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Hsa-Mir-320c, Hsa-Mir-200c-3p, and Hsa-Mir-449c-5p as Potential Specific miRNA Biomarkers of COPD: A Pilot Study. PATHOPHYSIOLOGY 2022; 29:143-156. [PMID: 35466228 PMCID: PMC9036303 DOI: 10.3390/pathophysiology29020013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/25/2022] [Accepted: 03/25/2022] [Indexed: 12/03/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease commonly induced by cigarette smoke. The expression of miRNAs can be altered in patients with COPD and could be used as a biomarker. We aimed to identify a panel of miRNAs in bronchoalveolar lavage (BAL) to differentiate COPD patients from smokers and non-smokers with normal lung function. Accordingly, forty-five subjects classified as COPD, smokers, and non-smokers (n = 15 per group) underwent clinical, functional characterization and bronchoscopy with BAL. The mean age of the studied population was 61.61 ± 12.95 years, BMI 25.72 ± 3.82 Kg/m2, FEV1/FVC 68.37 ± 12.00%, and FEV1 80.07 ± 23.63% predicted. According to microarray analysis, three miRNAs of the most upregulated were chosen: miR-320c, miR-200c-3p, and miR-449c-5p. These miRNAs were validated by qPCR and were shown to be differently expressed in COPD patients. ROC analysis showed that these three miRNAs together had an area under the curve of 0.89 in differentiating COPD from controls. Moreover, in silico analysis of candidate miRNAs by DIANA-miRPath showed potential involvement in the EGFR and Hippo pathways. These results suggest a specific 3-miRNA signature that could be potentially used as a biomarker to distinguish COPD patients from smokers and non-smoker subjects.
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[Chronic obstructive pulmonary disease: the right treatment for the right patient]. Internist (Berl) 2021; 62:679-685. [PMID: 33860810 PMCID: PMC8217063 DOI: 10.1007/s00108-021-01021-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 12/26/2022]
Abstract
In den vergangenen Jahren wurden auf dem Gebiet der chronisch-obstruktiven Lungenerkrankung (COPD) große Therapiestudien publiziert, die 2020 um mehrere Post-hoc-Analysen ergänzt wurden. Die neuen Erkenntnisse flossen in das Update des Global-Initiative-for-Chronic-Obstructive-Lung-Disease(GOLD)-Report 2021 ein. Im vorliegenden Beitrag werden die aktualisierten Grundlagen und Empfehlungen zur Therapie der COPD beschrieben. Dabei wird auf die Indikationen von inhalativen Kortikosteroiden (ICS), lang wirksamen Muskarinantagonisten (LAMA) und/oder lang wirksamen β‑Mimetika (LABA) eingegangen. Die Therapie der COPD wird der des Asthma bronchiale gegenübergestellt. Diskutiert wird auch, wie sich eine gleichzeitig bestehende Asthmakomponente auf die Behandlungsstrategie bei COPD auswirkt. Ein Schwerpunkt des Beitrags liegt auf der Triple-Therapie mit LAMA, LABA und ICS. In diesem Zusammenhang werden die Studienlage und die Indikationen beschrieben. Die Bronchodilatation bleibt weiterhin die Grundlage der COPD-Therapie. Für Patienten mit gehäuften Exazerbationen bedeutet eine Triple-Therapie mit LAMA + LABA + ICS einen Mortalitätsvorteil. Weitere Analysen oder Studien sollen klären, ob dieser Effekt für spezifische Subgruppen stärker ausgeprägt ist.
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Zhou A, Luo L, Liu N, Zhang C, Chen Y, Yin Y, Zhang J, He Z, Xie L, Xie J, Li J, Zhou Z, Chen Y, Chen P. Prospective development of practical screening strategies for diagnosis of asthma-COPD overlap. Respirology 2019; 25:735-742. [PMID: 31774229 DOI: 10.1111/resp.13743] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 09/24/2019] [Accepted: 10/29/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE ACO is a syndrome with high prevalence. However, a pragmatic diagnostic criterion to differentiate ACO is non-existent. We aimed to establish an effective model for screening ACO. METHODS A multicentre survey was developed to assess the clinical criteria considered important and applicable by pulmonologists for screening ACO. These experts were asked to take the surveys twice. The expert grading method, analytic hierarchy process and ROC curve were used to establish the model, which was then validated by a cross-sectional study of 1066 patients. The GINA/GOLD document was the gold standard in assessing this model. RESULTS Increased variability of symptoms, paroxysmal wheezing, dyspnoea, historical diagnosis of COPD or asthma, allergic constitution, exposure to risk factors, the FEV1 /FVC < 70% and a positive BDT were important for screening ACO. According to the weight of each criterion, we confirmed that patients meeting six or more of these eight criteria should be considered to have ACO. We called this Chinese screening model for ACO 'CSMA'. It differentiated patients with ACO with a sensitivity of 83.33%, while the sensitivity of clinician-driven diagnosis had a sensitivity of only 42.73%. CONCLUSION CSMA is a workable model for screening ACO and provides a simple tool for clinicians to efficiently diagnose ACO.
