Search

Chronic obstructive pulmonary disease (COPD) is often diagnosed with other comorbid conditions. This can complicate therapy overall by contributing to adverse events leading to poor outcomes to not only COPD, but other comorbid conditions. This manuscript will discuss common comorbid conditions often seen with COPD, update vaccination recommendations for COPD patients, and provide information regarding smoking cessation in COPD. The senior care pharmacist has an important role where they can recommend medication adjustments to potentially avoid these adverse events, immunize their patients appropriately, and provide assistance with smoking cessation to improve not only COPD outcomes but outcomes associated with other comorbid conditions. [ABSTRACT FROM AUTHOR]

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

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

Abstract Background Previous studies have suggested an increased risk of asthma related to indoor dampness problems, but their role in the etiology of Asthma-COPD Overlap Syndrome has not been studied. We utilized a population-based incident case–control study to assess potential effect of indoor dampness and molds at home and at work on development of ACOS. Methods We recruited systematically all new cases of asthma diagnosed during a 2.5-year study period (1997–2000) and randomly selected controls from the source population of adults 21–63 years old and representing 500,000 persons-years in the Pirkanmaa Hospital District, South Finland. Exposure indicators included water damage, damp stains or paint peeling, visible mold, and mold odor, asked separately for home and workplace. The clinically diagnosed case series consisted of 521 adults with newly diagnosed asthma. Altogether 25 of them satisfied the criteria for ACOS-cases, i.e. FEV1/FVC

Newer guidelines for the use of inhaled corticosteroids in chronic obstructive pulmonary disease (COPD) state that they should be reserved for those patients who are likely to derive the greatest benefits from this medication class. This makes the latest Global Initiative for Chronic Obstructive Lung disease (GOLD) guidelines of great importance. This article examines the utility of a previous diagnosis of asthma, the presence of eosinophilia, elevated immunoglobulin E, and positive bronchodilator response in identifying the people with COPD who also have asthma, and it presents two case studies of patients with COPD to illustrate the use of the GOLD guidelines in clinical practice. [ABSTRACT FROM AUTHOR]

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

OBJECTIVE: The aim of this study was to review evidence to determine whether "pure" chronic obstructive pulmonary disease (COPD) patients without a history of asthma differ in the clinical characteristics, severity of airflow limitation, and clinical outcomes compared to patients with Asthma-COPD Overlap Syndrome (ACOS). MATERIALS AND METHODS: An electronic search was performed in the MEDLINE, EMBASE, SCOPUS and Web of Science databases to identify comparing the clinical characteristics and outcomes between ACOS and "pure" COPD. The included studies were subjected to meta-analysis and risk of bias assessment using ROBINS-E tool. Eleven observational studies were included. RESULTS: The results of the meta-analysis showed increased expression of lung function parameters like forced expiration volume (FEV) at 1 sec{mean difference (MD) 2.36; 95% CI [0.05,4.66]; p=0.004; I2= 72%} and clinical symptoms in terms of fever {Relative Risk (RR) 0.34, p<0.0001}, wheezing {RR 0.39, p<0.0001} and dyspnea {RR 0.53, p<0.0001}. The comorbidities associated with ACOS patients were similar to that found in patients with "pure" COPD. Interestingly, higher body mass index (BMI) was found in patients with ACOS (MD -0.73 95% CI [-1.06, -0.41], p<0.0001. CONCLUSIONS: The result showed higher risk in onset of frequent acute exacerbations, severe exacerbations requiring hospitalization and higher number of exacerbations experienced per year in ACOS patients. Within the limitations of the review, ACOS can be regarded as separate entity of co-existence which is classically associated with higher BMI, worsened lung function parameters and exacerbations with a varing degree of clinical symptoms. [ABSTRACT FROM AUTHOR]

Copyright of Polish Journal of Allergology / Alergologia Polska is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

José Luis Izquierdo,1 Borja G Cosio2,3 1Department of Pneumology and Medicine, Hospital Universitario, Universidad de Alcalá, Guadalajara, Spain; 2Department of Respiratory Medicine, Hospital Son Espases-IdISBa, Palma de Mallorca, Spain; 3CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain Background: The use of inhaled corticosteroids (ICS) in combination with bronchodilators in patients with COPD has been shown to decrease the rate of disease exacerbations and to improve the lung function and patients’ quality of life. However, their use has also been associated with an increased risk of pneumonia. Materials and methods: We have reviewed existing clinical evidence on the risks and benefits of ICS in COPD, including large randomized clinical trials, meta-analyses, and clinical reviews. Results: A large body of evidence supports the clinical benefits of ICS in patients with COPD in terms of exacerbations, symptoms, lung function, and quality of life. The incidence of adverse events related to ICS, including pneumonia, varies strongly among the studies and seems to be dose dependent, with recent well-designed, large studies on low-dose ICS reporting similar safety profiles in ICS and non-ICS groups. Conclusion: The benefits of ICS in COPD continue to outweigh the risks, especially when lower ICS doses are employed. Given that the data on ICS withdrawal in COPD are scarce and conflicting, we argue that using reduced doses of ICS could be an optimal strategy to manage patients with COPD. Keywords: acute exacerbations, anti-inflammatory effects, COPD, asthma-COPD overlap syndrome, inhaled corticosteroids, lower doses of ICS, pneumonia

