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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

Changes in clinical variables after treatment with inhaled budesonide/formoterol.Notes: Results for pulmonary function parameters, radiological parameters, and CAT scores were compared between pretreatment and 3 months after therapy with budesonide/formoterol using nonparametric Wilcoxon rank sum tests. Bars indicate standard errors.Abbreviations: CAT, chronic obstructive pulmonary disease assessment test; %CSA <5, percentage of total cross-sectional area of pulmonary vessels less than 5 mm2; FEV1, forced expiratory volume in 1 second; LAV%, percentage of low attenuation volume; PEF, peak expiratory flow; Post, 3 months after treatment with budesonide/formoterol; Pre, pretreatment with budesonide/formoterol; WA%, percentage of wall area.
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f4-copd-10-947: Changes in clinical variables after treatment with inhaled budesonide/formoterol.Notes: Results for pulmonary function parameters, radiological parameters, and CAT scores were compared between pretreatment and 3 months after therapy with budesonide/formoterol using nonparametric Wilcoxon rank sum tests. Bars indicate standard errors.Abbreviations: CAT, chronic obstructive pulmonary disease assessment test; %CSA <5, percentage of total cross-sectional area of pulmonary vessels less than 5 mm2; FEV1, forced expiratory volume in 1 second; LAV%, percentage of low attenuation volume; PEF, peak expiratory flow; Post, 3 months after treatment with budesonide/formoterol; Pre, pretreatment with budesonide/formoterol; WA%, percentage of wall area.

Mentions: The general characteristics of patients treated with budesonide/formoterol are shown in Table 2. All the patients had been treatment-naïve until the initiation of budesonide/formoterol treatment in this study. None of our study patients experienced any acute exacerbations during the study period (up to 12 weeks after initiating budesonide/formoterol treatment). Figure 4 shows the longitudinal changes in clinical outcomes for patients with ACOS. During the 12-week study period, budesonide/formoterol treatment resulted in significantly increased FEV1 (1.44±0.58 L vs 1.57±0.58 L, P=0.005) and self-reported diurnal variations in PEF readings (12.5±3.3 L vs 7.5±4.0 L, P=0.0002).


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)

Changes in clinical variables after treatment with inhaled budesonide/formoterol.Notes: Results for pulmonary function parameters, radiological parameters, and CAT scores were compared between pretreatment and 3 months after therapy with budesonide/formoterol using nonparametric Wilcoxon rank sum tests. Bars indicate standard errors.Abbreviations: CAT, chronic obstructive pulmonary disease assessment test; %CSA <5, percentage of total cross-sectional area of pulmonary vessels less than 5 mm2; FEV1, forced expiratory volume in 1 second; LAV%, percentage of low attenuation volume; PEF, peak expiratory flow; Post, 3 months after treatment with budesonide/formoterol; Pre, pretreatment with budesonide/formoterol; WA%, percentage of wall area.
© Copyright Policy
Related In: Results  -  Collection

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

f4-copd-10-947: Changes in clinical variables after treatment with inhaled budesonide/formoterol.Notes: Results for pulmonary function parameters, radiological parameters, and CAT scores were compared between pretreatment and 3 months after therapy with budesonide/formoterol using nonparametric Wilcoxon rank sum tests. Bars indicate standard errors.Abbreviations: CAT, chronic obstructive pulmonary disease assessment test; %CSA <5, percentage of total cross-sectional area of pulmonary vessels less than 5 mm2; FEV1, forced expiratory volume in 1 second; LAV%, percentage of low attenuation volume; PEF, peak expiratory flow; Post, 3 months after treatment with budesonide/formoterol; Pre, pretreatment with budesonide/formoterol; WA%, percentage of wall area.
Mentions: The general characteristics of patients treated with budesonide/formoterol are shown in Table 2. All the patients had been treatment-naïve until the initiation of budesonide/formoterol treatment in this study. None of our study patients experienced any acute exacerbations during the study period (up to 12 weeks after initiating budesonide/formoterol treatment). Figure 4 shows the longitudinal changes in clinical outcomes for patients with ACOS. During the 12-week study period, budesonide/formoterol treatment resulted in significantly increased FEV1 (1.44±0.58 L vs 1.57±0.58 L, P=0.005) and self-reported diurnal variations in PEF readings (12.5±3.3 L vs 7.5±4.0 L, P=0.0002).

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