Comparison of therapeutic response between asthma,COPD, and ACOS patients by evaluation of spirometric findings

Main Article Content

Zahra Pakzad
Mohammad esmaeil Hejazi
Horia Shojaan
Niusha Kalami
Veghar Hejazi
Tahereh Vaezi

Keywords

Therapeutic response, Asthma, COPD, ACOS, spirometry

Abstract

Asthma and Chronic obstructive pulmonary disease (COPD ) both are a common public health problem that affects a large portion of population. Nearly 20% of patients with obstructive lung disease have fea-tures of both asthma and COPD called ACOS that GOLD_GINA guidelines defines as persistent airflow limitation with several features of asthma and several features of COPD. Yet there is a little data available about diagnosis and treatment of this entity and current study aimed to compare therapeutic response between asthma, COPD and Asthma-COPD overlap syndrome (ACOS) subjects through spirometric data. In the present cross-sectional study, 30 known patients with mild to moderate asthma, 30 known patients with mild to moderate COPD and 30 known patients with mild to moderate ACOS according to GOLD_GINA guidelines were enrolled. We assessed post bronchodilator the ratio of the forced expiratory volume in the first one second to the forced vital capacity of the lungs (fev1) and the forced expiratory volume in the first one second to the forced vital capacity of the lungs (fev1/fvc) in all patients. Then they took stan-dard treatment for 2 months and after this period spirometry was repeated. Spirometric data’s changes was compared between the three groups by SPSS26 statistical software. Fev1 changes in response to treatment did not differ significantly between three groups (p > 0.05) but fev1/fvc changes differed significantly and this parameter in asthma was more than ACOS and in COPD was least. (In asthma, spirometric symbol-ized therapeutic response is more significant than ACOS, and in ACOS, it is more important than COPD in terms of fev1/fvc changes) and there was not any difference between the three groups regarding to FEV1 changes.
 

 