Aleksander Kania,1 Rafał Krenke,2 Krzysztof Kuziemski,3 Małgorzata Czajkowska-Malinowska,4 Natalia Celejewska-Wójcik,1 Barbara Kuźnar-Kamińska,5 Małgorzata Farnik,6 Juliusz Bokiej,7 Marta Miszczuk,2 Iwona Damps-Konstańska,3 Marcin Grabicki,5 Marzena Trzaska-Sobczak,6 Krzysztof Sładek,1 Halina Batura-Gabryel,5 Adam Barczyk6 1Department of Pulmonology, II Chair of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland; 2Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland; 3Department of Allergology and Pneumonology, Medical University of Gdańsk, Gdańsk, Poland; 4Department of Lung Diseases and Respiratory Failure, Regional Center of Pulmonology, Bydgoszcz, Poland; 5Department of Pulmonology, Allergology and Respiratory Oncology, Poznań University of Medical Sciences, Poznań, Poland; 6Department of Pneumology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland; 7Department of Lung Diseases, Regional Hospital Center Jelenia Góra, Jelenia Góra, Poland Background: This study aimed to examine the distribution of predefined phenotypes, demographic data, clinical outcomes, and treatment of patients who were included in the Polish cohort of the Phenotypes of COPD in Central and Eastern Europe (POPE) study. Patients and methods: This was a sub-analysis of the data from the Polish cohort of the POPE study, an international, multicenter, observational cross-sectional survey of COPD patients in Central and Eastern European countries. The study included patients aged .40 years, with a confirmed diagnosis of COPD, and absence of exacerbation for at least 4 weeks before study inclusion. A total of seven Polish centers participated in the study. Results: Among the 430 Polish COPD patients enrolled in the study, 61.6% were non-exacerbators (NON-AE), 25.3% were frequent exacerbators with chronic bronchitis (AE CB), 7.9% were frequent exacerbators without chronic bronchitis (AE NON-CB), and 5.1% met the definition of asthma-COPD overlap syndrome (ACOS). There were statistically significant differences among these phenotypes in terms of symptom load, lung function, comorbidities, and treatment. Patients with the AE CB phenotype were most symptomatic with worse lung function, and more frequently reported anxiety and depression. Patients with the ACOS phenotype were significantly younger and were diagnosed with COPD earlier than those with other COPD phenotypes; those with the ACOS phenotype were also more often atopic and obese. Conclusion: There is significant heterogeneity among COPD patients in the Polish population in terms of phenotype and clinical outcome. The non-exacerbator phenotype is observed most frequently in Poland, while the frequent exacerbator with chronic bronchitis phenotype is the most symptomatic. Keywords: chronic obstructive pulmonary disease, asthma-COPD overlap syndrome, phenotypes

Steven J Pascoe,1 Wei Wu,2,3 Kathryn A Collison,1 Linda M Nelsen,4 Keele E Wurst,5 Laurie A Lee6 1Respiratory Medicines Development Center, GSK, Research Triangle Park, NC, USA; 2Biostatistics, PAREXEL International, Research Triangle Park, NC, USA; 3Clinical Statistics, GSK, Research Triangle Park, NC, USA; 4Value Evidence and Outcomes, GSK, Collegeville, PA, USA; 5Epidemiology, GSK, Collegeville, PA, USA; 6Research and Development, GSK, Stevenage, UK Background: There is no consensus on how to define patients with symptoms of asthma and chronic obstructive pulmonary disease (COPD). A diagnosis of asthma–COPD overlap (ACO) syndrome has been proposed, but its value is debated. This study (GSK Study 201703 [NCT02302417]) investigated the ability of statistical modeling approaches to define distinct disease groups in patients with obstructive lung disease (OLD) using medical history and spirometric data.Methods: Patients aged ≥18 years with diagnoses of asthma and/or COPD were categorized into three groups: 1) asthma (nonobstructive; reversible), 2) ACO (obstructive; reversible), and 3) COPD (obstructive; nonreversible). Obstruction was defined as a post-bronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity