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Affiliation(s)
- Aiyuan Zhou
- Department of Respiratory and Critical Care Medicine, Second Xiangya Hospital, Central South University, Changsha, China.,Research Unit of Respiratory Disease, Central South University, Changsha, China.,Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China
| | - Lijuan Luo
- Department of Respiratory and Critical Care Medicine, Second Xiangya Hospital, Central South University, Changsha, China.,Research Unit of Respiratory Disease, Central South University, Changsha, China.,Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China
| | - Nian Liu
- Department of Respiratory Medicine, Hunan Provincial People's Hospital, Hunan Normal University, Changsha, China
| | - Cheng Zhang
- Department of Respiratory Medicine, The People's Hospital of Guizhou Province, Guiyang, China
| | - Yahong Chen
- Department of Respiratory Medicine, Third Hospital of Peking University, Beijing, China
| | - Yan Yin
- Department of Respiratory Medicine, First Hospital of China Medical University, Shenyang, China
| | - Jing Zhang
- Department of Respiratory Medicine, Zhong Shan Hospital of Fudan University, Shanghai, China
| | - Zhiyi He
- Evidence-Based Medical Center, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lihua Xie
- Department of Respiratory Medicine, Third Xiangya Hospital, Central South University, Changsha, China
| | - Jungang Xie
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinhua Li
- Department of Respiratory and Critical Care Medicine, Second Xiangya Hospital, Central South University, Changsha, China.,Research Unit of Respiratory Disease, Central South University, Changsha, China.,Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China
| | - Zijing Zhou
- Department of Respiratory and Critical Care Medicine, Second Xiangya Hospital, Central South University, Changsha, China.,Research Unit of Respiratory Disease, Central South University, Changsha, China.,Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China
| | - Yan Chen
- Department of Respiratory and Critical Care Medicine, Second Xiangya Hospital, Central South University, Changsha, China.,Research Unit of Respiratory Disease, Central South University, Changsha, China.,Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China
| | - Ping Chen
- Department of Respiratory and Critical Care Medicine, Second Xiangya Hospital, Central South University, Changsha, China.,Research Unit of Respiratory Disease, Central South University, Changsha, China.,Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China
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4
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Miravitlles M. Diagnosis of asthma-COPD overlap: Is it possible a global definition? Pulmonology 2019; 24:143-145. [PMID: 29754717 DOI: 10.1016/j.pulmoe.2018.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- M Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
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5
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Jenkins C, FitzGerald JM, Martinez FJ, Postma DS, Rennard S, van der Molen T, Gardev A, Genofre E, Calverley P. Diagnosis and management of asthma, COPD and asthma-COPD overlap among primary care physicians and respiratory/allergy specialists: A global survey. CLINICAL RESPIRATORY JOURNAL 2019; 13:355-367. [PMID: 30825365 DOI: 10.1111/crj.13016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 02/05/2019] [Accepted: 02/24/2019] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) is a heterogenous condition with clinical features shared by both asthma and COPD. OBJECTIVES This online global survey of respiratory/allergy specialists and primary care practitioners (PCPs) was performed to understand current clinical approaches to the differential diagnosis and management of asthma, COPD and ACO. METHODS Respondents were recruited through: (a) a global online physician respondent community (49,980 PCPs and 7205 specialists); (b) market research agents; (c) experts; (d) professional societies; (e) colleague invitation. Respondents were presented with a survey including hypothetical clinical scenarios of diagnostic uncertainty to identify management approaches. RESULTS 891 responses (447 PCPs and 444 specialists) were collected across 13 countries. Reported features used for diagnosis of asthma and COPD were consistent with practice guidelines, but there was variability in those selected for ACO diagnosis. Features typically selected by specialists focused on spirometry/history, while PCPs focused on previous treatment/symptoms. Most respondents could correctly diagnose patients with features of ACO; however, features selected for theoretical diagnosis were often different to those selected in the case scenarios. Additionally, treatment selection was often inconsistent with guidelines, with over half of respondents not recommending inhaled corticosteroids in a patient with ACO and dominant features of asthma. CONCLUSION While most PCPs and respiratory/allergy specialists can reach a working diagnosis of ACO, there remains uncertainty around which diagnostic features are most important and what constitutes optimal management. It is imperative that clinical studies including patients with ACO are initiated, allowing the generation of evidence-based management strategies.
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Affiliation(s)
- Christine Jenkins
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia.,Department of Thoracic Medicine, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - J Mark FitzGerald
- Institute for Heart and Lung Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York
| | - Dirkje S Postma
- Department of Pulmonary Medicine and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Stephen Rennard
- Pulmonary and Critical Care Medicine, University of Nebraska Medical Center, Omaha, Nebraska.,Early Clinical Development, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
| | - Thys van der Molen
- Department of Primary Care, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Asparuh Gardev
- Global Medical Affairs, AstraZeneca, Cambridge, United Kingdom
| | | | - Peter Calverley
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom
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6
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Izquierdo JL, Miravitlles M, Esquinas C, Pérez M, Calle M, López Campos JL, Rodríguez González-Moro JM, Casanova C, Esteban C, de Lucas P. Características de los pacientes con EPOC tratados en neumología en España según grupos GOLD y fenotipos clínicos GesEPOC. Arch Bronconeumol 2018; 54:559-567. [DOI: 10.1016/j.arbres.2018.03.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/15/2018] [Accepted: 03/18/2018] [Indexed: 10/14/2022]
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7
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Río Ramírez MT, Juretschke Moragues MA, Fernández González R, Álvarez Rodríguez V, Aznar Andrés E, Zabaleta Camino JP, Romero Pareja R, Esteban de la Torre A. Value of Exhaled Nitric Oxide (FeNO) And Eosinophilia During the Exacerbations of Chronic Obstructive Pulmonary Disease Requiring Hospital Admission. COPD 2018; 15:369-376. [PMID: 30064275 DOI: 10.1080/15412555.2018.1482532] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
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.
