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Biomarker-based detection of asthma-COPD overlap syndrome in COPD populations.

Tamada T, Sugiura H, Takahashi T, Matsunaga K, Kimura K, Katsumata U, Takekoshi D, Kikuchi T, Ohta K, Ichinose M - Int J Chron Obstruct Pulmon Dis (2015)

Bottom Line: Asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) was proposed by the science committees of both Global Initiative for Asthma (GINA) and Global Initiative for Chronic Obstructive Lung Disease (GOLD).However, the definition of ACOS has remained unclear all over the world, and the prevalence rate of ACOS is basically dependent on the patient's symptoms or the physician's opinion, based on questionnaire testing.The results from the current study should be useful to identify the subgroup requiring early intervention by inhaled corticosteroids/long-acting beta agonist combination in COPD in order to improve the long-term management for ACOS.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.

ABSTRACT
Asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) was proposed by the science committees of both Global Initiative for Asthma (GINA) and Global Initiative for Chronic Obstructive Lung Disease (GOLD). However, the definition of ACOS has remained unclear all over the world, and the prevalence rate of ACOS is basically dependent on the patient's symptoms or the physician's opinion, based on questionnaire testing. In the current case report, we investigated the prevalence rate of COPD patients with high levels of fractional exhaled nitric oxide (FENO) or immunoglobulin E (IgE) as candidate markers of ACOS in COPD, as a multicenter, cross-sectional study. Outpatients with COPD were enrolled from Tohoku University Hospital, Sendai, Japan, and five hospitals (Tohoku University Hospital, Sendai, Japan; NTT East Tohoku Hospital, Sendai, Japan; Wakayama Medical University Hospital, Kimiidera, Japan; Hiraka General Hospital, Yokote, Japan; Iwate Prefectural Isawa Hospital, Oshu, Japan) with pulmonary physicians from March 1, 2013 to February 28, 2014. When they were estimated using 35 ppb as the cutoff value of FENO, the prevalence rate of ACOS was 16.3% in COPD. When estimated by both FENO and IgE, the high-FENO/high-IgE group was 7.8% in COPD. To the best of our knowledge, this study is the first to detect the prevalence rate of ACOS in COPD populations by using objective biomarkers. The results from the current study should be useful to identify the subgroup requiring early intervention by inhaled corticosteroids/long-acting beta agonist combination in COPD in order to improve the long-term management for ACOS.

No MeSH data available.


Related in: MedlinePlus

Histogram of FENO values in the subjects.Notes: All 331 COPD patients were measured for FENO before their enrollment. The frequencies of patients without ICS are indicated by white bars, and ICS users are indicated by gray bars. The number of patients with FENO over 25 ppb were 112 (36.9%) cases; the number of patients with FENO over 35 ppb were 54 (16.3%) cases; and the number of patients with FENO over 50 ppb were 17 (5.1%) cases.Abbreviations: COPD, chronic obstructive pulmonary disease; ICS, inhaled corticosteroids; FENO, fractional exhaled nitric oxide.
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f1-copd-10-2169: Histogram of FENO values in the subjects.Notes: All 331 COPD patients were measured for FENO before their enrollment. The frequencies of patients without ICS are indicated by white bars, and ICS users are indicated by gray bars. The number of patients with FENO over 25 ppb were 112 (36.9%) cases; the number of patients with FENO over 35 ppb were 54 (16.3%) cases; and the number of patients with FENO over 50 ppb were 17 (5.1%) cases.Abbreviations: COPD, chronic obstructive pulmonary disease; ICS, inhaled corticosteroids; FENO, fractional exhaled nitric oxide.

Mentions: A histogram of the FENO values is shown in Figure 1. The median value of FENO was 20 ppb (IQR, 12–29 ppb). Because several cutoff values of FENO were proposed in recent popular reports,1,15–18 FENO was estimated by three representative cut-off values in the current study. The number of cases with FENO >25 ppb were 112 (36.9%) >35 ppb were 54 (16.3%); and >50 ppb were 17 (5.1%). It is known that both smoking and ICS treatment decrease FENO levels.21 In the present study, current smokers included 46 (13.9%) cases and ICS users included 126 (38.1%) cases (Table 1). It is thought that the effect of ICS on the FENO value is much more potent than the effect of smoking status.19,20 The distributions of ICS users are indicated by gray bars in Figure 1. The FENO values of these patients are likely to be underestimated in the current study. The procedures of the pulmonary function tests were according to the American Thoracic Society (ATS)/European Respiratory Society (ERS) guidelines. In any case, our present study revealed that there were definitely patients with asthma-like airway inflammation as represented by the high FENO values among the COPD outpatients, and that its prevalence rate was 16.3% when these values were estimated using 35 ppb as the cutoff value of FENO.