Background: Asthma - chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) is characterized by a persistent airway obstruction that has several features of asthma and several features of COPD. ACOS was reported to have lower pulmonary function values compared to patients who had only asthma or COPD. Bronchial hyper-responsiveness profile in ACOS has also not been clearly determined. Objective: The current study was conducted with the aimed to determine the pulmonary function and bronchial hyper-responsiveness profile of ACOS. Methodology: This study was a cross sectional study conducted at Asthma-COPD Outpatient Clinic of national referral hospital for respiratory diseases, the Persahabatan Hospital, Jakarta, Indonesia. ACOS diagnosis was made using the modified 2017 Global Initiative for Asthma (GINA) and Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Patients are diagnosed with ACOS if they have at least three clinical features that support asthma and COPD. Results: The study involved 60 subjects. After bronchodilator (BD) test, the mean or median forced vital capacity (FVC)% predicted, forced expiratory volume within 1 second (FEV1)% predicted, FEV1/FVC ratio, FEV1 and the percentage of FEV1 were increased of 853%, 76.4%, 67.8%, 158.3 mL, and 101% respectively. Positive methacholine challenge test was found in 97.1% of ACOS patients. ACOS patients had mean post-BD FEV1/FVC of 67.7%, median percentage of FEV1 increase of 10.1% and most of them had positive methacholine challenge test. Conclusion: The ACOS group had mean or median pre-BD VC% predicted, FVC% predicted, FEV1% predicted and FEV1/FVC of 82.2%, 77.4%, 66% and 65.9%, respectively. After BD administration, ACOS group had mean or median FVC% predicted, FEV1% predicted, FEV1/FVC, FEV1 increase and percentage of FEV1 increase of 85.3%, 76.4%, 67.8%, 158.3 mL, and 10.1%, respectively. Positive bronchial provocation test was found in 97.1% of ACOS patients. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Modern Laboratory Medicine is the property of Journal of Modern Laboratory Medicine Editorial Department and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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

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

INTRODUCTION: Measurement of fractional exhaled nitric oxide (FeNO) is a simple, noninvasive, reproducible, and convenient method for assessing airway inflammation. We here assessed the value of FeNO for distinguishing asthma-COPD overlap syndrome (ACOS) and chronic obstructive pulmonary disease (COPD) in patients hospitalized due to exacerbation of COPD. METHODS: A total of 100 consecutive patients diagnosed with COPD and hospitalized due to disease exacerbation were included and divided into the COPD-alone group and ACOS group. FeNO was measured at the beginning of hospitalization and at discharge. RESULTS: There was no correlation between FeNO values measured at the time of hospitalization and hospital duration (r = -0.10, P = 0.334). However, the mean FeNO value at the beginning of hospitalization was significantly higher in the ACOS group than in the COPD-alone group (25.5 [11-149] vs. 13.0 [5-50]; P < 0.001). The initial FeNO value was a good predictor of ACOS, with an optimum value of 18.5 parts per billion (sensitivity, 80%; specificity, 80%; positive and negative predictive values, 63.6% and 90.6%, respectively). CONCLUSION: The FeNO level can identify ACOS in patients hospitalized for COPD exacerbation, providing a new diagnostic tool for the clinical management of ACOS and COPD. [ABSTRACT FROM AUTHOR]

Dong-Won Lee,1 Hyun-Jung Jin,2 Kyeong-Cheol Shin,2 Jin-Hong Chung,2 Hyoung-Woo Lee,3 Kwan-Ho Lee2 1Division of Pulmonology, Department of Internal Medicine, Andong Sungso Hospital, Andong, 2Division of Pulmonology and Allergy, 3Division of Endocrinology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, South Korea Background: Sarcopenia and decreased bone-mineral density (BMD) are common in elderly people, and are major comorbidities of obstructive airway disease (OAD). However, the relationship between sarcopenia and BMD in each OAD phenotype, especially asthma–COPD overlap syndrome (ACOS), is not yet clear. We aimed to evaluate differences in BMD according to the presence of sarcopenia in each OAD phenotype. Materials and methods: Among the research subjects in KNHANES IV and V (2008–2011), 5,562 were ≥50 years old and underwent qualified spirometry and dual-energy X-ray absorptiometry. A total of 947 subjects were included in the study: 89 had asthma, 748 COPD, and 110 ACOS. Results: In the COPD and ACOS phenotypes, T-scores were lower in the sarcopenia group than the nonsarcopenia group. Prevalence rates of osteopenia and osteoporosis were higher in the sarcopenia group than the nonsarcopenia group. (P

Bo Ding,1 Mark Small2 1AstraZeneca Gothenburg, Mölndal, Sweden; 2Adelphi Real World, Bollington, Macclesfield, UK Background: Asthma and chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) is an increasingly recognized phenotype. Few randomized clinical trials have been conducted in patients with ACOS; therefore, scientific evidence concerning ACOS is scarce and a therapeutic approach remains unclear. The aim of this study was to evaluate current treatment trends for patients with ACOS, identified as those with a dual definition of asthma and COPD, in a real-world COPD cohort.Methods: Data were analyzed from patients with asthma and COPD in the USA, France, Germany, Italy, Spain, and the UK who participated in the 2012 and 2013 Adelphi Respiratory Disease Specific Programmes (DSPs). Patients with ACOS were identified in the COPD population; these patients had a physician-confirmed, concomitant asthma diagnosis. Physicians completed a patient record form providing information on patient and disease characteristics including prescribed respiratory treatment. Pairwise comparisons were made between the ACOS, asthma, and COPD populations using χ2 tests.Results: In total, 9,042 patients with asthma-only, 7,119 patients with COPD-only, and 523 patients with ACOS (a dual diagnosis of asthma and COPD) participated in the study. The most commonly prescribed regimens were inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) + long-acting muscarinic antagonist (LAMA); (ACOS 30%, asthma 1.4%, and COPD 32%), ICS/LABA (19%, 41.5%, and 17%, respectively), and LAMA (6%, 0.4%, and 19%, respectively); 18% of patients with ACOS were not prescribed an ICS. Patients with ACOS had a significantly higher incidence of gastroesophageal reflux disease, diabetes, and obesity and experienced more exacerbations in the past year than those with COPD or asthma.Conclusions: The majority of patients with ACOS, as defined in this research, were prescribed similar treatment to those with COPD. There is a need, however, for better treatment for patients with ACOS, as indicated by symptoms and exacerbation levels. A clearer therapeutic approach for patients with ACOS is required. Keywords: asthma–COPD overlap syndrome, asthma, chronic obstructive pulmonary disease, ACO, pharmacotherapy