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Affiliation(s)
- Maria Teresa Río Ramírez
- a Department of Respiratory Medicine , Hospital Universitario de Getafe, Universidad Europea de Madrid (UEM) , Getafe , Spain
| | | | | | | | - Elena Aznar Andrés
- c Department of Emergency , Hospital Universitario de Getafe , Getafe , Spain
| | | | | | - Andrés Esteban de la Torre
- d Department of Intensive Care , CIBERES of Respiratory Diseases (CIBERES) Hospital Universitario de Getafe , Getafe , Spain
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8
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Pérez de Llano L, López-Campos JL, Cosío BG. The post-truth behind the asthma-COPD overlap and the orbit of Mercury: lessons from the CHACOS study. Arch Bronconeumol 2018; 54:175-176. [PMID: 29463430 DOI: 10.1016/j.arbres.2018.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 01/17/2018] [Accepted: 01/17/2018] [Indexed: 12/18/2022]
Affiliation(s)
| | - Jose Luis López-Campos
- Servicio de Neumología, Hospital Universitario Virgen del Rocío, Sevilla, España; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España
| | - Borja G Cosío
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España; Servicio de Neumología, Hospital Universitario Son Espases-IdISBa, Palma de Mallorca, Baleares, España.
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9
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Kim SH, Moon JY, Lee JH, Ban GY, Kim S, Kim MA, Kim JH, Kim MH, Park CS, Park SY, Kwon HS, Kwon JW, Jung JW, Kang HR, Park JS, Kim TB, Park HW, Cho YS, Yoo KH, Oh YM, Lee BJ, Jang AS, Cho SH, Park HS, Park CS, Yoon HJ. Perceptions of Severe Asthma and Asthma-COPD Overlap Syndrome Among Specialists: A Questionnaire Survey. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2018; 10:225-235. [PMID: 29676069 PMCID: PMC5911441 DOI: 10.4168/aair.2018.10.3.225] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 11/17/2017] [Accepted: 12/10/2017] [Indexed: 12/18/2022]
Abstract
Purpose Severe asthma and asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) are difficult to control and are often associated with poor clinical outcomes. However, much is not understood regarding the diagnosis and treatment of severe asthma and ACOS. To evaluate the current perceptions of severe asthma and COPD among asthma and COPD specialists, we designed an e-mail and internet-based questionnaire survey. Methods Subjects were selected based on clinical specialty from among the members of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Academy of Tuberculosis and Respiratory Diseases. Of 432 subjects who received an e-mail invitation to the survey, 95 subjects, including 58 allergists and 37 pulmonologists, responded and submitted their answers online. Results The specialists estimated that the percentage of severe cases among total asthma patients in their practice was 13.9%±11.0%. Asthma aggravation by stepping down treatment was the most common subtype, followed by frequent exacerbation, uncontrolled asthma despite higher treatment steps, and serious exacerbation. ACOS was estimated to account for 20.7% of asthma, 38.0% of severe asthma, and 30.1% of COPD cases. A history of smoking, persistently low forced expiratory volume in 1 second (FEV1), and low FEV1 variation were most frequently classified as the major criteria for the diagnosis of ACOS among asthma patients. Among COPD patients, the highly selected major criteria for ACOS were high FEV1 variation, positive bronchodilator response, a personal history of allergies and positive airway hyperresponsiveness. Allergists and pulmonologists showed different assessments and opinions on asthma phenotyping, percentage, and diagnostic criteria for ACOS. Conclusions Specialists had diverse perceptions and clinical practices regarding severe asthma and ACOS patients. This heterogeneity must be considered in future studies and strategy development for severe asthma and ACOS.