Biomarker-based detection of asthma-COPD overlap syndrome in COPD populations.

Tamada T, Sugiura H, Takahashi T, Matsunaga K, Kimura K, Katsumata U, Takekoshi D, Kikuchi T, Ohta K, Ichinose M - Int J Chron Obstruct Pulmon Dis (2015)

Histogram of FENO values in the subjects.Notes: All 331 COPD patients were measured for FENO before their enrollment. The frequencies of patients without ICS are indicated by white bars, and ICS users are indicated by gray bars. The number of patients with FENO over 25 ppb were 112 (36.9%) cases; the number of patients with FENO over 35 ppb were 54 (16.3%) cases; and the number of patients with FENO over 50 ppb were 17 (5.1%) cases.Abbreviations: COPD, chronic obstructive pulmonary disease; ICS, inhaled corticosteroids; FENO, fractional exhaled nitric oxide.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4608617&req=5

f1-copd-10-2169: Histogram of FENO values in the subjects.Notes: All 331 COPD patients were measured for FENO before their enrollment. The frequencies of patients without ICS are indicated by white bars, and ICS users are indicated by gray bars. The number of patients with FENO over 25 ppb were 112 (36.9%) cases; the number of patients with FENO over 35 ppb were 54 (16.3%) cases; and the number of patients with FENO over 50 ppb were 17 (5.1%) cases.Abbreviations: COPD, chronic obstructive pulmonary disease; ICS, inhaled corticosteroids; FENO, fractional exhaled nitric oxide.
Mentions: A histogram of the FENO values is shown in Figure 1. The median value of FENO was 20 ppb (IQR, 12–29 ppb). Because several cutoff values of FENO were proposed in recent popular reports,1,15–18 FENO was estimated by three representative cut-off values in the current study. The number of cases with FENO >25 ppb were 112 (36.9%) >35 ppb were 54 (16.3%); and >50 ppb were 17 (5.1%). It is known that both smoking and ICS treatment decrease FENO levels.21 In the present study, current smokers included 46 (13.9%) cases and ICS users included 126 (38.1%) cases (Table 1). It is thought that the effect of ICS on the FENO value is much more potent than the effect of smoking status.19,20 The distributions of ICS users are indicated by gray bars in Figure 1. The FENO values of these patients are likely to be underestimated in the current study. The procedures of the pulmonary function tests were according to the American Thoracic Society (ATS)/European Respiratory Society (ERS) guidelines. In any case, our present study revealed that there were definitely patients with asthma-like airway inflammation as represented by the high FENO values among the COPD outpatients, and that its prevalence rate was 16.3% when these values were estimated using 35 ppb as the cutoff value of FENO.

Bottom Line: Asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) was proposed by the science committees of both Global Initiative for Asthma (GINA) and Global Initiative for Chronic Obstructive Lung Disease (GOLD).However, the definition of ACOS has remained unclear all over the world, and the prevalence rate of ACOS is basically dependent on the patient's symptoms or the physician's opinion, based on questionnaire testing.The results from the current study should be useful to identify the subgroup requiring early intervention by inhaled corticosteroids/long-acting beta agonist combination in COPD in order to improve the long-term management for ACOS.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.

ABSTRACT
Asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) was proposed by the science committees of both Global Initiative for Asthma (GINA) and Global Initiative for Chronic Obstructive Lung Disease (GOLD). However, the definition of ACOS has remained unclear all over the world, and the prevalence rate of ACOS is basically dependent on the patient's symptoms or the physician's opinion, based on questionnaire testing. In the current case report, we investigated the prevalence rate of COPD patients with high levels of fractional exhaled nitric oxide (FENO) or immunoglobulin E (IgE) as candidate markers of ACOS in COPD, as a multicenter, cross-sectional study. Outpatients with COPD were enrolled from Tohoku University Hospital, Sendai, Japan, and five hospitals (Tohoku University Hospital, Sendai, Japan; NTT East Tohoku Hospital, Sendai, Japan; Wakayama Medical University Hospital, Kimiidera, Japan; Hiraka General Hospital, Yokote, Japan; Iwate Prefectural Isawa Hospital, Oshu, Japan) with pulmonary physicians from March 1, 2013 to February 28, 2014. When they were estimated using 35 ppb as the cutoff value of FENO, the prevalence rate of ACOS was 16.3% in COPD. When estimated by both FENO and IgE, the high-FENO/high-IgE group was 7.8% in COPD. To the best of our knowledge, this study is the first to detect the prevalence rate of ACOS in COPD populations by using objective biomarkers. The results from the current study should be useful to identify the subgroup requiring early intervention by inhaled corticosteroids/long-acting beta agonist combination in COPD in order to improve the long-term management for ACOS.

No MeSH data available.


Related in: MedlinePlus