Limits...
Clinical, physiological, and radiological features of asthma-chronic obstructive pulmonary disease overlap syndrome.

Suzuki T, Tada Y, Kawata N, Matsuura Y, Ikari J, Kasahara Y, Tatsumi K - Int J Chron Obstruct Pulmon Dis (2015)

Bottom Line: Asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) is associated with rapid decline in lung function, poorer health-related quality-of-life outcomes, and frequent exacerbations, compared to COPD alone.Compared to baseline, budesonide/formoterol treatment significantly increased the forced expiratory volume in 1 second and decreased the degree of airway wall thickness (percentage of wall area) as well as pulmonary microvascular density (%CSA <5) in ACOS patients.Higher %CSA <5 might be a characteristic feature of ACOS.

View Article: PubMed Central - PubMed

Affiliation: Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan.

ABSTRACT

Background: Asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) is associated with rapid decline in lung function, poorer health-related quality-of-life outcomes, and frequent exacerbations, compared to COPD alone. Although the numbers of patients with ACOS have increased, there is little established evidence regarding diagnostic criteria and treatment options. Thus, the aim of our study was to clarify the clinical, physiological, and radiological features of patients with ACOS.

Methods: We examined a total of 100 patients with COPD and 40 patients with ACOS, who were selected based on clinical criteria. All patients underwent baseline testing, including a COPD assessment test, pulmonary function tests, and multidetector row computed tomography imaging. Percentage of low attenuation volume, percentage of wall area, and percentage of total cross-sectional area of pulmonary vessels less than 5 mm(2) (%CSA <5) were determined using multidetector row computed tomography. ACOS patients were administered a fixed dose of budesonide/formoterol (160/4.5 μg, two inhalations; twice daily) for 12 weeks, after which the ACOS patients underwent multidetector row computed tomography to measure the same parameters.

Results: At baseline, the ACOS patients and COPD patients had a similar degree of airflow limitation, vital capacity, and residual volume. ACOS patients had higher COPD assessment test scores, percentage of wall area, and %CSA <5 than COPD patients. Compared to baseline, budesonide/formoterol treatment significantly increased the forced expiratory volume in 1 second and decreased the degree of airway wall thickness (percentage of wall area) as well as pulmonary microvascular density (%CSA <5) in ACOS patients.

Conclusion: Our results suggest that ACOS is characterized by an airway lesion-dominant phenotype, in contrast to COPD. Higher %CSA <5 might be a characteristic feature of ACOS.

No MeSH data available.


Related in: MedlinePlus

Comparison of radiological variable results between COPD and ACOS patients.Notes: Results for radiological variables were compared between ACOS and COPD patients by Mann–Whitney U-tests. Bars indicate standard errors.Abbreviations: ACOS, asthma–chronic obstructive pulmonary disease overlap syndrome; COPD, chronic obstructive pulmonary disease; %CSA <5, percentage of total cross-sectional area of pulmonary vessels less than 5 mm2; LAV%, percentage of low attenuation volume; WA%, percentage of wall area.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4440433&req=5

f3-copd-10-947: Comparison of radiological variable results between COPD and ACOS patients.Notes: Results for radiological variables were compared between ACOS and COPD patients by Mann–Whitney U-tests. Bars indicate standard errors.Abbreviations: ACOS, asthma–chronic obstructive pulmonary disease overlap syndrome; COPD, chronic obstructive pulmonary disease; %CSA <5, percentage of total cross-sectional area of pulmonary vessels less than 5 mm2; LAV%, percentage of low attenuation volume; WA%, percentage of wall area.

Mentions: As with COPD, it is well known that asthma involves small airway inflammation and remodeling. Recent evidence showed that wall thickness of the proximal airways as detected by CT scanning (WA%) predicted small airway impairment and showed good correlations with FEV1 and residual volume results.24 The CT metric of %CSA <5 has been used to evaluate pulmonary vessel alterations and perfusion.25 In addition, we previously reported that %CSA <5 was negatively correlated with LAV% results for COPD patients.15 Thus, we focused on these two MDCT variables (WA% and %CSA <5) and compared them between ACOS and COPD patients. There was no significant difference in LAV% results between COPD and ACOS patients (ACOS vs COPD: 4.5%±8.2% vs 6.2%±9.3%, P=0.963). However, ACOS patients had significantly higher WA% values (ACOS vs COPD: 79.1%±4.0% vs 76.9%±3.4%, P=0.001) and higher %CSA <5 results (ACOS vs COPD: 0.861±0.249 vs 0.731±0.265, P=0.011) than those with COPD (Figure 3). These findings were characteristic of ACOS and had not been previously reported.