Abstract 263 | PDF Downloads 347 XML Downloads 60 HTML Downloads 91

References

1. Lambrecht BN, and Hammad H. The immunology of asthma. Nat Immunol. 2015; 16: 45–56. https://doi.org/10.1038/ni.3049
2. Borish L, and Culp JA. Asthma: a syndrome com-posed of heterogeneous diseases. Ann Allergy Asthma Immunol. 2008; 101: 1–9. https://doi.org/10.1016/S1081-1206(10)60826-5
3. Hogg JC, and Timens W. The pathology of chronic obstructive pulmonary disease. Annu Rev Pathol. 2009; 4: 435–459. https://doi.org/10.1146/annurev.pathol.4.110807.092145
4. Barnes PJ, Burney PG, Silverman EK, et al. Chronic obstructive pulmonary disease. Nat Rev Dis Primers. 2015; 1: 15076. https://doi.org/10.1038/nrdp.2015.76
5. Global Initiative for Asthma (GINA). Global strat-egy for asthma management and prevention. 2018.https://ginasthma.org/wp-content/uploads/2018/04/wms-GINA-2018-report-V1.3-002.pdf
6. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of COPD. 2019. https://goldcopd.org/wp-content/uploads/2018/11/GOLD-2019-v1.7-FINAL14Nov2018-WMS.pdf
7. Suzuki M, Makita H, Konno S, et al. Asthma-like features and clinical course of chronic obstructive pulmonary disease. An analysis from the Hokkaido COPD cohort study. Am J Respir Crit Care Med. 2016; 194: 1358–1365. https://doi.org/10.1164/rccm.201602-0353OC 8. Gibson PG, and Simpson JL. The overlap syndrome of asthma and COPD: what are its features and how important is it? Thorax. 2009; 64: 728–735. https://doi.org/10.1136/thx.2008.108027
9. Global Initiative for Asthma (GINA). Diagnosis and initial treatment of asthma, COPD and asthma-COPD overlap. 2017. https://ginasthma.org/asthma-copd-and-asthma-copd-overlap-syndrome-acos/
10. Leung JM, and Sin DD. Asthma-COPD overlap syndrome: pathogenesis, clinical features, and therapeutic targets. https://doi.org/10.1136/bmj.j3772
11. Menezes AMB, Montes de Oca M, Perez-Padilla R, et al. Increased risk of exacerbation and hospital-ization in subjects with an overlap phenotype: COPD-asthma. Chest. 2014; 145: 297–304. https://doi.org/10.1378/chest.13-0622
12. Miravitlles M, Soriano JB, Ancochea J, et al. Characterisation of the overlap COPD-asthma phenotype. Focus on physical activity and health status. Respir Med. 2013; 107: 1053–1060. https://doi.org/10.1016/j.rmed.2013.03.007
13. Kim M, Tillis W, Patel P, et al. Association between asthma-COPD overlap syndrome and healthcare utilizations among US adult population. Curr Med Res Opin. 2019; 35: 1191–1196. https://doi.org/10.1080/03007995.2019.1565531
14. Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA). Diagnosis of Asthma, COPD and Asthma-COPD overlap syndrome (ACOS). Global Initiative for Asthma website. http://www.ginasthma.org/. Accessed June 19, 2015.
15. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, man-agement, and prevention of chronic obstructive pulmonary disease (2020 report). http://www.goldcopd.org/gold-reports. Accessed December 24, 2019.
16. Vonk JM, Jongepier H, Panhuysen CI, et al. Risk factors associated with the presence of irreversible airflow limitation and reduced transfer coefficient in patients with asthma after 26 years of follow up. Thorax. 2003; 58: 322–327. https://doi.org/10.1136/thorax.58.4.322
17. Kocks JW, Chrystyn H, van der Palen J, et al. Systematic review of association between critical errors in inhalation and health outcomes in asthma and COPD. NPJ Prim Care Respir Med 2018; 28: 43. https://doi.org/10.1038/s41533-018-0110-x
18. Louie S, Zeki AA, Schivo M, et al. The asthma–chronic obstructive pulmonary disease overlap syndrome: pharmacotherapeutic considerations. Expert Rev Clin Pharmacol. 2013; 6: 197–219. https://doi.org/10.1586/ecp.13.2
19. Contoli M, Baraldo S, Marku B, et al. Fixed air-flow obstruction due to asthma or chronic obstruc-tive pulmonary disease: 5-year follow-up. J Allergy Clin Immunol. 2010; 125: 830–837. https://doi.org/10.1016/j.jaci.2010.01.003
20. Hardin M, Silverman EK, Barr RG, et al. The clin-ical features of the overlap between COPD and asthma. Respir Res. 2011; 12: 127. https://doi.org/10.1186/1465-9921-12-127
21. Kauppi P, Kupiainen H, Lindqvist A, et al. Overlap syndrome of asthma and COPD predicts low qual-ity of life. J Asthma. 2011; 48: 279–285. https://doi.org/10.3109/02770903.2011.555576
22. Soler-Cataluña JJ, Cosío B, Izquierdo JL, et al. Consensus document on the overlap phenotype COPD-asthma in COPD. Arch Bronconeumol. 2012; 48(9): 331–337. https://doi.org/10.1016/j.arbres.2011.12.009
23. Christenson SA, Steiling K, van den Berge M, et al. Asthma–COPD overlap. Clinical relevance of genomic signatures of type 2 inflammation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2015; 191: 758–766. https://doi.org/10.1164/rccm.201408-1458OC
24. Miravitlles M. Diagnosis of asthma_COPD over-lap: the five commandments. Eur Respir J. 2017; 49: 1700506. http://doi.org/10.1183/13993003.00506-2017
25. Weatherall M, Travers J, Shirtcliffe PM, et al. Distinct clinical phenotypes of airways disease defined by cluster analysis. Eur Respir J. 2009; 34(4): 812–818. https://doi.org/10.1183/09031936.00174408
26. Kostikas K, Clemens A, and Patalano F. The asthma-COPD overlap syndrome: do we really need another syndrome in the already complex matrix of airway disease? Int J Chron Obstruct Pulmon Dis. 2016; 11: 1297–1306. https://doi.org/10.2147/COPD.S107307
27. Shifren A, Byers DE, and Witt CA. Washington manual of pulmonary medicine subspecialty con-sult. 2nd ed. Wolters Kluwer; 2005. Publisher: Lippincott Williams & Wilkins (LWW)
28. Brzostek D, and Kokot M. Asthma-chronic obstructive pulmonary disease overlap syndrome in Poland. Findings of an epidemiological study. Postepy Dermatol Alergol. 2014; 31(6): 372–379. https://doi.org/10.5114/pdia.2014.47120
29. Miravitlles M, Alvarez-Gutierrez FJ, Calle M, et al. Algorithm for identification of asthma-COPD overlap: consensus between the Spanish COPD and asthma guidelines. Eur Respir J. 2017; 49(5): 1700068.https://doi.org/10.1183/13993003.00068-2017