Obstructive Pulmonary Disease Overlap Syndrome Research Articles

Pulmonary hypertension in newly diagnosed obstructive sleep apnea-chronic obstructive pulmonary disease overlap syndrome patients attending a tertiary care centre-a cross-sectional analysis.

Overlap syndrome is the association of obstructive sleep apnea (OSA) with chronic obstructive pulmonary disorder and with other chronic respiratory diseases. Patients with overlap syndrome have a worse prognosis compared with chronic obstructive pulmonary disorder or OSA alone. Additionally, patients with combined chronic obstructive pulmonary disorder and OSA are more likely to develop pulmonary hypertension and right heart failure much earlier than those without overlap. To assess the occurrence of pulmonary hypertension (PH) in newly diagnosed OSA-chronic obstructive pulmonary disorder overlap syndrome patients attending a tertiary care centre. This cross-sectional study was conducted at Department of Pulmonary Medicine, Government Medical College, Kozhikode, Kerala, South India, among patients with OSA above 40years of age who were proactively evaluated to pick out those with undiagnosed overlap. A period of 6months after getting ethical clearance from June 2018 was selected as the study period. Among patients with symptoms suggestive of OSA above 40years of age who gave the informed consent were enrolled after screening with Standard Sleep questionnaires (Berlin questionnaire, STOP BANG and Epworth Sleepiness Scale). Enrolled patients underwent routine spirometry and sleep study using the standard Level 1 overnight polysomnography (Level1 OPSG). Patients were classified in to two groups as OSA patients (group I), having an apnea hypopnea index (AHI) > 5/hr alone and the second group as those OSA patients (group II), with an obstructive spirometry pattern who were the overlap group. Arterial blood gas analysis (a sample of radial arterial blood was drawn with the patient awake and supine, and was analyzed for pH, PaCO2 and PaO2) and echocardiography (ECHO) of the two groups were compared as a non-invasive method to assess pulmonary artery hypertension and results were analyzed in a systematic manner. Among the 84 patients enrolled, 16.7% had overlap syndrome and the rest had OSA alone. Statistically significant higher mean weight and BMI for those with overlap syndrome compared to the OSA group were observed. Mean FVC (forced vital capacity), FEV1 (forced expiratory volume 1s), and FEV1/FVC were lower in those with overlap syndrome compared to OSA group. The mean values of ABG parameters revealed higher PaCO2 and lower PaO2 among the group with overlap syndrome which were statistically significant. However, there was no significant difference in resting room air SaO2 value between the two groups. The mean values of sleep duration and efficiency were significantly lower in those with overlap syndrome with a p value < 0.001. The mean value of arousal and REM (rapid eye movement) sleep percentage were significantly higher among those with overlap syndrome (p < 0.001). Mean value of NREM (non-rapid eye movement) sleep percentage was lower among the group with overlap syndrome compared with the OSA group, and this difference was statistically significant. The mean AHI value of the overlap syndrome group was 39.79 ± 7.54 and this was significantly higher than the OSA group (p < 0.004). Among the 14 patients who had ECHO evidence of pulmonary hypertension, 9 (64.3%) belonged to the overlap group which shows that they are a highly vulnerable group for developing pulmonary hypertension (PH) and requires early detection and more rigorous treatment. This study confirms that OSA patients with modest daytime level of hypoxemia and mild-moderate chronic airflow limitation have a high prevalence of PH. Chronic airway obstruction may be asymptomatic in some subjects and this stresses the necessity of pulmonary function test in OSA.

