Tuberc Respir Dis.  2018 Oct;81(4):289-298. 10.4046/trd.2017.0064.

Increased Risk of Exacerbation in Asthma Predominant Asthma–Chronic Obstructive Pulmonary Disease Overlap Syndrome

Affiliations
  • 1Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea. plmjhlee@cha.ac.kr
  • 2Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea.
  • 3Division of Pulmonary and Critical Care Medicine, Department of Medicine, Ewha Womans University College of Medicine, Seoul, Korea.
  • 4Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 5Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea.
  • 6Department of Internal Medicine, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
  • 7Department of Pulmonary and Critical Care Medicine, Konkuk University School of Medicine, Seoul, Korea.

Abstract

BACKGROUND
Obstructive airway disease patients with increased variability of airflow and incompletely reversible airflow obstruction are often categorized as having asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS). ACOS is heterogeneous with two sub-phenotypes: asthma-ACOS and COPD-ACOS. The objective of this study was to determine the difference in risk of exacerbation between the two sub-phenotypes of ACOS.
METHODS
A total of 223 patients exhibiting incompletely reversible airflow obstruction with increased variability (spirometrically defined ACOS) were enrolled. These patients were divided into asthma-ACOS and COPD-ACOS according to their physician's diagnosis and smoking history of 10 pack-years. Within-group comparisons were made for asthma-ACOS versus COPD-ACOS and light smokers versus heavy smokers.
RESULTS
Compared to patients with COPD-ACOS, patients with asthma-ACOS experienced exacerbation more often despite their younger age, history of light smoking, and better lung function. While the light-smoking group showed better lung function, they made unscheduled outpatient clinic visits more frequently. On multivariate analysis, asthma-ACOS and poor inhaler compliance were significantly associated with more than two unscheduled clinic visits during the previous year.
CONCLUSION
Spirometrically defined ACOS includes heterogeneous subgroups with different clinical features. Phenotyping of ACOS by physician's diagnosis could be significant in predicting future risk of exacerbation.

Keyword

Asthma; Pulmonary Disease, Chronic Obstructive; Phenotype

MeSH Terms

Ambulatory Care
Ambulatory Care Facilities
Asthma*
Compliance
Diagnosis
Humans
Lung
Lung Diseases, Obstructive*
Multivariate Analysis
Nebulizers and Vaporizers
Phenotype
Pulmonary Disease, Chronic Obstructive
Smoke
Smoking
Smoke