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Affiliation(s)
- Sang Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ji Yong Moon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jae Hyun Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ga Young Ban
- Department of Pulmonary, Allergy and Critical Care Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sujeong Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Mi Ae Kim
- Department of Internal Medicine, CHA University School of Medicine, Seongnam, Korea
| | - Joo Hee Kim
- Department of Internal Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Min Hye Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Chan Sun Park
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - So Young Park
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyouk Soo Kwon
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Woo Kwon
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jae Woo Jung
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hye Ryun Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Sook Park
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Tae Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Heung Woo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - You Sook Cho
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Kwang Ha Yoo
- Department of Internal Medicine, Konkuk University, School of Medicine, Seoul, Korea
| | - Yeon Mok Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Jae Lee
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - An Soo Jang
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sang Heon Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hae Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Choon Sik Park
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Ho Joo Yoon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
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Plaza V, Álvarez F, Calle M, Casanova C, Cosío BG, López-Viña A, Pérez de Llano L, Quirce S, Román-Rodríguez M, Soler-Cataluña JJ, Miravitlles M. Consensus on the Asthma–COPD Overlap (ACO) Between the Spanish COPD Guidelines (GesEPOC) and the Spanish Guidelines on the Management of Asthma (GEMA). ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.arbr.2017.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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11
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Corlateanu A, Covantev S, Mathioudakis AG, Botnaru V, Siafakas N. Ashtma-Chronic obstructive pulmonary disease overlap syndrome (ACOS): current evidence and future research directions. ACTA ACUST UNITED AC 2017. [DOI: 10.1186/s40749-017-0025-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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12
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Rodrigue C, Beauchesne MF, Mallette V, Lemière C, Larivée P, Blais L. Characterization of Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome: A Qualitative Analysis. COPD 2017; 14:330-338. [PMID: 28494181 DOI: 10.1080/15412555.2017.1318841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Approximately 15-20% of patients with chronic obstructive pulmonary disease (COPD) also display characteristics of asthma. In May 2014, the asthma-COPD overlap syndrome (ACOS) was briefly addressed in the Global Initiative for Asthma (GINA) and Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy documents. We evaluated how pulmonologists diagnose and treat ACOS and how they assess its control. Pulmonologists from two university healthcare centers, having ≥ 1 year experience, treating patients with asthma, COPD, or ACOS, were invited to participate in focus groups. Two focus groups (1 hour duration) were convened with seven and five participants, respectively. According to pulmonologists from both institutions, ACOS is a new name for an existing syndrome rather than a new disease. It is characterized by incomplete reversible airflow limitations and changes in forced expiratory volume in one second over time. The pulmonologists noted that its diagnosis must be based on clinical characteristics, pulmonary function test results, and clinical intuition. To diagnose ACOS, pulmonologists must rely on their clinical judgment. They also agreed that the treatment of patients with ACOS should target the features of both asthma and COPD. Pulmonologists from both institutions used asthma control criteria to assess ACOS control. A deeper understanding would enable clinicians to establish specific criteria for the diagnosis, treatment, and follow-up of subjects with ACOS.
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Affiliation(s)
- Claudie Rodrigue
- a Faculty of Pharmacy , Université de Montréal , Montreal , Canada
| | - Marie-France Beauchesne
- a Faculty of Pharmacy , Université de Montréal , Montreal , Canada.,b Pharmacy Department , Centre Hospitalier Universitaire de Sherbrooke , Sherbrooke , Canada.,c Centre de Recherche , Centre Hospitalier Universitaire de Sherbrooke , Sherbrooke , Canada.,f Faculty of Medicine , Université de Sherbrooke , Sherbrooke , Canada
| | - Valérie Mallette
- a Faculty of Pharmacy , Université de Montréal , Montreal , Canada
| | - Catherine Lemière
- d Faculty of Medicine , Université de Montréal , Montreal , Canada.,e Research Center , Hôpital du Sacré-Coeur de Montréal , Montreal , Canada
| | - Pierre Larivée
- c Centre de Recherche , Centre Hospitalier Universitaire de Sherbrooke , Sherbrooke , Canada.,f Faculty of Medicine , Université de Sherbrooke , Sherbrooke , Canada
| | - Lucie Blais
- a Faculty of Pharmacy , Université de Montréal , Montreal , Canada.,e Research Center , Hôpital du Sacré-Coeur de Montréal , Montreal , Canada
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13
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Plaza V, Álvarez F, Calle M, Casanova C, Cosío BG, López-Viña A, Pérez de Llano L, Quirce S, Román-Rodríguez M, Soler-Cataluña JJ, Miravitlles M. Consensus on the Asthma-COPD Overlap Syndrome (ACOS) Between the Spanish COPD Guidelines (GesEPOC) and the Spanish Guidelines on the Management of Asthma (GEMA). Arch Bronconeumol 2017; 53:443-449. [PMID: 28495077 DOI: 10.1016/j.arbres.2017.04.002] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/28/2017] [Accepted: 04/01/2017] [Indexed: 12/24/2022]
Abstract
Following a proposal by the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), sponsor of the Spanish COPD Guidelines (GesEPOC) and the Spanish Guidelines on the Management of Asthma (GEMA), authors of both papers have unified the criteria for the diagnosis of asthma-COPD overlap syndrome (ACOS). This consensus defines ACOS as the presence in a given patient of three elements: significant smoking exposure, chronic airflow limitation and asthma. Diagnosis is confirmed when a patient (35years of age or older), smoker or ex-smoker of more than 10 pack-years, presents airflow limitation (post-bronchodilator FEV1/FVC<0.7) that persists after treatment with bronchodilators and inhaled corticosteroids (even after systemic corticosteroids in selected cases), and an objective current diagnosis of asthma (according to GEMA criteria). In cases in which the diagnosis of asthma cannot be demonstrated, marked positive results on a bronchodilator test (FEV1≥15% and ≥400mL) or elevated blood eosinophil count (≥300eosinophils/μL) will also be diagnostic of ACOS. The opinion of another 33 experts who had not participated in the consensus was sought using a modified Delphi survey. Up to 80% of respondents gave a very positive opinion of the consensus, and declared that it was better than other previous proposals. The GesEPOC-GEMA consensus on ACOS provides a unique perspective of the diagnostic problem, using a simple proposal and a pragmatic diagnostic algorithm that can be applied at any healthcare level.