Seiichi Kobayashi, Masakazu Hanagama, Shinsuke Yamanda, Masatsugu Ishida, Masaru YanaiDepartment of Respiratory Medicine, Japanese Red Cross Ishinomaki Hospital, Ishinomaki, JapanBackground: The clinical phenotypes and underlying mechanisms of asthma-COPD overlap syndrome (ACOS) remain elusive. This study aimed to investigate a comparison of COPD patients with and without ACOS, focusing on inflammatory biomarkers, in an outpatient COPD cohort.Methods: We conducted a cross-sectional study analyzing prospectively collected data from the Ishinomaki COPD Network registry. All participants were diagnosed with COPD, confirmed by using spirometry, and were aged 40–90 years and former smokers. Patients with features of asthma including both variable respiratory symptoms and variable expiratory airflow limitation were identified and defined as having ACOS. Then, the inflammatory biomarkers such as fractional exhaled nitric oxide level, blood eosinophil count and percentage, total immunoglobulin E (IgE) level, and presence of antigen-specific IgE were evaluated.Results: A total of 257 patients with COPD were identified, including 37 (14.4%) with ACOS. Patients with ACOS tended to be younger, have a shorter smoking history, and use more respiratory medications, especially inhaled corticosteroids and theophylline. Mean fractional exhaled nitric oxide level was significantly higher in those with ACOS than in those without ACOS (38.5 parts per billion [ppb] vs 20.3 ppb, P

Tadahiro Goto, Carlos A Camargo Jr, Kohei Hasegawa Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA Purpose: Recent studies propose TH2-mediated inflammation in patients with asthma–chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS). However, little is known about whether fractional exhaled nitric oxide (FeNO) differs between patients with ACOS and those with COPD alone. To address this knowledge gap, a nationally representative sample was analyzed to determine the difference in FeNO levels between patients with ACOS and those with COPD alone in the US population.Patients and methods: This is a cross-sectional analysis of the National Health and Nutrition Examination Survey from 2007 through 2012. All subjects aged ≥40 years with COPD were identified. ACOS was defined as self-reported wheezing in past 12 months plus bronchodilator response (forced expiratory volume increase of >200 mL and >12%) or self-reported physician diagnosis of asthma.Results: A total of 197 subjects with COPD were identified in the National Health and Nutrition Examination Survey. Of these, 23% met the criteria of ACOS. The FeNO level was higher in subjects with ACOS compared with those with COPD alone in both unadjusted (mean 21.2 ppb vs 13.0 ppb; difference, 8.2 [95% CI, 0.2 to 16.2]; P=0.045) and adjusted (difference, 8.2 [95% CI, 0.9 to 15.5]; P=0.03) analyses. Although there was no significant difference among current smokers, the FeNO level was significantly higher in non-current smokers with ACOS than non-smokers with COPD alone (mean 31.9 ppb vs 20.3 ppb; adjusted difference, 20.5 [95% CI, 4.4 to 36.6]; P=0.02). In a sensitivity analysis using an alternative definition of ACOS, the results did not change materially. The diagnostic value of FeNO to discriminate ACOS from COPD alone was not sufficient, with the area under the curve of 0.63 (95% CI, 0.54 to 0.72).Conclusion: By using nationally representative US data, it was found that 23% of COPD subjects met the ACOS criteria and also that the FeNO level was higher in subjects with ACOS compared with those with COPD alone, particularly in non-current smokers. Keywords: COPD, asthma–COPD overlap syndrome, fractional exhaled nitric oxide

