ACO (Asthma–COPD Overlap) Is Independent from COPD: The Case Against

Calverley, Peter M.A.; Walker, Paul

doi:10.3390/diagnostics11071189

Cited by 3 publications

(4 citation statements)

References 95 publications

(120 reference statements)

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“…In the present study, the ACO group showed a significant decrease in both FEV 1 (L) and FEV 1 (%pred) compared to the asthma group, suggesting greater airway obstruction. Past studies have shown that both FEV 1 and FVC decrease due to smoking and exposure to other noxious inhaled insults [30]. Smoking leads to a lower FEV 1 and increased air-trapping in the lungs [31].…”

Section: Discussionmentioning

confidence: 99%

Higher Prevalence and Severity of Eosinophilic Otitis Media in Patients with Asthma-COPD Overlap Compared with Asthma Alone

Sato,

Seo,

Tagaya

et al. 2023

Int Arch Allergy Immunol

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Introduction: Eosinophilic otitis media (EOM) is well-known to frequently co-exist with adult-onset asthma. Both diseases are similar type 2 inflammation and are considered to have a “one airway, one disease” relationship. Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO), characterized by airway obstruction caused by airway wall thickening (AWT), is a severe condition with a higher incidence of mortality compared to asthma alone or COPD alone. Based on the “one airway, one disease” concept, we hypothesized that the inflammatory pathophysiology of EOM differs depending on its comorbidity with ACO or with asthma alone. Methods: A total of 77 chronic rhinosinusitis (CRS) patients with asthma were enrolled in this study. The subjects were divided into 2 groups: a group with comorbid asthma alone (asthma group; 46 patients), and a group with comorbid ACO (ACO group; 31 patients). The 2 groups were compared and assessed with regard to various factors, including the patients’ clinical characteristics, prevalence rate of EOM, EOM severity, EOMs relationships with smoking and AWT, and the eosinophil and neutrophil cell counts in the middle ear effusion (MEE). Results: The ACO group included significantly more males (p < 0.05), was significantly older (p < 0.05), and showed significantly lower lung function values (FEV1 [L], FEV1 [%pred]) (p < 0.01) compared with the asthma group. The ACO group also had a significant history of smoking as shown by the Brinkman index (p < 0.01) and greater AWT as assessed by high-resolution computed tomography (p < 0.05). The EOM prevalence rate was significantly higher in the ACO group (p < 0.05), especially with increased ACO severity (p < 0.05). The EOM severity was also significantly higher in the ACO group (p < 0.05) and also correlated with the ACO severity (p < 0.05). The pretreatment ear clinical characteristics score and the average air conduction hearing level were significantly higher in the ACO group (p < 0.05). The eosinophil percentage in the MEE/otorrhea was significantly lower in the ACO group (25.3%) than in the asthma group (54.7%) (p < 0.05). Conversely, the neutrophil percentage was significantly higher in the ACO group (75.7% vs. 41.9%) (p < 0.05). Conclusions: Our findings suggest that, in CRS patients with asthma, comorbidity with ACO may be a clinical factor leading to increased EOM prevalence and severity, as well as a higher neutrophil infiltration percentage in the middle ear. Cessation of smoking and early therapeutic intervention for ACO may mitigate progression of bronchial remodeling (i.e., reduce AWT) and help reduce the prevalence and severity of EOM.

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Section: Discussionmentioning

confidence: 99%

Higher Prevalence and Severity of Eosinophilic Otitis Media in Patients with Asthma-COPD Overlap Compared with Asthma Alone

Sato,

Seo,

Tagaya

et al. 2023

Int Arch Allergy Immunol

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“…By contrast, Figure 6 of Colak and colleagues ( 7 ) shows that having an FEV 1 below 80% predicted predicts both exacerbation and mortality risk, irrespective of the presence of comorbid asthma. These data help inform the debate about the utility of ACO as a diagnostic category ( 10 ). Multiple different definitions of ACO have been proposed ( 10 , 11 ), but as defined by Colak and colleagues, self-reported and/or hospital-confirmed asthma in people with a history of cigarette smoking was associated with worse outcomes when the FEV 1 was below 80% predicted.…”

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confidence: 93%

“…These data help inform the debate about the utility of ACO as a diagnostic category ( 10 ). Multiple different definitions of ACO have been proposed ( 10 , 11 ), but as defined by Colak and colleagues, self-reported and/or hospital-confirmed asthma in people with a history of cigarette smoking was associated with worse outcomes when the FEV 1 was below 80% predicted. Although the inclusion of individuals hospitalized with an asthma exacerbation may have biased the outcomes observed, a similar pattern was seen when the individuals defined by self-reported asthma were examined.…”

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confidence: 93%

Understanding the People Excluded from Chronic Obstructive Pulmonary Disease Clinical Trials

Krishnan

Calverley

2022

Am J Respir Crit Care Med

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“…We believe that it is possible to produce a paper of great interest to readers. I express my deepest gratitude to the two groups of authors, Peter Calverley and Paul Walker from Liverpool, UK [ 6 ] and Naoya Fujino and Hisatoshi Sugiura from Sendai, Japan [ 7 ], who gave us the opportunity to publish pro–con reviews in this Special Issue.…”

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confidence: 99%