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Affiliation(s)
- Vicente Plaza
- Servei de Pneumologia, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
| | - Francisco Álvarez
- Servicio de Neumología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Myriam Calle
- Servicio de Neumología, Hospital Clínico San Carlos, Madrid, España
| | - Ciro Casanova
- Servicio de Neumología, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España
| | - Borja G Cosío
- Servicio de Neumología, Hospital Universitario Son Espases-IdISBa, CIBERES, Palma de Mallorca, Illes Balears, España
| | - Antolín López-Viña
- Servicio de Neumología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | | | - Santiago Quirce
- Servicio de Alergología, Hospital Universitario La Paz, Madrid, España
| | | | | | - Marc Miravitlles
- Servei de Pneumologia, Hospital Universitari Vall d'Hebron, Barcelona, España
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Miravitlles M, Alvarez-Gutierrez FJ, Calle M, Casanova C, Cosio BG, López-Viña A, Pérez de Llano L, Quirce S, Roman-Rodríguez M, Soler-Cataluña JJ, Plaza V. Algorithm for identification of asthma-COPD overlap: consensus between the Spanish COPD and asthma guidelines. Eur Respir J 2017; 49:49/5/1700068. [PMID: 28461301 DOI: 10.1183/13993003.00068-2017] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 01/27/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Marc Miravitlles
- Pneumology Dept, Hospital Universitari Vall d'Hebron, Barcelona, Spain .,CIBER de Enfermedades Respiratorias (CIBERES), Spain
| | - Francisco Javier Alvarez-Gutierrez
- Medical-Surgical Unit of Respiratory Diseases, Virgen del Rocio University Hospital, Biomedicine Institute of Seville (IBiS), Seville, Spain
| | - Myriam Calle
- Dept of Respiratory Medicine, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain.,Dept of Medicine, Institut d'Investigació Biomédica San Carlos (IdISSC), Madrid, Spain
| | - Ciro Casanova
- Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Borja G Cosio
- CIBER de Enfermedades Respiratorias (CIBERES), Spain.,Hospital Universitario Son Espases IdISPa, Palma de Mallorca, Spain
| | | | | | - Santiago Quirce
- CIBER de Enfermedades Respiratorias (CIBERES), Spain.,Dept of Allergy, Hospital La Paz, Institute for Health Research (IdiPAZ), Madrid, Spain
| | | | | | - Vicente Plaza
- Dept of Respiratory Medicine, Hospital de la Santa CreuiSant Pau, Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain
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15
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Chou KT, Su KC, Hsiao YH, Huang SF, Ko HK, Tseng CM, Su VYF, Perng DW. Post-bronchodilator Reversibility of FEV 1 and Eosinophilic Airway Inflammation in COPD. Arch Bronconeumol 2017; 53:547-553. [PMID: 28438346 DOI: 10.1016/j.arbres.2017.01.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/31/2016] [Accepted: 01/22/2017] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The relationship between bronchodilator responsiveness and eosinophilic airway inflammation has not been well documented in COPD. It has been investigated in this retrospective study. This issue has grown in importance due to increasing interest in the asthma-COPD overlap syndrome. METHODS 264 stable COPD patients with no past history of asthma were retrospectively analyzed. Correlation analyses between FEV1 reversibility and sputum eosinophil levels were conducted. Sputum eosinophil levels were dichotomized using FEV1 reversibility cut-off points (>0.4L and >15% vs. >0.2L and >12%) and compared. The effectiveness of FEV1 reversibility to predict sputum eosinophilia (>3%) was analyzed with a logistic regression and a ROC analysis. RESULTS 82 (31.1%) patients with higher FEV1 reversibility values (0.14 vs. 0.11L, P=.01) presented sputum eosinophilia. FEV1 reversibility was weakly correlated with the sputum eosinophil level (r=0.162, P=.008). Patients with FEV1>0.4L and >15% increment had higher sputum eosinophil levels (6.11 vs. 1.02%, P=.049) whereas the level did not differ when dichotomized by FEV1 increment >0.2L and >12%. Very positive FEV1 reversibility (>0.4L and >15%) predicted sputum eosinophilia after adjustment forage, baseline FEV1 and FVC (OR: 4.262, P=.029). In the ROC analysis, the AUC was 0.58 (P=.034), and FEV1 increment>0.4L and >15% had a positive predictive value of 63.6% and an overall accuracy of 70.1%. CONCLUSIONS FEV1 reversibility was weakly correlated with sputum eosinophil levels in COPD. Positive FEV1 reversibility (>0.4L and >15%) is moderately successful in predicting sputum eosinophilia (>3%).
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Affiliation(s)
- Kun-Ta Chou
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Center of Sleep Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taiwan
| | - Kang-Cheng Su
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Center of Sleep Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Han Hsiao
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shiang-Fen Huang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Kuo Ko
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ching-Min Tseng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Vincent Yi-Fong Su
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Diahn-Warng Perng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taiwan.