Sevket Ozkaya,1 Adem Dirican,2 Tibel Tuna3 1Department of Pulmonary Medicine, Faculty of Medicine, Bahçes¸ehir University, Istanbul, 2Department of Pulmonary Medicine, Samsun Medical Park Hospital, 3Department of Pulmonary Medicine, Samsun Chest Diseases and Thoracic Surgery Hospital, Samsun, Turkey Abstract: Airway obstruction is variable in asthma, while it is progressive and persistent in chronic bronchitis and emphysema. However, some of the patients presenting with symptoms of chronic airway diseases have clinical features of both asthma and COPD. The group with “Asthma–COPD Overlap Syndrome” (ACOS) phenotype was characterized by definitely irreversible airway obstruction accompanied by symptoms and signs of reversibility. In this study, we aimed to classify obstructive airway diseases by clinical, radiological, and pulmonary function tests. Patients at Samsun Medical Park Hospital Chest Diseases outpatient clinic were evaluated between January 2013 and April 2016, and a total of 235 patients were included in this study. Mean age of the patients was 55.3±14.5 (15–88) years, and the male/female ratio was 45/190. The baseline pulmonary function test results of the patients were as follows: mean forced vital capacity (FVC) values 2,825±1,108 (710–6,870) mL and 74.3±22.4 (24–155)%, forced expiratory volume in 1 second (FEV1) values 1,789±774 (480–4,810) mL and 58.1±20.0 (20–130)%, FEV1/FVC values 62.5±6.8 (39–70)%. Reversibility criteria following bronchodilator treatment were present in 107 (45.5%) patients. We specified five subgroups for patients according to their clinical, radiological, and pulmonary test findings, namely Group 1 (asthma), Group 2 (ACOS), Group 3 (chronic bronchitis), and Group 4 (emphysema). Additionally, a group of patients who had clinical and spirometric features of both asthma and chronic bronchitis in association with underlying emphysema (emphysema with chronic bronchitis and emphysema with asthma) was defined as the undifferentiated obstruction (UNDO) group. Number and percentage distribution of patients by groups were 58 (24.7%) in the asthma group, 70 (29.8%) in the ACOS group, 61 (26%) in the chronic bronchitis group, 32 (13.6%) in the emphysema group, and 14 (6%) in the UNDO group. In conclusion, in our study, the types of obstructive airway diseases could be classified based on clinical, radiological, and pulmonary function test findings into five groups, including asthma, ACOS, chronic bronchitis, emphysema, and both asthma and chronic bronchitis in association with underlying emphysema (emphysema with chronic bronchitis and emphysema with asthma) or the so-called undifferentiated obstruction. We suggest that these patient groups can be determined more accurately by studies that evaluate the association between spirometric FEV1, FEV1/FVC values, and reversibility ratios. Keywords: asthma, COPD, asthma–COPD overlap syndrome, reversibility, spirometry

Kazuyoshi Kurashima, Yotaro Takaku, Chie Ohta, Noboru Takayanagi, Tsutomu Yanagisawa, Yutaka Sugita Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan Objective: The COPD assessment test (CAT) consists of eight nonspecific scores of quality of life. The aim of this study was to compare the health-related quality of life and severity of airflow limitation in patients with asthma, COPD, and asthma–COPD overlap syndrome (ACOS) using the CAT.Methods: We examined CAT and lung functions in 138 patients with asthma, 99 patients with COPD, 51 patients with ACOS, and 44 patients with chronic cough as a control. The CAT score was recorded in all subjects, and the asthma control test was also administered to patients with asthma and ACOS. The CAT scores were compared, and the relationships between the scores and lung function parameters were analyzed.Results: The total CAT scores and scores for cough, phlegm, and dyspnea were higher in patients with ACOS than in patients with asthma and COPD. The total CAT scores were correlated with the percent predicted forced expiratory volume in 1 second only in patients with COPD. The total CAT scores and dyspnea scores adjusted by the percent predicted forced expiratory volume in 1 second were higher in patients with ACOS than in patients with COPD and asthma. The CAT scores and asthma control test scores were more closely correlated in patients with ACOS than in patients with asthma.Conclusion: Patients with ACOS have higher disease impacts and dyspnea sensation unproportional to the severity of airflow limitation. Keywords: asthma–COPD overlap syndrome, asthma control test, ACT, COPD assessment test, CAT, quality of life, dyspnea sensation

Background Few studies to date have investigated the antioxidant nutrients such as vitamin C (ascorbic acid), vitamin E (α-tocopherol), retinol and carotenoids in plasma from patients with pulmonary disease in Japan. To clarify the role of antioxidant nutrients such as vitamin C, vitamin E, retinol and various carotenoids in plasma of Japanese patients with chronic obstructive lung diseases (COPD), asthma-COPD overlap syndrome (ACOS) and/or bronchial asthma (BA), we compared to healthy elderly controls. Methods Ascorbic acid (AA), carotenoids (lutein, zeaxanthin, β-cryptoxanthin, α-carotene, β-carotene and lycopene), retinol and α-tocopherol levels in plasma were determined by using a high performance liquid chromatography. Reduced glutathione (GSH), oxidised glutathione (GSSG) in whole blood and urinary 8-OHdG were also determined. Results Plasma AA level of COPD subjects was significantly lower than that of healthy elderly people. Conversely, ACOS and BA subjects showed no significant difference from healthy elderly people. Moreover, plasma lycopene and total carotenoid levels and GSH content in blood were significantly lower in COPD subjects than these in healthy elderly people. However, other redox markers such as GSSG, GSH/GSSG ratio and urinary 8-OHdG found no significant differences between COPD, ACOS and BA compared to healthy elderly people. Conclusions These results suggested that COPD of Japanese patients may develop partly because of oxidative stress derived from a shortage of antioxidant nutrients, especially of AA and lycopene, as well as GSH while this may not be the case in both ACOS and BA. [ABSTRACT FROM AUTHOR]