Clinical, physiological, and radiological features of asthma-chronic obstructive pulmonary disease overlap syndrome.

Suzuki T, Tada Y, Kawata N, Matsuura Y, Ikari J, Kasahara Y, Tatsumi K - Int J Chron Obstruct Pulmon Dis (2015)

Comparison of radiological variable results between COPD and ACOS patients.Notes: Results for radiological variables were compared between ACOS and COPD patients by Mann–Whitney U-tests. Bars indicate standard errors.Abbreviations: ACOS, asthma–chronic obstructive pulmonary disease overlap syndrome; COPD, chronic obstructive pulmonary disease; %CSA <5, percentage of total cross-sectional area of pulmonary vessels less than 5 mm2; LAV%, percentage of low attenuation volume; WA%, percentage of wall area.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4440433&req=5

f3-copd-10-947: Comparison of radiological variable results between COPD and ACOS patients.Notes: Results for radiological variables were compared between ACOS and COPD patients by Mann–Whitney U-tests. Bars indicate standard errors.Abbreviations: ACOS, asthma–chronic obstructive pulmonary disease overlap syndrome; COPD, chronic obstructive pulmonary disease; %CSA <5, percentage of total cross-sectional area of pulmonary vessels less than 5 mm2; LAV%, percentage of low attenuation volume; WA%, percentage of wall area.
Mentions: As with COPD, it is well known that asthma involves small airway inflammation and remodeling. Recent evidence showed that wall thickness of the proximal airways as detected by CT scanning (WA%) predicted small airway impairment and showed good correlations with FEV1 and residual volume results.24 The CT metric of %CSA <5 has been used to evaluate pulmonary vessel alterations and perfusion.25 In addition, we previously reported that %CSA <5 was negatively correlated with LAV% results for COPD patients.15 Thus, we focused on these two MDCT variables (WA% and %CSA <5) and compared them between ACOS and COPD patients. There was no significant difference in LAV% results between COPD and ACOS patients (ACOS vs COPD: 4.5%±8.2% vs 6.2%±9.3%, P=0.963). However, ACOS patients had significantly higher WA% values (ACOS vs COPD: 79.1%±4.0% vs 76.9%±3.4%, P=0.001) and higher %CSA <5 results (ACOS vs COPD: 0.861±0.249 vs 0.731±0.265, P=0.011) than those with COPD (Figure 3). These findings were characteristic of ACOS and had not been previously reported.

Bottom Line: Asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) is associated with rapid decline in lung function, poorer health-related quality-of-life outcomes, and frequent exacerbations, compared to COPD alone.Compared to baseline, budesonide/formoterol treatment significantly increased the forced expiratory volume in 1 second and decreased the degree of airway wall thickness (percentage of wall area) as well as pulmonary microvascular density (%CSA <5) in ACOS patients.Higher %CSA <5 might be a characteristic feature of ACOS.

View Article: PubMed Central - PubMed

Affiliation: Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan.

ABSTRACT

Background: Asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) is associated with rapid decline in lung function, poorer health-related quality-of-life outcomes, and frequent exacerbations, compared to COPD alone. Although the numbers of patients with ACOS have increased, there is little established evidence regarding diagnostic criteria and treatment options. Thus, the aim of our study was to clarify the clinical, physiological, and radiological features of patients with ACOS.

Methods: We examined a total of 100 patients with COPD and 40 patients with ACOS, who were selected based on clinical criteria. All patients underwent baseline testing, including a COPD assessment test, pulmonary function tests, and multidetector row computed tomography imaging. Percentage of low attenuation volume, percentage of wall area, and percentage of total cross-sectional area of pulmonary vessels less than 5 mm(2) (%CSA <5) were determined using multidetector row computed tomography. ACOS patients were administered a fixed dose of budesonide/formoterol (160/4.5 μg, two inhalations; twice daily) for 12 weeks, after which the ACOS patients underwent multidetector row computed tomography to measure the same parameters.

Results: At baseline, the ACOS patients and COPD patients had a similar degree of airflow limitation, vital capacity, and residual volume. ACOS patients had higher COPD assessment test scores, percentage of wall area, and %CSA <5 than COPD patients. Compared to baseline, budesonide/formoterol treatment significantly increased the forced expiratory volume in 1 second and decreased the degree of airway wall thickness (percentage of wall area) as well as pulmonary microvascular density (%CSA <5) in ACOS patients.

Conclusion: Our results suggest that ACOS is characterized by an airway lesion-dominant phenotype, in contrast to COPD. Higher %CSA <5 might be a characteristic feature of ACOS.

No MeSH data available.


Related in: MedlinePlus