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

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

Clinical Significance of High Mobility Group Box 1 Expression in Inflammation of Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome

To clarify clinical significance of high mobility group box 1 level in inflammation of asthma-chronic obstructive pulmonary disease overlap syndrome. A total of 124 asthma patients in acute attack (asthma group), 124 chronic obstructive pulmonary disease patients in acute exacerbation (chronic obstructive pulmonary disease group) and 124 asthma-chronic obstructive pulmonary disease overlap syndrome patients in acute exacerbation (asthma-chronic obstructive pulmonary disease overlap syndrome group) hospitalized in the department of geriatric respiratory medicine and the second department of respiratory medicine of our hospital from January 2020 to June 2022 were enrolled. The C-reactive protein level, white blood cell counts and high mobility group box 1 concentration were measured and compared in three groups. The relation of serum high mobility group box 1 level to C-reactive protein level or white blood cell counts was assessed through Pearson correlation. The relation of serum high mobility group box 1 level to forced expiratory volume 1 % predicted or forced expiratory volume 1/forced vital capacity was assessed through Pearson correlation. The general data presented no difference among three groups (p>0.05). The C-reactive protein level, white blood cell counts and high mobility group box 1 concentration of asthma-chronic obstructive pulmonary disease overlap syndrome patients presented elevation relative to those of asthma patients and chronic obstructive pulmonary disease patients (p<0.05). The serum high mobility group box 1 level presented a positive association with C-reactive protein level or white blood cell counts in asthma-chronic obstructive pulmonary disease overlap syndrome group (p<0.05). The serum high mobility group box 1 level presented a negative association with forced expiratory volume 1 % predicted or forced expiratory volume 1/forced vital capacity in asthma-chronic obstructive pulmonary disease overlap syndrome group (p<0.05). High mobility group box 1 level in blood specimens of asthma-chronic obstructive pulmonary disease overlap syndrome patient’s presents a marked elevation, suggesting that high mobility group box 1 has crucial clinical significance in diagnosis and therapy of asthma-chronic obstructive pulmonary disease overlap syndrome.

Asthma and COPD Overlap Syndrome (ACOS): Risk Factors and Contributing Factors.

Background:The exact description of asthma and chronic obstructive pulmonary disease overlap syndrome (ACOS) is uncertain. This study aims to determine the frequency and symptoms of ACOS and to verify certain risk factors associated with ACOS. Methods:Severe asthmatic patients with and without ACOS above 40 years old participated in this cross-sectional study. The receiver operating curve analysis (ROC) was used to assess the best cutoff values of age, body mass index (BMI), and spirometric data to distinguish asthma patients with overlap syndrome from asthma patients without overlap syndrome. Univariable and multivariable binary logistic regression was used to determine demographic and clinical factors that were associated with ACOS and asthma. Results:Of the 88 patients, 46 (52.2%) had ACOS and 42 (47.7%) had just severe asthma. The mean age of ACOS patients (Sd) was 54.91(12.57) years and in asthma-only patients was 48.69 (13.51). The ROC analysis for age and BMI showed that age ⩾ 49 years and BMI ⩾ 27 kg/m2were the best predictors of ACOS in this study. Spirometry data showed that the forced vital capacity (FVC) (lit) > 2.16, forced expiratory volume in the first second (FEV1) > 69, FEV1 / FVC > 96.5, and FVC (%) > 63 cut points could be used to determine the diagnostic criteria between ACOS and asthma only, respectively. Multivariate modeling showed that among the demographic and clinical variables, only age over 49 years (odds ratio [OR], 3.53 [95% CI, 1.07-11.63]p= 0.025) and living in a big city (OR, 7.42 [95% CI, 1.75-31.49]p= 0.007) were significant. Conclusion:Age over 49 and BMI above 27 have a significant association with ACOS. Also, living in a big city is considered to be another risk factor for ACOS compared with asthma. Spirometry can help distinguish ACOS from severe asthma in this study.

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

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

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

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

Chronic obstructive pulmonary disease and obstructive sleep apnoea overlap: co-existence, co-morbidity, or causality?

The chronic obstructive pulmonary disease and obstructive sleep apnoea overlap syndrome is associated with higher morbidity and mortality rates than either disease alone. There is evidence of a bidirectional relationship between the two conditions, with the overlap syndrome encompassing a spectrum of clinical phenotypes. This review examines the evidence for the various factors that determine the overlap syndrome, the impact overlap syndrome has on co-morbidities, and implications for diagnosis and treatment. The accurate diagnosis of the overlap syndrome is critical given its implications for treatment optimisation and reduction in healthcare utilisation and costs.

