohorte TRACE

ObjectivesIn a clinical phenotype-based management strategy for COPD, it would be preferable to at least assign all patients to a phenotype, but to a single phenotype only. The aim of this study was to evaluate whether all patients are assigned to one and only one phenotype using the Spanish COPD guidelines (GesEPOC) and to evaluate the criteria that define these categories. MethodThe Time-based Register and Analysis of COPD Endpoints study (TRACE; clinicaltrials.gov NCT03485690) is a prospective cohort of COPD patients attending annual visits since 2012, which collects GesEPOC phenotypes. Although the GesEPOC recommends that patients considered to be at low risk are not phenotyped, an analysis of the criteria for identifying high- and low-risk phenotypes was performed, comparing the distribution of phenotypes and the criteria applied between these 2 groups. ResultsThe cohort included 970 patients with a confirmed diagnosis of COPD, divided into 427 (44.02%) low-risk and 543 (55.9%) high-risk patients. The most frequent phenotype was the non-exacerbator (44.9% of high-risk patients). Overall, 20.6% of low-risk patients met criteria for asthma-COPD overlap syndrome, while 9.2% of the cohort did not meet the diagnostic criteria for any phenotype, and 19.1% met the criteria for 2 phenotypes, with no differences between risk groups. ConclusionsOur data highlight some of the weaknesses of the current clinical phenotype strategy, revealing overlapping categories in some cases, and patients to whom no phenotype was assigned.

Astma, przewlekła obturacyjna choroba płuc (POChP), zespół współistnienia astmy i POChP a ryzyko ciężkiego przebiegu COVID-19

Asthma, chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap syndrome (ACOS) significantly affect the patient's respiratory system, which requires individualised treatment and professional control During the SARS-CoV-2 pandemic, all respiratory diseases were taken into consideration as risk factors for severe COVID-19 ACE2 and TMPRSS2 genes, which are crucial for SARS-CoV-2 to enter the host cell, have different expression in the occurrence of asthma or COPD Also, comparing the severity and mortality of patients with coexistence of asthma or COPD and COVID-19, only COPD patients had worse outcomes of COVID-19, and their mortality was significantly higher Although ACOS is also a potential risk factor for hospitalisation and mortality in COVID-19 patients, the condition still requires further studies This overview presents the current state of knowledge on the relationship between the diseases mentioned above and COVID-19

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

Development and Clinical Application of a Novel Non-contact Early Airflow Limitation Screening System Using an Infrared Time-of-Flight Depth Image Sensor.

Obstructive pulmonary diseases, such as diffuse panbronchiolitis (DPB), asthma, chronic obstructive pulmonary disease (COPD), and asthma COPD overlap syndrome (ACOS) trigger a severe reaction at some situations. Detecting early airflow limitation caused by diseases above is critical to stop the progression. Thus, there is a need for tools to enable self-screening of early airflow limitation at home. Here, we developed a novel non-contact early airflow limitation screening system (EAFL-SS) that does not require calibration to the individual by a spirometer. The system is based on an infrared time-of-flight (ToF) depth image sensor, which is integrated into several smartphones for photography focusing or augmented reality. The EAFL-SS comprised an 850 nm infrared ToF depth image sensor (224 × 171 pixels) and custom-built data processing algorithms to visualize anterior-thorax three-dimensional motions in real-time. Multiple linear regression analysis was used to determine the amount of air compulsorily exhaled after maximal inspiration (referred to as the forced vital capacity, FVCEAFL–SS) from the ToF-derived anterior-thorax forced vital capacity (FVC), height, and body mass index as explanatory variables and spirometer-derived FVC as the objective variable. The non-contact measurement is automatically started when an examinee is sitting 35 cm away from the EAFL-SS. A clinical test was conducted with 32 COPD patients (27/5 M/F, 67–93 years) as typical airflow limitation cases recruited at St. Marianna University Hospital and 21 healthy volunteers (10/11 M/F, 23–79 years). The EAFL-SS was used to monitor the respiration of examinees during forced exhalation while sitting still, and a spirometer was used simultaneously as a reference. The forced expiratory volume in 1 s (FEV1%EAFL–SS) was evaluated as a percentage of the FVCEAFL–SS, where values less than 70% indicated suspected airflow limitation. Leave-one-out cross-validation analysis revealed that this system provided 81% sensitivity and 90% specificity. Further, the FEV1EAFL–SS values were closely correlated with that measured using a spirometer (r = 0.85, p < 0.0001). Hence, EAFL-SS appears promising for early airflow limitation screening at home.