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16
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Baarnes CB, Andersen ZJ, Tjønneland A, Ulrik CS. Incidence and long-term outcome of severe asthma-COPD overlap compared to asthma and COPD alone: a 35-year prospective study of 57,053 middle-aged adults. Int J Chron Obstruct Pulmon Dis 2017; 12:571-579. [PMID: 28228656 PMCID: PMC5312695 DOI: 10.2147/copd.s123167] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Incidence and prognosis for severe asthma–COPD overlap is poorly characterized. We investigated incidence and long-term outcome for patients with asthma–COPD overlap compared to asthma and COPD alone. Materials and methods A total of 57,053 adults (aged 50–64 years) enrolled in the Danish Diet, Cancer, and Health cohort (1993–1997) were followed in the National Patients Registry for admissions for asthma (DJ45–46) and COPD (DJ40–44) and vital status. Asthma–COPD overlap was defined as at least one hospital admission for asthma and one for COPD (different time points), and incident asthma–COPD overlap as at least one of the diagnoses occurring after enrollment into the Diet, Cancer, and Health cohort. Results A total of 1,845 (3.2%) and 4,037 (7.1%) participants had admissions for asthma and COPD, respectively, with 662 (1.2%) participants with asthma–COPD overlap. Incidence rate of asthma–COPD overlap per 1,000 person-years was higher in women (0.73) than in men (0.54) (P<0.02). Mortality rate was higher in asthma–COPD overlap (25.9 per 1,000 person-years) compared with COPD (23.1, P<0.05) and asthma (7.9, P<0.001) alone. Compared to COPD alone, mortality was higher in women with asthma–COPD overlap (19.6 and 25.5, respectively; P<0.01), and the excess mortality rate for asthma–COPD overlap patients was most prominent for younger age groups (12.9 compared to 7.2 and 4.6 for COPD and asthma alone, respectively; P<0.01). Conclusion This large population-based study revealed a higher incidence of severe asthma–COPD overlap in women compared to men, and furthermore that all-cause mortality is higher in women and younger subjects with asthma–COPD overlap compared with those with asthma or COPD alone.
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Affiliation(s)
| | | | | | - Charlotte Suppli Ulrik
- Department of Pulmonary Medicine, Hvidovre Hospital, Hvidovre; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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17
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Araújo D, Padrão E, Morais-Almeida M, Cardoso J, Pavão F, Leite RB, Caldas AC, Marques A. Asthma-chronic obstructive pulmonary disease overlap syndrome - Literature review and contributions towards a Portuguese consensus. REVISTA PORTUGUESA DE PNEUMOLOGIA 2017; 23:90-99. [PMID: 28089081 DOI: 10.1016/j.rppnen.2016.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 11/05/2016] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Phenotypic 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. METHODS A 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. RESULTS There 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. CONCLUSIONS The 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.
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Affiliation(s)
- D Araújo
- Institute of Health Sciences, Universidade Católica Portuguesa, Portugal; Pulmonology Department, Centro Hospitalar de São João, Porto, Portugal
| | - E Padrão
- Institute of Health Sciences, Universidade Católica Portuguesa, Portugal; Pulmonology Department, Centro Hospitalar de São João, Porto, Portugal.
| | - M Morais-Almeida
- Coordinator of Allergy Center of CUF Hospitals, Lisbon, Portugal
| | - J Cardoso
- Pulmonology Department, Centro Hospitalar de Lisboa Central, Lisboa, Portugal; Nova Medical School, Lisbon, Portugal
| | - F Pavão
- Institute of Health Sciences, Universidade Católica Portuguesa, Portugal
| | - R B Leite
- Institute of Health Sciences, Universidade Católica Portuguesa, Portugal; Faculty of Health, Medicine and Life Sciences, Maastricht University, Portugal
| | - A C Caldas
- Institute of Health Sciences, Universidade Católica Portuguesa, Portugal
| | - A Marques
- Pulmonology Department, Centro Hospitalar de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Portugal
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18
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García-García MDC, Hernández-Borge J, Barrecheguren M, Miravitlles M. The challenge of diagnosing a mixed asthma-COPD phenotype (ACOS) in clinical practice. Ther Adv Respir Dis 2016; 10:175-8. [PMID: 26968234 DOI: 10.1177/1753465816630209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
| | | | - Miriam Barrecheguren
- Pneumology Department, Hospital General Universitari Vall d'Hebron, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Marc Miravitlles
- Pneumology Department, Hospital General Universitari Vall d'Hebron, P. Vall d'Hebron 119-129, 08035, Barcelona, Spain
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19
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Kalinina EP, Denisenko YK, Vitkina TI, Lobanova EG, Novgorodtseva TP, Antonyuk MV, Gvozdenko TA, Knyshova VV, Nazarenko AV. The Mechanisms of the Regulation of Immune Response in Patients with Comorbidity of Chronic Obstructive Pulmonary Disease and Asthma. Can Respir J 2016; 2016:4503267. [PMID: 27660519 PMCID: PMC5021859 DOI: 10.1155/2016/4503267] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 07/03/2016] [Accepted: 08/10/2016] [Indexed: 01/19/2023] Open
Abstract
Background. Comorbidity of chronic obstructive pulmonary disease (COPD) and asthma (asthma COPD overlap syndrome, ACOS) is a significant problem in pulmonary practice, whose pathogenetic issues are not clarified yet. Objective. To study the features of the regulation of immune response in patients with comorbid COPD and asthma. Methods. We assessed the levels of CD3+, CD4+, CD8+, CD4+/CD8+, CD19+, CD25+, HLA-DR, total IgE, TNF-α, IL-4, IFN-γ, TXB2, and LTB4 in patients with comorbid COPD and asthma. Results. The study involved 44 people with COPD, 39 people with asthma, and 12 people with comorbid COPD and asthma. The specific features in comorbid COPD and asthma were lymphocytosis, increased absolute count of T-helper cells, increased cytotoxic T-lymphocytes in relative and absolute count, increased relative and absolute numbers of B-lymphocytes, and high levels of total IgE. The elevated levels of TNF-α and IL-4 and inhibition of IFN-γ production were detected. The content of LTB4 was maximal; TXB2 levels were higher than in control group but lower than in COPD and asthma. Conclusion. In comorbid COPD and asthma inflammation increased even during stable period. High levels of eicosanoids, low production of Th1-type cytokines, and active synthesis of opposition IL-4, along with increased IgE, indicate the activation of Th2-type immune response.