A More Efficient, Accessible, and Team-Friendly PSH

Article| September 2022 A More Efficient, Accessible, and Team-Friendly PSH Christopher Steel, MD Christopher Steel, MD Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor September 2022, Vol. 86, 16. https://doi.org/10.1097/01.ASM.0000874224.72186.4b Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Christopher Steel; A More Efficient, Accessible, and Team-Friendly PSH. ASA Monitor 2022; 86:16 doi: https://doi.org/10.1097/01.ASM.0000874224.72186.4b Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: accountable care organizations, asthma-chronic obstructive pulmonary disease overlap syndrome, consultation, health personnel, perioperative care, precision, steel, fee for service payment plan, value-based care, best practice In 2014, ASA began hosting the Perioperative Surgical Home (PSH) Learning Collaborative to develop, pilot, and evaluate the PSH model. Two additional Learning Collaboratives followed, leading to iterative improvements, more data on the model's success, additional proven pathways and protocols, and more. The dedicated innovators who participated in our learning collaboratives reduced readmissions and lengths of stay, aligned with bundled payment and ACOs, and decreased episode of care costs, to name a few of the many achievements participants realized. But these champions were just the tip of the spear, innovators who established proof of concept, scaled the model across services lines, then pointed the way for other adopters to follow. The Learning Collaboratives were wildly successful in moving the needle for health care organizations, but they also presented a high bar to entry – the number of health care professionals who had meaningful access to the protocols, lessons, and outcomes... You do not currently have access to this content.

Asthma–chronic obstructive pulmonary disease overlap syndrome – a brief review

Asthma–chronic obstructive pulmonary disease overlap syndrome – a brief review

Combined intermittent and sustained hypoxia is a novel and deleterious cardio-metabolic phenotype.

Chronic obstructive pulmonary disease and obstructive sleep apnea overlap syndrome is associated with excess mortality, and outcomes are related to the degree of hypoxemia. People at high altitudes are susceptible to periodic breathing, and hypoxia at altitude is associated with cardio-metabolic dysfunction. Hypoxemia in these scenarios may be described as superimposed sustained hypoxia (SH) plus intermittent hypoxia (IH), or overlap hypoxia (OH), the effects of which have not been investigated. We aimed to characterize the cardio-metabolic consequences of OH in mice. C57BL/6J mice were subjected to either SH (FiO2 = 0.10), IH (FiO2 = 0.21 for 12 h, and FiO2 oscillating between 0.21 and 0.06, 60 times/hour, for 12 h), OH (FiO2 = 0.13 for 12 h, and FiO2 oscillating between 0.13 and 0.06, 60 times/hour, for 12 h), or room air (RA), n = 8/group. Blood pressure and intraperitoneal glucose tolerance test were measured serially, and right ventricular systolic pressure (RVSP) was assessed. Systolic blood pressure transiently increased in IH and OH relative to SH and RA. RVSP did not increase in IH, but increased in SH and OH by 52% (p < .001) and 20% (p = .001). Glucose disposal worsened in IH and improved in SH, with no change in OH. Serum low- and very-low-density lipoproteins increased in OH and SH, but not in IH. Hepatic oxidative stress increased in all hypoxic groups, with the highest increase in OH. OH may represent a unique and deleterious cardio-metabolic stimulus, causing systemic and pulmonary hypertension, and without protective metabolic effects characteristic of SH.

Circulating C-reactive protein levels in patients with suspected obstructive sleep apnea.