Clinico-Physiological and Molecular Characterization of Asthma-COPD Overlap Syndrome- A Hospital based Observational Study

Clinico-Physiological and Molecular Characterization of Asthma-COPD Overlap Syndrome- A Hospital based Observational Study

Chronic Obstructive Pulmonary Disease (COPD) and Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome (ACOS) are Risk Factors for Cryptococcosis

Cryptococcosis is a fungal infection of global importance affecting the central nervous system and other organs such as the lungs. The severity of cryptococcosis is largely dependent on the integrity of the host immune system. The protection to cryptococcosis is associated with Th1 immune response while Th2 results in susceptibility to Cryptococcus infection. Asthma is a chronic inflammatory disease commonly coordinated by Th2 immune response. The airway inflammation in Chronic Obstructive Pulmonary Disease (COPD) patients is characterized by increased neutrophils, macrophages, proteases, IL-6, IL-8, and Th1 cytokines. Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome (ACOS) patients present phenotype that shares Th1 (COPD) and Th2 (asthma). There are several risk factors associated with Cryptococcus infection, including smoking, that cause airway remodeling and dysregulated and damaging airway inflammation.

Effect of Pulmonary Rehabilitation in Patients with Asthma COPD Overlap Syndrome: A Randomized Control Trial.

ObjectivesWe sought to evaluate the effectiveness of six weeks pulmonary rehabilitation (PR) in patients with asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS).MethodsWe enrolled 28 patients with ACOS. Fourteen patients were randomly allocated to the PR group, which comprised of supervised endurance training, supervised resistance training, breathing exercises, self management, and education. The other 14 patients were allocated to the control group, who were asked to continue their usual routine strategies for six weeks. All patients were assessed at baseline and after six weeks using the six minute walk test (6MWT), St George Respiratory Questionnaire (SGRQ), pulmonary function test (PFT), and Bode index (BI).ResultsWe saw a significant improvement in 6MWT (p = 0.001), SGRQ (p = 0.007), and BI (p < 0.001) in the PR group after six weeks compared to the control group. There was no significant difference between the groups for PFT (p = 0.182) after six weeks.ConclusionsUse of a short-term PR program in ACOS patients results in favorable changes in functional capacity, health-related quality of life, and BI. However, short-term PR was not sufficient to register changes in pulmonary function in these patients.

Dynamic-Ventilatory Digital Radiography in Air Flow Limitation: A Change in Lung Area Reflects Air Trapping

Objective: The aim of this study was to determine the utility of dynamic-ventilatory digital radiography (DR) for pulmonary function assessment in patients with airflow limitation. Methods: One hundred and eighteen patients with airflow limitation (72 patients with lung cancer before surgery, 35 patients with chronic obstructive pulmonary disease [COPD], 6 patients with asthma, and 5 patients with asthma-COPD overlap syndrome) were assessed with dynamic-ventilatory DR. The patients were instructed to inhale and exhale slowly and maximally. Sequential chest X-ray images were captured in 15 frames per second using a dynamic flat-panel imaging system. The relationship between the lung area and the rate of change in the lung area due to respiratory motion with respect to pulmonary function was analyzed. Results: The rate of change in the lung area from maximum inspiration to maximum expiration (Rs ratio) was associated with the RV/TLC ratio (r = 0.48, p < 0.01) and the percentage of the predicted FEV₁ (r = –0.33, p < 0.01) in patients with airflow limitations. The Rs ratio also decreased in an FEV₁-dependent manner. Conclusion: The rate of change in the lung area due to respiratory motion evaluated with dynamic DR reflects air trapping. Dynamic DR is a potential tool for the comprehensive assessment of pulmonary function in patients with COPD.