Background Asthma and chronic obstructive pulmonary disease ( COPD) are heterogeneous diseases. The phenotypes that have clinical features of both asthma and COPD are still incompletely understood. Objective To clarify the best discriminators of the asthma- COPD overlap phenotype from asthma and COPD subgroups using a clustering approach. Methods This study assessed pathophysiological parameters, including mRNA expression levels of T helper cell-related transcription factors, namely TBX21 (Th1), GATA3 (Th2), RORC (Th17) and FOXP3 (Treg), in peripheral blood mononuclear cells in asthma patients (n=152) and in COPD patients (n=50). Clusters were determined using k-means clustering. Exacerbations of asthma and COPD were recorded during the 1-year follow-up period. Results The cluster analysis revealed four biological clusters: cluster 1, predominantly patients with COPD; cluster 2, patients with an asthma- COPD overlap phenotype; cluster 3, patients with non-atopic and late-onset asthma; and cluster 4, patients with early-onset atopic asthma. Hazard ratios for exacerbation were 2.5 (95% confidence interval [ CI], 1.1-5.6) in cluster 1 and 2.3 (95% CI, 1.0-5.0) in cluster 2 compared with patients in other clusters. Cluster 2 was discriminated from other clusters by total serum IgE level ≥310 IU/ mL, blood eosinophil counts ≥280 cells/μL, a higher ratio of TBX21/ GATA3, FEV1/ FVC ratio <0.67 and smoking ≥10 pack-years with an area under the curve of 0.94 (95% CI, 0.90-0.98) in the receiver operating characteristic analysis. Conclusions and Clinical Relevance The asthma- COPD overlap phenotype was characterized by peripheral blood eosinophilia and higher levels of IgE despite the Th2-low endotype. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical efficacy of inhaled corticosteroids in the treatment of patients with asthma-COPD overlap syndrome (ACOS) and its influence on the endothelial cell function. Methods: Ninety-five patients with ACOS admitted into our hospital were randomly divided into two groups. Forty-eight patients in the control group were treated with western medicine, and the observation group was treated with fluticasone propionate on the basis of control group. The lung function indexes, endothelial cell function indexes, ACT score and CAT score were compared between two groups before and after treatment, and the clinical efficacy was also compared. Results: After treatment, the effective rate of observation group was 89.4%, which was much higher than that of the control group with (77.1%, P＜0.05). The FEV1, FEV1/FVC, IC/TLC, and RV/TLC in both groups were obviously improved, and the FEV1, FEV1/FVC, IC/TLC, RV/TLC and DLCO of observation group improved much better than those of the control group (P＜0.05). And the serum SICAM and ET-1 levels of observation group after treatment were much lower than those of the control group, while the serum NO was much higher (P＜0.05). Additionally, the ACT score of observation group was significantly higher than that of the control group, while the CAT score was markedly lower(P＜0.05). Conclusions: Inhaled corticosteroids had a great capability in the treatment of patients with ACOS, which could significantly improve the clinical symptoms, lung function and endothelial cell function. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) and asthma are the most common chronic pulmonary disorders. One in every twelve persons worldwide have asthma or COPD. COPD and asthma are characterized by airway obstruction and chronic airway inflammation. When there are both signs and symptoms of both asthma and COPD in a person, this condition is called Asthma-COPD Overlap Syndrome. Asthma-COPD Overlap Syndrome should be considered when an asthmatic person has persistent airflow limitation and smoking history, or when a person with COPD has a history of childhood asthma and shows reversibility in respiratory function tests and eosinophilia in airflow inflammation. The aim of this article is to describe clinical features and treatment of Asthma-COPD Overlap Syndrome. [ABSTRACT FROM AUTHOR]

Copyright of Archivos de Bronconeumología (English Edition) is the property of Sociedad Espanola de Neumologia y Cirugia Toracica (SEPAR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Rationale: The burden of chronic obstructive pulmonary disease (COPD) is increasing, yet there are limited data on early life risk factors.Objectives: To investigate the role of childhood lung function in adult COPD phenotypes.Methods: Prebronchodilator spirometry was performed for a cohort of 7-year-old Tasmanian children (n = 8,583) in 1968 who were resurveyed at 45 years, and a selected subsample (n = 1,389) underwent prebronchodilator and post-bronchodilator spirometry. For this analysis, COPD was spirometrically defined as a post-bronchodilator FEV1/FVC less than the lower limit of normal. Asthma-COPD overlap syndrome (ACOS) was defined as the coexistence of both COPD and current asthma. Associations between childhood lung function and asthma/COPD/ACOS were examined using multinomial regression.Measurements and Main Results: At 45 years, 959 participants had neither current asthma nor COPD (unaffected), 269 had current asthma alone, 59 had COPD alone, and 68 had ACOS. The reweighted prevalence of asthma alone was 13.5%, COPD alone 4.1%, and ACOS 2.9%. The lowest quartile of FEV1 at 7 years was associated with ACOS (odds ratio, 2.93; 95% confidence interval, 1.32-6.52), but not COPD or asthma alone. The lowest quartile of FEV1/FVC ratio at 7 years was associated with ACOS (odds ratio, 16.3; 95% confidence interval, 4.7-55.9) and COPD (odds ratio, 5.76; 95% confidence interval, 1.9-17.4), but not asthma alone.Conclusions: Being in the lowest quartile for lung function at age 7 may have long-term consequences for the development of COPD and ACOS by middle age. Screening of lung function in school age children may identify a high-risk group that could be targeted for intervention. Further research is needed to understand possible modifiers of these associations and develop interventions for children with impaired lung function. [ABSTRACT FROM AUTHOR]