To assess determinants of C-reactive protein (CRP) in a cohort of patients referred for investigation of obstructive sleep apnea (OSA) and to determine whether the overlap of OSA and chronic obstructive pulmonary disease (overlap syndrome) is associated with higher levels of CRP. This was a cross-sectional study that included 2,352 patients seen at the West Australian Sleep Disorders Research Institute between 2006 and 2010. All patients had circulating CRP levels measured and spirometry performed. OSA was defined as an apnea-hypopnea index ≥ 5 events/h, and chronic obstructive pulmonary disease was defined as a forced expiratory volume in 1 second/forced vital capacity ratio < 0.70 and age > 40 years. Univariate and multivariate regression analysis were used to identify CRP determinants. The mean age was 51 years (60% male), the median apnea-hypopnea index was 27 events/h, the median 3% oxygen desaturation index was 24 events/h, the mean forced expiratory volume in 1 second was 88% predicted, and the median CRP was 3.0 mg/L. In multivariate analyses, age, body mass index, female sex, neck circumference, apnea-hypopnea index, and desaturation markers (nadir and mean oxygen saturation) were independently associated with higher CRP. Spirometric variables were not predictors. There was no significant difference in CRP among patients with OSA with or without coexisting chronic obstructive pulmonary disease. Markers of OSA severity (apnea-hypopnea index and oxygenation), age, body mass index, neck circumference, and female sex were independent predictors of circulating CRP levels. OSA overlapping with chronic obstructive pulmonary disease was not associated with increased CRP compared to either condition alone, suggesting other mechanisms for the increased cardiovascular disease risk in overlap syndrome. Recognizing factors that predict CRP will help identify patients at higher risk of cardiovascular disease and aid risk stratification. Shah A, Mukherjee S, McArdle N, Singh B, Ayas N. Circulating C-reactive protein levels in patients with suspected obstructive sleep apnea. J Clin Sleep Med. 2022;18(4):993-1001.

Risk for Cardiovascular Disease and One-Year Mortality in Patients With Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea Syndrome Overlap Syndrome.

Background: Patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSAS) overlap syndrome (OS) are thought to be at increased risk for cardiovascular diseases. Objective: To evaluate the burden of cardiovascular diseases and long-term outcomes in patients with OS. Methods: This was a retrospective cohort study. The prevalence of cardiovascular diseases and 1-year mortality were compared among patients diagnosed with OS (OS group), COPD alone (COPD group) and OSAS alone (OSAS group), and Cox proportional hazards models were used to assess independent risk factors for all-cause mortality. Results: Overall, patients with OS were at higher risk for pulmonary hypertension (PH), heart failure and all-cause mortality than patients with COPD or OSAS (all p < 0.05). In multivariate Cox regression analysis, the Charlson comorbidity index (CCI) score [adjusted hazard ratio (aHR): 1.273 (1.050–1.543); p = 0.014], hypertension [aHR: 2.006 (1.005–4.004); p = 0.048], pulmonary thromboembolism (PTE) [aHR: 4.774 (1.335–17.079); p = 0.016] and heart failure [aHR: 3.067 (1.521–6.185); p = 0.002] were found to be independent risk factors for 1-year all-cause mortality. Conclusion: Patients with OS had an increased risk for cardiovascular diseases and 1-year mortality. More efforts are needed to identify the causal relationship between OS and cardiovascular diseases, promoting risk stratification and the management of these patients.

Prevalence of Cardiovascular Events and Their Risk Factors in Patients With Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea Overlap Syndrome.

Rationale: Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) have been identified as independent risk factors for cardiovascular diseases. However, the impact of COPD and OSA overlap syndrome (OS) on cardiovascular outcomes remains to be elucidated.Objective: To determine the prevalence of cardiovascular events and their risk factors in OS patients.Methods: Seventy-four patients who had OS between January 2015 and July 2020 were retrospectively enrolled, and 222 COPD-only patients and 222 OSA-only patients were pair-matched for age and sex from the same period and served as the OS-free control group. The prevalence rates of coronary heart disease (CHD), arrhythmia, heart failure, and pulmonary arterial hypertension (PAH) were compared among the three groups, and multivariable logistic regression models were used to screen the risk factors for specific cardiovascular events.Results: OS patients had higher prevalence rates of heart failure (10.8 vs. 0.5 and 1.4%, respectively) and PAH (31.1 vs. 4.5 and 17.1%, respectively) than those with OSA alone or COPD alone (all P < 0.01). The CHD prevalence was also significantly higher in the OS group than in the COPD-alone group (25.7 vs. 11.7%, P < 0.01). There was no significant difference in the prevalence of arrhythmia among the three groups (20.3, 22.5, and 13.1%, respectively, P > 0.05). In OS patients, risk factors for CHD included hypertension, diabetes, body mass index, lactate dehydrogenase level, and tidal volume; risk factors for heart failure included diabetes, partial pressure of oxygen, partial pressure of carbon dioxide, maximum ventilatory volume, and neutrophilic granulocyte percentage; and risk factors for PAH included minimum nocturnal oxygen saturation, partial pressure of carbon dioxide, and brain natriuretic peptide and lactate dehydrogenase levels.Conclusions: OS patients have a higher prevalence of cardiovascular events, which is associated with hypoxemia, hypercapnia, and impaired lung function in these patients.