Plasma neutrophil extracellular trap level is modified by disease severity and inhaled corticosteroids in chronic inflammatory lung diseases

A flow cytometry-based method was developed to quantify in vivo circulating neutrophil extracellular trap (NET) levels in plasma and compare them in patients with different chronic inflammatory lung diseases. Seventeen asthmatic and 11 control children, 12 adult controls, 46 asthmatic, 6 COPD and 6 adult patients with asthma-COPD overlap syndrome (ACOS) were recruited in the study. The presence of NETs in unstimulated cell-free plasma was confirmed and visualized by confocal laser-scanning microscopy. No significant differences were found in plasma NET levels between children and adults, children with or without asthma and adults with or without asthma, COPD or ACOS. When asthmatic patients were stratified according to their disease severity the average plasma NET level was significantly higher in asthmatic patients with more serious symptoms (adjusted p = 0.027). Patients with poorer pulmonary functions had higher plasma NET levels which negatively correlated with the FEV1 values (r = −0.39, p = 0.002). Patients who were medicated daily with inhaled corticosteroids (ICS) had significantly lower average plasma NET level than patients who did not or just occasionally used ICS (p = 0.027). If further studies confirm the NET-lowering effect of ICS in the circulation, it can be utilized in diseases where NETosis contributes to the pathogenesis.

Serum IL-8 and VEGFA are Two Promising Diagnostic Biomarkers of Asthma-COPD Overlap Syndrome.

BackgroundAsthma-COPD overlap (ACO; previously referred to as asthma-COPD overlap syndrome) is characterized by persistent airflow limitation consistent with COPD, together with several distinguishing features of asthma. Asthma-COPD overlap syndrome is a condition of mixing symptoms of asthma and COPD, because of its complexity, it is difficult to find effective diagnostic markers in clinic.PurposeOur aims were to detect the expression of serum cytokines in patients with asthma, explore the diagnostic potential of differential serum cytokines in ACOS.Patients and MethodsNinety asthmatic patients were divided into ACOS group and non-ACOS group according to the major and minor criteria of ACOS, 15 kinds of cytokines including IL-3, IL-4, IL-8, IL-9, IL-13, IL-17A, VEGFA, VEGFC, VEGFD, bFGF, Fit-1 PIGF, Tie-2 were detected by MSD, and IL-27 and TGF-beta were determined by ELISA assay.ResultsThe serum levels of IL-9, VEGFA and PIGF in patients with ACOS were significantly higher than those in non-ACOS group (P<0.05, respectively), while the level of IL-8 and IL-17A in subjects with ACOS was lower than that in the non-ACOS group (P<0.05, respectively). We analyzed the correlation between several difference factors and FEV1/FVC% in the ACOS group, found VEGFA was negatively correlated with FEV1/FVC%, while IL-8 and IL-17A were positively correlated with FEV1/FVC%. Finally, three correlation factors were analyzed by ROC curve for the occurrence of ACOS.ConclusionThe results suggested that IL-8 was highly sensitive and VEGFA was highly specificity, both of which could be used as biomarkers for the diagnosis of ACOS.

Indoor mold odor in the workplace increases the risk of Asthma-COPD Overlap Syndrome: a population-based incident case\u2013control study

BackgroundPrevious studies have suggested an increased risk of asthma related to indoor dampness problems, but their role in the etiology of Asthma-COPD Overlap Syndrome has not been studied. We utilized a population-based incident case–control study to assess potential effect of indoor dampness and molds at home and at work on development of ACOS.MethodsWe recruited systematically all new cases of asthma diagnosed during a 2.5-year study period (1997–2000) and randomly selected controls from the source population of adults 21–63 years old and representing 500,000 persons-years in the Pirkanmaa Hospital District, South Finland. Exposure indicators included water damage, damp stains or paint peeling, visible mold, and mold odor, asked separately for home and workplace. The clinically diagnosed case series consisted of 521 adults with newly diagnosed asthma. Altogether 25 of them satisfied the criteria for ACOS-cases, i.e. FEV1/FVC < 0.70 in post-bronchodilator spirometry. The control series, including 932 controls, were from a random sample of source population, after excluding 76 (7.5%) controls with asthma.ResultsIn logistic regression analysis adjusting for confounders, the risk of ACOS was significantly related to presence of mold odor in the workplace (OR 3.43; 95% CI 1.04–11.29), but not to other dampness indicators. The fraction of ACOS attributable to workplace mold odor was 70.8% (95% CI 3.8–91.1%) among the exposed. The risk of ACOS was not related to mold exposures at home.ConclusionsPresent results provide new evidence of the significant relation between workplace exposure to mold odor and adult-onset ACOS.