Background Some studies suggest that asthma- COPD overlap syndrome ( ACOS) is associated with worse outcomes than chronic obstructive pulmonary disease ( COPD). The goal of this study was to further explore the clinical characteristics and survival of patients with ACOS identified in a real-life cohort of patients with COPD. Methods Data from the French COPD cohort ' INITIATIVES BronchoPneumopathie Chronique Obstructive' ( n = 998 patients) were analyzed to assess the frequency of ACOS defined as a physician diagnosis of asthma before the age of 40 years and to analyze its impact. Univariate analyses were performed to assess the relationship between ACOS and sociodemographic characteristics, risk factors (smoking, occupational exposure, atopic diseases), symptoms (chronic bronchitis, dyspnea-modified Medical Research Council scale and baseline dyspnea index), quality of life (QoL), mood disorders, exacerbations, comorbidities, lung function, prescribed treatment, and survival. Results ACOS was diagnosed in 129 patients (13%). In multivariate analyses, ACOS was associated negatively with cumulative smoking (odds ratio [ OR]: 0.992; 95% CI 0.984-1.000 per pack-year) and positively with obesity: OR: 1.97 [1.22-3.16], history of atopic disease (hay fever: OR: 5.50 [3.42-9.00] and atopic dermatitis: OR 3.76 [2.14-6.61]), and drug use ( LABA + ICS: 1.86 [1.27-2.74], antileukotrienes 4.83 [1.63-14.34], theophylline: 2.46 [1.23-4.91], and oral corticosteroids: [2.99;.1.26-7.08]). No independent association was found with dyspnea, QoL, exacerbations, and mortality. Conclusions Compared to 'pure' COPD patients, patients with ACOS exhibit lower cumulative smoking, suffer more from obesity and atopic diseases, and use more asthma treatments. Disease severity (dyspnea, QoL, exacerbations, comorbidities) and prognosis (mortality) are not different from 'pure' COPD patients. [ABSTRACT FROM AUTHOR]

Purpose of Review: The asthma-COPD overlap syndrome (ACOS) has reemerged in the medical literature. This review addresses our current understanding of ACOS as a clinical and biological entity and how new and existing therapies may be targeted to this group. Recent Findings: Many studies suggest that ACOS is common and associated with more morbidity than asthma and COPD in general. However, there is no consensus on an ACOS definition, likely due to the heterogeneity of the disease. Variable definitions have led to variable results in ACOS studies. Given this clinical variability, biomarkers (e.g., eosinophils and type 2 inflammatory markers) are increasingly being used to identify an ACOS molecular phenotype which appears to be more responsive to inhaled corticosteroids. Summary: Although ACOS has become a popular diagnosis, it is unclear whether identifying ACOS as a separate disease entity is clinically useful. Future studies should focus on identifying key clinical features and biomarkers that characterize vulnerable and treatment-responsive patients. [ABSTRACT FROM AUTHOR]

Rationale: Despite the increasing recognition of asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) as a clinical entity, it remains poorly characterized due to a lack of agreement on its definition and diagnostic criteria.Objectives: The aim of this study was to use spirometry and computed tomography (CT) to help better define ACOS as well as to classify subjects with ACOS based on Global Initiative for Chronic Obstructive Lung Disease (GOLD) letter grade.Methods: We analyzed 10,192 subjects enrolled in the COPDGene Study. Subjects were non-Hispanic white or African American current or former smokers aged 45-80 years with at least a 10-pack-year smoking history. Subjects were categorized as having either ACOS with a bronchodilator response or chronic obstructive pulmonary disease with emphysema on the basis of spirometry, high-resolution CT, and a history of asthma or hay fever.Measurements and Main Results: Subjects with ACOS were younger (60.6 vs. 65.9 years old; P < 0.0001), more likely to be African American (26.8% vs. 14.4%; P < 0.0001), had a higher body mass index (29.6 vs. 25.1 kg/m(2); P < 0.0001), and were more likely to be current smokers (50.9% vs. 20.7%; P < 0.0001). The majority of subjects with ACOS were categorized as GOLD grade B. Despite less severe spirometry and CT findings in subjects with ACOS, there was no significant difference in severe or frequent exacerbations.Conclusions: Bronchodilator responsiveness and degree of emphysema can help define ACOS. When defined on the basis of bronchodilator responsiveness and degree of emphysema, patients with ACOS represent a unique and high-risk group with distinct clinical features. [ABSTRACT FROM AUTHOR]