Clinical Features of Patients with Asthma, Bronchiectasis, and Combination of Both Conditions

Background: Asthma and bronchiectasis are critical diseases for public health. In some patients, asthma and bronchiectasis exist together, and bronchiectasis negatively affects asthma control. This study aimed to evaluate the clinical impacts of coexisting asthma and bronchiectasis on patients. Methods: This was a retrospective single-center study on data collected from electronic medical records between January 2014 and January 2017. Patients were divided into three groups, wherein asthma (n = 33), bronchiectasis (n = 33), and coexisting asthma and bronchiectasis (n = 33) were compared. Asthma diagnosis was made according to the guidelines of Global Initiative for Asthma. Confirmation of bronchiectasis diagnosis was made by high-resolution computed tomography. Patients with cystic fibrosis and those who have asthma–chronic obstructive pulmonary disease overlap syndrome were excluded from the study. Results: Medical records of 1467 patients were analyzed. Among them, well-matching 99 patients in terms of gender and comorbid diseases were taken (33 of them had only asthma, 33 had only bronchiectasis, and 33 had coexisting asthma and bronchiectasis). Forty (40.5%) men and 59 (59.5%) women with a mean age of 45.0 ± 5.2 were included in the study. Asthma and bronchiectasis coexistence had lower forced expiratory volume in 1 s (FEV1) (%), forced vital capacity (FVC) (%), FEV1/FVC (%), and FEV1 (L) ratios (P = 0.0001). Moreover, total immunoglobulin E levels were the highest in this group (P = 0.0001). The most frequently observed microorganism in the culture tests was Pseudomonas aeruginosa in the bronchiectasis-only as well as in asthma + bronchiectasis groups. Conclusions: Asthmatic patients who have bronchiectasis revealed lower asthma control levels and worse respiratory function test results than other groups.

Distant Compliance with Treatment in Patients with Chronic Respiratory Diseases: Asthma, Copd and Asthma-Copd Overlap Syndrome. Prospective Study

Abstract Medications prescribed for chronic diseases such as asthma, chronic obstructive pulmonary disease (COPD) or asthma-COPD overlap (ACO) syndrome should be administered in the long term and compliance becomes a health care concern. Noncompliance adversely affects the outcome of treatment and results in the consumption of human and material resources. The aim of our study was to identify the factors that cause non-compliance with treatment in children, adolescents, and adults with asthma/COPD/ACO in Romania, the methods by which these factors can be understood and corrected, and the evaluation of symptoms. To achieve the goal, regular visits were carried out with symptom control questionnaires (Asthma Control Test (ACT), COPD Assessment Test (CAT)) and FEV1 evaluation using spirometry. The results obtained indicate low long-term compliance (12.35%) due to patients’ abstinence from regular check-ups. In conclusion, we can say that the factors related to doctors have been successfully corrected, but it remains a challenge in correcting the factors related to patients and the health regime.

Asthma-chronic obstructive pulmonary disease overlap syndrome.