Assessment of the role of fractional exhaled nitric oxide in the diagnosis of asthma–chronic obstructive pulmonary disease overlap

Introduction Bronchial asthma and chronic obstructive pulmonary disease (COPD) are airway diseases with different etiology and a different presentation. Sometimes, asthma and COPD are present within the same patient as asthma–COPD overlap syndrome (ACOS). Aim To assess the role of fractional exhaled nitric oxide (FeNO) in the diagnosis of ACOS. Patients and methods A total of 60 patients with newly diagnosed stable COPD (n=20), bronchial asthma (n=20), and ACOS (n=20) were included from May 2016 to May 2017. COPD, asthma, and ACOS diagnosis depended on clinical history and examination and spirometric criteria according to GINA guidelines (2015). FeNO was measured and compared between the studied patients groups. The cutoff value for FeNO which can help in differentiating ACOS from COPD was determined. Results In the current study, the level of FeNO was significantly higher in the studied patients with ACOS in comparison with patients with COPD alone, and FeNO had significant positive correlation with sputum eosinophils % in patients with ACOS (P=0.013). Moreover, this study showed that the cutoff value of FeNO to differentiate ACOS from COPD was 20 parts per billion (with 80% sensitivity and 85% specificity and area under the curve=0.84). Conclusion This study showed that the measurement of FeNO can be used for early differentiation of ACOS from COPD alone for helping their proper management as early as possible.

Using fractional exhaled nitric oxide level to differentiate asthma–COPD overlap syndrome from chronic obstructive pulmonary disease

INTRODUCTION: Measurement of fractional exhaled nitric oxide (FeNO) is a simple, noninvasive, reproducible, and convenient method for assessing airway inflammation. We here assessed the value of FeNO for distinguishing asthma-COPD overlap syndrome (ACOS) and chronic obstructive pulmonary disease (COPD) in patients hospitalized due to exacerbation of COPD. METHODS: A total of 100 consecutive patients diagnosed with COPD and hospitalized due to disease exacerbation were included and divided into the COPD-alone group and ACOS group. FeNO was measured at the beginning of hospitalization and at discharge. RESULTS: There was no correlation between FeNO values measured at the time of hospitalization and hospital duration (r = −0.10, P = 0.334). However, the mean FeNO value at the beginning of hospitalization was significantly higher in the ACOS group than in the COPD-alone group (25.5 [11–149] vs. 13.0 [5–50]; P CONCLUSION: The FeNO level can identify ACOS in patients hospitalized for COPD exacerbation, providing a new diagnostic tool for the clinical management of ACOS and COPD.

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.

Alpha-1 Antitrypsin Deficiency and Chronic Obstructive Pulmonary Disease: Between Overlaps, Phenotypes and Illnesses

Alpha-1 antitrypsin deficiency (AATD) or alpha-1 antitrypsin proteinase inhibitor (α1-Pi) deficiency, is a genetic disorder leading to a higher risk of pulmonary, hepatic and other organrelated diseases. The spectrum of diseases associated with AATD is large and includes pulmonary conditions (COPD, asthma, asthma-COPD overlap syndrome, bronchiectasis, etc.) as well as extrapulmonary (liver diseases, systemic vasculitis, rheumatoid arthritis, panniculitis, multiple sclerosis, peripheral neuropathy). We present a review of AATD focusing on its connection to other conditions.