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Affiliation(s)
- Elena P. Kalinina
- Institute of Medical Climatology and Rehabilitation Treatment, Vladivostok Branch of Far Eastern Scientific Center of Physiology and Pathology of Respiration, 73g Russkaya St., Vladivostok 690105, Russia
| | - Yulia K. Denisenko
- Institute of Medical Climatology and Rehabilitation Treatment, Vladivostok Branch of Far Eastern Scientific Center of Physiology and Pathology of Respiration, 73g Russkaya St., Vladivostok 690105, Russia
| | - Tatyana I. Vitkina
- Institute of Medical Climatology and Rehabilitation Treatment, Vladivostok Branch of Far Eastern Scientific Center of Physiology and Pathology of Respiration, 73g Russkaya St., Vladivostok 690105, Russia
| | - Elena G. Lobanova
- Institute of Medical Climatology and Rehabilitation Treatment, Vladivostok Branch of Far Eastern Scientific Center of Physiology and Pathology of Respiration, 73g Russkaya St., Vladivostok 690105, Russia
| | - Tatyana P. Novgorodtseva
- Institute of Medical Climatology and Rehabilitation Treatment, Vladivostok Branch of Far Eastern Scientific Center of Physiology and Pathology of Respiration, 73g Russkaya St., Vladivostok 690105, Russia
| | - Marina V. Antonyuk
- Institute of Medical Climatology and Rehabilitation Treatment, Vladivostok Branch of Far Eastern Scientific Center of Physiology and Pathology of Respiration, 73g Russkaya St., Vladivostok 690105, Russia
| | - Tatyana A. Gvozdenko
- Institute of Medical Climatology and Rehabilitation Treatment, Vladivostok Branch of Far Eastern Scientific Center of Physiology and Pathology of Respiration, 73g Russkaya St., Vladivostok 690105, Russia
| | - Vera V. Knyshova
- Institute of Medical Climatology and Rehabilitation Treatment, Vladivostok Branch of Far Eastern Scientific Center of Physiology and Pathology of Respiration, 73g Russkaya St., Vladivostok 690105, Russia
| | - Anna V. Nazarenko
- Institute of Medical Climatology and Rehabilitation Treatment, Vladivostok Branch of Far Eastern Scientific Center of Physiology and Pathology of Respiration, 73g Russkaya St., Vladivostok 690105, Russia
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20
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Sin DD, Miravitlles M, Mannino DM, Soriano JB, Price D, Celli BR, Leung JM, Nakano Y, Park HY, Wark PA, Wechsler ME. What is asthma-COPD overlap syndrome? Towards a consensus definition from a round table discussion. Eur Respir J 2016; 48:664-73. [PMID: 27338195 DOI: 10.1183/13993003.00436-2016] [Citation(s) in RCA: 249] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/22/2016] [Indexed: 01/10/2023]
Abstract
Patients with asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) have been largely excluded from pivotal therapeutic trials and, as a result, its treatment remains poorly defined and lacking firm evidence. To date, there is no universally accepted definition of ACOS, which has made it difficult to understand its epidemiology or pathophysiology. Despite many uncertainties, there is emerging agreement that some of the key features of ACOS include persistent airflow limitation in symptomatic individuals 40 years of age and older, a well-documented history of asthma in childhood or early adulthood and a significant exposure history to cigarette or biomass smoke. In this perspective, we propose a case definition of ACOS that incorporates these key features in a parsimonious algorithm that may enable clinicians to better diagnose patients with ACOS and most importantly enable researchers to design therapeutic and clinical studies to elucidate its epidemiology and pathophysiology and to ascertain its optimal management strategies.