Reference

1. Gibson PG, Simpson JL. The overlap syndrome of asthma and COPD: what are its features and how important is it. Thorax. 2009; 64:728–735.
Article
2. Zeki AA, Schivo M, Chan A, Albertson TE, Louie S. The asthma-COPD overlap syndrome: a common clinical problem in the elderly. J Allergy (Cairo). 2011; 2011:861926.
Article
3. Louie S, Zeki AA, Schivo M, Chan AL, Yoneda KY, Avdalovic M, et al. The asthma-chronic obstructive pulmonary disease overlap syndrome: pharmacotherapeutic considerations. Expert Rev Clin Pharmacol. 2013; 6:197–219.
Article
4. Miravitlles M, Soler-Cataluna JJ, Calle M, Molina J, Almagro P, Quintano JA, et al. Spanish COPD Guidelines (GesEPOC): pharmacological treatment of stable COPD. Spanish Society of Pulmonology and Thoracic Surgery. Arch Bronconeumol. 2012; 48:247–257.
5. Global Initiative for Asthma. Diagnosis of diseases of chronic airflow limitation: asthma, COPD and asthma-COPD overlap syndrome (ACOS), 2014 [Internet]. Bethesda: Global Initiative for Asthma;2014. cited 2014 Jul 27. Available from: http://www.ginasthma.org/documents/14.
6. Lange P, Parner J, Vestbo J, Schnohr P, Jensen G. A 15-year follow-up study of ventilatory function in adults with asthma. N Engl J Med. 1998; 339:1194–1200.
Article
7. Kauppi P, Kupiainen H, Lindqvist A, Tammilehto L, Kilpelainen M, Kinnula VL, et al. Overlap syndrome of asthma and COPD predicts low quality of life. J Asthma. 2011; 48:279–285.
Article
8. Hardin M, Silverman EK, Barr RG, Hansel NN, Schroeder JD, Make BJ, et al. The clinical features of the overlap between COPD and asthma. Respir Res. 2011; 12:127.
Article
9. Menezes AM, Montes de, Perez-Padilla R, Nadeau G, Wehrmeister FC, Lopez-Varela MV, et al. Increased risk of exacerbation and hospitalization in subjects with an overlap phenotype: COPD-asthma. Chest. 2014; 145:297–304.
10. Sin DD. Asthma-COPD overlap syndrome: what we know and what we don't. Tuberc Respir Dis. 2017; 80:11–20.
Article
11. Rhee CK, Yoon HK, Yoo KH, Kim YS, Lee SW, Park YB, et al. Medical utilization and cost in patients with overlap syndrome of chronic obstructive pulmonary disease and asthma. COPD. 2014; 11:163–170.
Article
12. Shaya FT, Dongyi D, Akazawa MO, Blanchette CM, Wang J, Mapel DW, et al. Burden of concomitant asthma and COPD in a Medicaid population. Chest. 2008; 134:14–19.
Article
13. Soriano JB, Visick GT, Muellerova H, Payvandi N, Hansell AL. Patterns of comorbidities in newly diagnosed COPD and asthma in primary care. Chest. 2005; 128:2099–2107.
Article
14. Kim DK, Park YB, Oh YM, Jung KS, Yoo JH, Yoo KH, et al. Korean asthma guideline 2014: summary of major updates to the Korean asthma guideline 2014. Tuberc Respir Dis. 2016; 79:111–120.
Article
15. Yoon HK, Park YB, Rhee CK, Lee JH, Oh YM. Committee of the Korean COPD Guideline 2014. Summary of the chronic obstructive pulmonary disease clinical practice guideline revised in 2014 by the Korean Academy of Tuberculosis and Respiratory Disease. Tuberc Respir Dis. 2017; 80:230–240.
Article
16. Siroux V, Pin I, Oryszczyn MP, Le Moual N, Kauffmann F. Relationships of active smoking to asthma and asthma severity in the EGEA study: epidemiological study on the genetics and environment of asthma. Eur Respir J. 2000; 15:470–477.
17. Polosa R, Russo C, Caponnetto P, Bertino G, Sarva M, Antic T, et al. Greater severity of new onset asthma in allergic subjects who smoke: a 10-year longitudinal study. Respir Res. 2011; 12:16.
Article
18. James AL, Palmer LJ, Kicic E, Maxwell PS, Lagan SE, Ryan GF, et al. Decline in lung function in the Busselton Health Study: the effects of asthma and cigarette smoking. Am J Respir Crit Care Med. 2005; 171:109–114.
19. Kupczyk M, ten Brinke A, Sterk PJ, Bel EH, Papi A, Chanez P, et al. Frequent exacerbators: a distinct phenotype of severe asthma. Clin Exp Allergy. 2014; 44:212–221.
20. Althuis MD, Sexton M, Prybylski D. Cigarette smoking and asthma symptom severity among adult asthmatics. J Asthma. 1999; 36:257–264.
Article
21. Seemungal TA, Donaldson GC, Paul EA, Bestall JC, Jeffries DJ, Wedzicha JA. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998; 157(5 Pt 1):1418–1422.
Article
22. Quint JK, Baghai-Ravary R, Donaldson GC, Wedzicha JA. Relationship between depression and exacerbations in COPD. Eur Respir J. 2008; 32:53–60.
Article
23. Donaldson GC, Seemungal TA, Bhowmik A, Wedzicha JA. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax. 2002; 57:847–852.
Article
24. Garcia-Aymerich J, Serra Pons I, Mannino DM, Maas AK, Miller DP, Davis KJ. Lung function impairment, COPD hospitalisations and subsequent mortality. Thorax. 2011; 66:585–590.
Article
25. Singh AK, Cydulka RK, Stahmer SA, Woodruff PG, Camargo CA Jr. Sex differences among adults presenting to the emergency department with acute asthma. Multicenter Asthma Research Collaboration Investigators. Arch Intern Med. 1999; 159:1237–1243.
26. Mullerova H, Shukla A, Hawkins A, Quint J. Risk factors for acute exacerbations of COPD in a primary care population: a retrospective observational cohort study. BMJ Open. 2014; 4:e006171.
Article
27. Kilic H, Kokturk N, Sari G, Cakir M. Do females behave differently in COPD exacerbation. Int J Chron Obstruct Pulmon Dis. 2015; 10:823–830.
28. Vestbo J, Anderson JA, Calverley PM, Celli B, Ferguson GT, Jenkins C, et al. Adherence to inhaled therapy, mortality and hospital admission in COPD. Thorax. 2009; 64:939–943.
Article
29. Stern L, Berman J, Lumry W, Katz L, Wang L, Rosenblatt L, et al. Medication compliance and disease exacerbation in patients with asthma: a retrospective study of managed care data. Ann Allergy Asthma Immunol. 2006; 97:402–408.
Article
30. O'Byrne PM, Pedersen S, Lamm CJ, Tan WC, Busse WW. START Investigators Group. Severe exacerbations and decline in lung function in asthma. Am J Respir Crit Care Med. 2009; 179:19–24.
31. Hasegawa K, Bittner JC, Nonas SA, Stoll SJ, Watase T, Gabriel S, et al. Children and adults with frequent hospitalizations for asthma exacerbation, 2012-2013: a multicenter observational study. J Allergy Clin Immunol Pract. 2015; 3:751–758.
Article
32. Hospers JJ, Postma DS, Rijcken B, Weiss ST, Schouten JP. Histamine airway hyper-responsiveness and mortality from chronic obstructive pulmonary disease: a cohort study. Lancet. 2000; 356:1313–1317.
Article
33. Scichilone N, Battaglia S, La Sala A, Bellia V. Clinical implications of airway hyperresponsiveness in COPD. Int J Chron Obstruct Pulmon Dis. 2006; 1:49–60.
Article
34. Kessler R, Partridge MR, Miravitlles M, Cazzola M, Vogelmeier C, Leynaud D, et al. Symptom variability in patients with severe COPD: a pan-European cross-sectional study. Eur Respir J. 2011; 37:264–272.
Article
35. Joo H, Han D, Lee JH, Rhee CK. Heterogeneity of asthma-COPD overlap syndrome. Int J Chron Obstruct Pulmon Dis. 2017; 12:697–703.
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