Context:The term “asthma–chronic obstructive pulmonary disease (COPD) overlap syndrome” (ACOS) has been applied to the condition, in which a person has clinical features of both asthma and COPD. Methods:The patients (N = 10) were presented to our clinic with low lung function, limited reversibility of airway obstruction, hyperinflation, abnormal body composition, dyspnea and episodic wheezing. Based on the clinical and laboratory findings, the patients were diagnosed with ACOS. Patients’ serum IL-2 (sIL-2), sIL-4 sIL-6, sIL-10, sIL-17, sTNF-α and sIFN-γ levels were investigated as an apoptotic marker and a marker for inflammation. Results:Having undergone omalizumab treatment and a long-term (12 months) later, patients had a decreased IgE, fractional exhaled nitric oxide concentrations (FENO), eosinophil, neutrophils, macrophages, eosinophil cationic peptide (ECP) and sIL-4 levels. Conclusion:To our knowledge, this is the first documentation of omalizumab use in ACOS. We demonstrated decreased IL-4, allergic pulmonary symptoms (dyspnea, wheezing, bronchial hyper responsiveness) and migraine attacks in the patients. [ABSTRACT FROM PUBLISHER]

Asthma and chronic obstructive pulmonary disease (COPD) represent two major public health problems. However, there is a significant proportion of patients with a mixed asthma-COPD phenotype. This condition is defined as asthma-COPD overlap syndrome (ACOS). Since there are no internationally accepted criteria for the diagnosis of that syndrome, its management remains difficult. Given the fact that patients with ACOS have an increased risk of exacerbation and hospitalization, there is a pressing need for a more targeted approach and better management. We propose that fractional exhaled nitric oxide (FeNO), a marker of eosinophilic inflammation, could help clinicians differentiate ACOS from asthma and COPD. We evaluate this hypothesis, using data derived from the existing literature. [ABSTRACT FROM AUTHOR]

Smoking is common in adults with asthma, yet a paucity of literature exists on smoking cessation strategies specifically targeting this subgroup. Adverse respiratory effects from personal smoking include worse asthma control and a predisposition to lower lung function and chronic obstructive pulmonary disease. Some data suggest that individuals with asthma are more likely than their non-asthmatic peers to smoke regularly at an earlier age. While quit attempts can be more frequent in smokers with asthma, they are also of shorter duration than in non-asthmatics. Considering these asthma-specific characteristics is important in order to individualize smoking cessation strategies. In particular, asthma-specific information such as "lung age" should be provided and longer-term follow-up is advised. Promising emerging strategies include reminders by cellular phone and web-based interventions using consumer health informatics. For adolescents, training older peers to deliver asthma education is another promising strategy. For smokers who are hospitalized for asthma, inpatient nicotine replacement therapy and counseling are a priority. Overall, improving smoking cessation rates in smokers with asthma may rely on a more personalized approach, with the potential for substantial health benefits to individuals and the population at large. [ABSTRACT FROM AUTHOR]

The aging lung undergoes structural changes, immunosenescence, and inflammation, rendering the elderly more susceptible to developing obstructive airway disease. Thus, asthma in those of chronological age ≥ 65 years is not rare. Elderly asthma (EA) imposes considerable burdens in terms of mortality and morbidity, and expenditure. However, clinicians lack knowledge of EA and thus often prescribe inappropriate management. In this review, we ask 3 key questions frequently encountered during EA diagnosis and treatment: 1) Is EA different?; 2) How can we appropriately diagnose EA?; 3) Are there management strategies specific to EA? Based on recent studies, we provide tentative answers as follows: 1) late-onset EA differs in clinical features and pathogenetic mechanisms from non-EA, and thus further phenotypic and endotypic characterization of EA is needed; 2) both over- and under-diagnosis of asthma in the elderly can be reduced if the objective diagnostic tests are appropriately performed; 3) cautious prescription of ICS to selected EA patients should be encouraged, and a multifaceted approach which involves increasing medical awareness and inhaler use proficiency and adherence, seeking the assistance of caregivers, and correcting micronutrient deficiencies is required to reduce acute exacerbations in EA patients., Competing Interests: There are no financial or other issues that might lead to a conflict of interest., (Copyright © 2023 The Korean Academy of Asthma, Allergy and Clinical Immunology • The Korean Academy of Pediatric Allergy and Respiratory Disease.)

Asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) is a commonly encountered yet loosely defined clinical entity. ACOS accounts for approximately 15-25% of the obstructive airway diseases and patients experience worse outcomes compared with asthma or COPD alone. Patients with ACOS have the combined risk factors of smoking and atopy, are generally younger than patients with COPD and experience acute exacerbations with higher frequency and greater severity than lone COPD. Pharmacotherapeutic considerations require an integrated approach, first to identify the relevant clinical phenotype(s), then to determine the best available therapy. The authors discuss the array of existing and emerging classes of drugs that could benefit those with ACOS and share their therapeutic approach. A consensus international definition of ACOS is needed to design prospective, randomized clinical trials to evaluate specific drug interventions on important outcomes such as lung function, acute exacerbations, quality of life and mortality. [ABSTRACT FROM AUTHOR]