Asthma, chronic obstructive pulmonary disease, tooth loss, and edentulism among adults in the United States: 2016 Behavioral Risk Factor Surveillance System survey

BackgroundAdults with chronic respiratory conditions, specifically asthma or chronic obstructive pulmonary disease (COPD), may be at risk of experiencing poor oral health due to systemic inflammation, challenges in routine oral health care, and adverse effects of medications used to treat these conditions. The authors examined the association of asthma, COPD, and coexisting asthma and COPD (asthma-COPD overlap syndrome [ACOS]) with tooth loss among US adults. MethodsThe authors conducted a cross-sectional study using 2016 Behavioral Risk Factor Surveillance System data (N = 387,217). The authors categorized the participants with missing permanent teeth into 4 groups: asthma only (n = 38,817), COPD only (n = 19,819), ACOS (n = 13,494), no asthma, no COPD (n = 315,087). The authors used adjusted multinomial logistic regressions to examine the associations between asthma and COPD categories and tooth loss. ResultsAccording to the authors, 5.3% of study participants reported they were edentulous; 10.7% reported 6 or fewer missing teeth. Participants with asthma only, COPD only, and ACOS had higher odds of reporting tooth loss (6 or more teeth) than those in the no asthma, no COPD group; adjusted odds ratios were 1.12 (95% confidence interval, 1.00 to 1.26) to 2.04 (95% confidence interval, 1.85 to 2.26). A lower percentage of participants with COPD and ACOS visited dentists in the past year than those with no asthma and no COPD. Interactive associations suggested participants with asthma or COPD with dental visits were less likely to report edentulism than those with neither asthma nor COPD and no dental visits. ConclusionsParticipants with asthma or COPD had higher odds of tooth loss compared with those with neither asthma nor COPD. Practical ImplicationsPeople with asthma or COPD should maintain routine dental visits to reduce the risk of experiencing tooth loss.

The characteristics of the frequent exacerbators with chronic bronchitis phenotype and the asthma-chronic obstructive pulmonary disease overlap syndrome phenotype in chronic obstructive pulmonary disease patients: A meta-analysis and system review.

To investigate the difference of clinical characteristics between chronic obstructive pulmonary disease (COPD) patients with the frequent exacerbators with chronic bronchitis (FE-CB) phenotype and those with the asthma-COPD overlap syndrome (ACO) phenotype.We searched CNKI, Wan Fang, Chongqing VIP, China Biology Medicine disc, PubMed, Cochrane Library, and EMBASE databases for studies published as of April 30, 2019. All studies that investigated COPD patients with the FE-CB and ACO phenotypes and which qualified the inclusion criteria were included. Cross-sectional/prevalence study quality recommendations were used to measure methodological quality. RevMan5.3 software was used for meta-analysis.Ten studies (combined n = 4568) qualified the inclusion criteria. The FE-CB phenotype of COPD was associated with significantly lower forced vital capacity percent predicted (mean difference [MD] -9.05, 95% confidence interval [CI] [-12.00, -6.10], P < .001, I = 66%), forced expiratory volume in 1 second (FEV1) (MD -407.18, 95% CI [-438.63, -375.72], P < .001, I = 33%), forced expiratory volume in 1 second percent predicted (MD -9.71, 95% CI [-12.79, -6.63], P < .001, I = 87%), FEV1/forced vital capacity (MD -5.4, 95% CI [-6.49, -4.30], P < .001, I = 0%), and body mass index (BMI) (MD -0.81, 95% CI [-1.18, -0.45], P < .001, I = 44%) as compared to the ACO phenotype. However, FE-CB phenotype was associated with higher quantity of cigarettes smoked (pack-years) (MD 6.45, 95% CI [1.82, 11.09], P < .001, I = 73%), COPD assessment test score (CAT) (MD 4.04, 95% CI [3.46, 4.61], P < .001, I = 0%), mMRC score (MD 0.54, 95% CI [0.46, 0.62], P < .001, I = 34%), exacerbations in previous year (1.34, 95% CI [0.98, 1.71], P < .001, I = 68%), and BMI, obstruction, dyspnea, exacerbations (BODEx) (MD 1.59, 95% CI [1.00, 2.18], P < .001, I = 86%) as compared to the ACO phenotype.Compared with the ACO phenotype, COPD patients with the FE-CB phenotype had poorer pulmonary function, lower BMI, and higher CAT score, quantity of cigarettes smoked (pack-years), exacerbations in previous year, mMRC score, and BODEx.This study is an analysis of published literature, which belongs to the second study. Therefore, this study does not require the approval of the ethics committee. The findings will be disseminated through a peer-reviewed journal publication or conference presentation.

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