Overlap of asthma and chronic obstructive lung disease (ACO) in patients with obstructive lung disease is growing in recognition, though there is no consistent agreement on the diagnostic criteria for the disease process. Patients with ACO have distinct clinical characteristics and trajectories, which are representative of a heterogenous, multifactorial, and incompletely understood inflammatory pathophysiology. Current treatment strategies are focused on titration of inhaled therapies such as long-acting bronchodilators, with increasing interest in the use of targeted biologic therapies aimed at the underlying inflammatory mechanisms. Future directions for research will focus on elucidating the varied inflammatory signatures leading to ACO, the development of consistent diagnostic criteria and biomarkers of disease, and improving the clinical management with an eye toward targeted therapies.

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.

Study of asthma–chronic obstructive pulmonary disease overlap syndrome among an Egyptian sample of chronic obstructive pulmonary disease and asthmatic patients

Background Asthma–chronic obstructive pulmonary diseases overlap syndrome (ACOS) carries a higher risk than either condition alone, with more symptoms, more exacerbations, higher cost, and increased mortality, so the diagnosis and accurate treatment of patients with ACOS is very important in the clinical setting.Aim To study the prevalence of ACOS among patients with asthma and those with COPD and to detect the predictive factors of ACOS.Patients and methods We conducted an observational cross-sectional study involving 100 patients with bronchial asthma and 100 patients with COPD. We recorded demographic data, spirometric data, chest radiograph finding, peripheral blood eosinophil and neutrophils, and response to inhaled corticosteroids.Results Among the 200 studied patients, 16% of patients with asthma and 20% of patients with COPD fulfilled the ACOS criteria. Male sex and prebronchodilator forced expiratory volume in first second/forced vital capacity% are predictors of ACOS development in asthmatic patients and that blood eosinophil are predictors of ACOS development in patients with COPD using odds ratio.Conclusion ACOS should be considered as an independent subgroup distinguished by demographic data, symptoms, spirometric indices, and granulocytic pattern.

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.

Effect of Bronchodilator and Steroid Use on Heart Disease and Stroke Risks in a Bronchiectasis-Chronic Obstructive Pulmonary Disease Overlap Cohort: A Propensity Score Matching Study.

Background: To determine the effects of bronchodilator, steroid, and anti-arrhythmia drug use on the risk of heart disease/stroke (HDS) in patients with bronchiectasis–chronic obstructive pulmonary disease overlap syndrome (BCOS). Methods: We retrospectively enrolled patients with BCOS (BCOS cohort, n = 1,493) and patients without bronchiectasis and chronic obstructive pulmonary disease (COPD) (non-BCOS cohort, n = 5,972). The cumulative incidence of HDS was analyzed through Cox proportional regression. We calculated adjusted hazard ratios (aHRs) and their 95% confidence intervals (CIs) for HDS after adjustments for sex, age, comorbidities, long-acting β2-agonist or long-acting muscarinic antagonist (LABAs/LAMAs) use, short-acting β2-agonist or short-acting muscarinic antagonist (SABAs/SAMAs) use, oral steroid (OSs) or inhaled corticosteroid steroid (ICSs) use, and anti-arrhythmia drugs use. Results: The aHR (95% CI) for HDS was 1.08 (0.28–4.06) for patients using LAMAs compared with those not using drugs. Regarding drug use days, the aHRs (95% CIs) were 32.2 (1.79–773.0), 1.85 (1.01–3.39), and 31.1 (3.25–297.80) for those with recent SABAs use, past ICSs use, and past anti-arrythmia drugs use, respectively. Regarding cumulative drug dose, the aHRs (95% CIs) were 2.12 (1.46–3.10), 3.48 (1.13–10.6), 3.19 (2.04–4.99), 28.1 (1.42–555.7), 2.09 (1.32–3.29), 2.28 (1.53–3.40), and 1.93 (1.36–2.74) for those with a low dose of SABAs, medium dose of SABAs, low dose of SAMAs, low dose of ICSs, medium dose of ICSs, low dose of OSs, and medium dose of OSs, respectively. Conclusions: Compared with patients without bronchiectasis and COPD, BCOS patients with recent SABAs, past ICSs, and past anti-arrhythmia drugs use; a low or medium SABAs ICSs, and OSs dose; and a low SAMAs dose had a higher risk of HDS. LAMAs were not associated with HDS.