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Affiliation(s)
- Don D Sin
- Centre for Heart Lung Innovation, St. Paul's Hospital, & Department of Medicine (Respiratory Division), University of British Columbia, Vancouver, BC, Canada
| | - Marc Miravitlles
- Servicio de Neumología, Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Spain
| | - David M Mannino
- Dept of Preventive Medicine and Environmental Health, University of Kentucky, College of Public Health, Lexington, KY, USA
| | - Joan B Soriano
- Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain
| | - David Price
- Centre for Academic Primary Care, The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK Research in Real-Life, Cambridge, UK
| | - Bartolome R Celli
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Janice M Leung
- Centre for Heart Lung Innovation, St. Paul's Hospital, & Department of Medicine (Respiratory Division), University of British Columbia, Vancouver, BC, Canada
| | - Yasutaka Nakano
- Dept of Medicine, Division of Respiratory Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Peter A Wark
- Priority Centre for Healthy Lungs, HMRI University of Newcastle, Newcastle, Australia
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21
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Kostikas K, Clemens A, Patalano F. The asthma-COPD overlap syndrome: do we really need another syndrome in the already complex matrix of airway disease? Int J Chron Obstruct Pulmon Dis 2016; 11:1297-306. [PMID: 27366057 PMCID: PMC4914074 DOI: 10.2147/copd.s107307] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The term asthma–COPD overlap syndrome (ACOS) is one of multiple terms used to describe patients with characteristics of both COPD and asthma, representing ~20% of patients with obstructive airway diseases. The recognition of both sets of morbidities in patients is important to guide practical treatment decisions. It is widely recognized that patients with COPD and coexisting asthma present with a higher disease burden, despite the conceptual expectation that the “reversible” or “treatable” component of asthma would allow for more effective management and better outcomes. However, subcategorization into terms such as ACOS is complicated by the vast spectrum of heterogeneity that is encapsulated by asthma and COPD, resulting in different clinical clusters. In this review, we discuss the possibility that these different clusters are suboptimally described by the umbrella term “ACOS”, as this additional categorization may lead to clinical confusion and potential inappropriate use of resources. We suggest that a more clinically relevant approach would be to recognize the extreme variability and the numerous phenotypes encompassed within obstructive airway diseases, with various degrees of overlapping in individual patients. In addition, we discuss some of the evidence to be considered when making practical decisions on the treatment of patients with overlapping characteristics between COPD and asthma, as well as the potential options for phenotype and biomarker-driven management of airway disease with the aim of providing more personalized treatment for patients. Finally, we highlight the need for more evidence in patients with overlapping disease characteristics and to facilitate better characterization of potential treatment responders.
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22
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Pérez de Llano LA, Cosío BG. Asthma, Chronic Obstructive Pulmonay Disease and Other Combinations. Arch Bronconeumol 2016; 52:499-500. [PMID: 27125582 DOI: 10.1016/j.arbres.2016.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/11/2016] [Accepted: 03/14/2016] [Indexed: 11/17/2022]
Affiliation(s)
| | - Borja G Cosío
- Department of Respiratory Medicine, Hospital Son Espases-Instituto de Investigación Sanitaria de Palma (IdISPa), Palma de Mallorca, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Palma de Mallorca, España
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23
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Tan LD, Bratt JM, Godor D, Louie S, Kenyon NJ. Benralizumab: a unique IL-5 inhibitor for severe asthma. J Asthma Allergy 2016; 9:71-81. [PMID: 27110133 PMCID: PMC4831605 DOI: 10.2147/jaa.s78049] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The presence of eosinophilic inflammation is a characteristic feature of chronic and acute inflammation in asthma. An estimated 5%–10% of the 300 million people worldwide who suffer from asthma have a severe form. Patients with eosinophilic airway inflammation represent approximately 40%–60% of this severe asthmatic population. This form of asthma is often uncontrolled, marked by refractoriness to standard therapy, and shows persistent airway eosinophilia despite glucocorticoid therapy. This paper reviews personalized novel therapies, more specifically benralizumab, a humanized anti-IL-5Rα antibody, while also being the first to provide an algorithm for potential candidates who may benefit from anti-IL-5Rα therapy.
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Affiliation(s)
- Laren D Tan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Jennifer M Bratt
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, School of Medicine, University of California Davis, Sacramento, CA, USA
| | - Dorottya Godor
- School of Medicine, Semmelweis University, Budapest, Hungary
| | - Samuel Louie
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, School of Medicine, University of California Davis, Sacramento, CA, USA
| | - Nicholas J Kenyon
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, School of Medicine, University of California Davis, Sacramento, CA, USA
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24
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Barrecheguren M, Esquinas C, Miravitlles M. How can we identify patients with asthma-COPD overlap syndrome in clinical practice? Arch Bronconeumol 2015; 52:59-60. [PMID: 26677759 DOI: 10.1016/j.arbres.2015.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 10/07/2015] [Accepted: 10/30/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Miriam Barrecheguren
- Servicio de Neumología, Hospital Universitari Vall d'Hebron, Barcelona, España; Ciber de Enfermedades Respiratorias (CIBERES)
| | - Cristina Esquinas
- Servicio de Neumología, Hospital Universitari Vall d'Hebron, Barcelona, España; Ciber de Enfermedades Respiratorias (CIBERES)
| | - Marc Miravitlles
- Servicio de Neumología, Hospital Universitari Vall d'Hebron, Barcelona, España; Ciber de Enfermedades Respiratorias (CIBERES).
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25
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Barrecheguren M, Esquinas C, Miravitlles M. The asthma-COPD overlap syndrome: a new entity? ACTA ACUST UNITED AC 2015. [DOI: 10.1186/s40749-015-0012-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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