Asthma-COPD Overlap

Leung, Clarus; Sin, Don D.

doi:10.1016/j.chest.2021.09.036

Cited by 35 publications

(27 citation statements)

References 86 publications

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“…Based on data from North America, Europe and Asia, it was estimated that 2.0% of the general population, 26.5% of patients with asthma, and 29.6% of patients with COPD were diagnosed with ACO 20. Notably, patients with ACO experience more frequent symptoms of dyspnoea and exacerbations leading to hospitalisations, which are associated with higher healthcare costs and mortality rates compared with those with asthma or COPD alone 21–23. However, the association between ACO and frailty has not been extensively studied yet, and it is also unclear whether this association significantly differs from that of COPD and asthma.…”

Section: Introductionmentioning

confidence: 99%

Frailty in asthma-COPD overlap: a cross-sectional study of association and risk factors in the NHANES database

Wang

Wen

et al. 2023

BMJ Open Resp Res

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BackgroundAsthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) is a condition characterised by the simultaneous presence of features of both asthma and COPD. The study aims to investigate the association between ACO and frailty among middle-aged and elderly populations, and identify the risk factors for frailty in individuals with ACO.MethodsWe conducted a cross-sectional study with 34 403 eligible participants (aged ≥40 years) from the National Health and Nutrition Examination Survey 1999–2018 cycles. Participants were stratified into four groups: ACO, asthma, COPD and non-asthma/COPD. Frailty assessment was based on frailty index, generating frail and non-frail group. Univariate and multivariate survey-weighted logistic regression analysis were used to determine the association between ACO and frailty, and to identify the risk factors for frailty in ACO.ResultsThe frailty prevalence in participants with ACO was 60.2%, significantly higher than that in those with asthma (32.3%) and COPD (40.6%). In the unadjusted model, participants with ACO exhibited six-fold higher odds of frailty (OR 6.30, 95% CI 5.29 to 7.49), which was significantly greater than those with COPD (OR 2.84, 95% CI 2.46 to 3.28) and asthma (OR 1.99, 95% CI 1.80 to 2.18), using the non-asthma/COPD group as a reference. After adjusting for all confounders, participants with ACO had over four times higher odds of frailty (OR 4.48, 95% CI 3.53 to 5.71), still higher than those with asthma and COPD. The findings remained robust in sensitivity and subgroup analyses. Furthermore, hypertension, cancer, cardiovascular disease, chronic kidney disease and cognitive disorders were identified as risk factors for frailty among ACO participants, while higher income and education levels were protective factors.ConclusionPatients (aged ≥40 years) with ACO were at a higher risk of frailty, regardless of age or sex, compared with those with asthma or COPD alone. Greater attention should be paid to patients with ACO, regardless of their age.

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Section: Introductionmentioning

confidence: 99%

Frailty in asthma-COPD overlap: a cross-sectional study of association and risk factors in the NHANES database

Wang

Wen

et al. 2023

BMJ Open Resp Res

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“…Insights into pharmacologic outcomes, especially for biologic therapies [44], may be gained if examined in relation to APS clusters. Lastly, recognition that atopy is not a single metric, APS as a biomarker may prove important as a standardized variable in future asthma cluster analyses (Table 1) and could enhance databases for understanding other respiratory conditions (e.g., asthma-COPD overlap) [45].…”

Section: Discussionmentioning

confidence: 99%

Allergic Polysensitization Clusters: Newly Recognized Severity Marker in Urban Asthmatic Adults

Patchett

Nriagu

Mavraj

et al. 2022

Int Arch Allergy Immunol

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Introduction: While reliable, quantitative in vitro testing for sensitivity to aeroallergens has been available for decades, such information has largely been ignored in clustering analyses of asthma. Our aim is to explore allergic polysensitization as a possible marker of asthma severity and, as such, to be considered as an integral marker in future asthma clustering analyses. Methods: We constructed a database of sensitizations to the 25 aeroallergens in our geographic area (zone 1, Northeastern US) using the ImmunoCAP® in vitro assay. We used the Scikit-Learn® machine learning library for model-based clustering to identify allergic polysensitization clusters. Clusters were compared for differences in common office-based clinical markers of asthma. Results: The database consisted of 509 patients. Unbiased machine learning identified ten clusters of increasing allergic polysensitization of varying sizes (n = 1–339) characterized by significant increases in mean serum immunoglobulin E (p < 0.001), peripheral blood eosinophil count (p < 0.001), and DLCO (p = 0.02). There was a significant decline in mean age at presentation (p < 0.001), FEV1/FVC (p = 0.01), and FEF25-75 (p = 0.002) with increasing allergic polysensitization. Finally, we identified two divergent paths for the poly-atopic march, one driven by perennial and the other by seasonal allergens. Conclusion: This pilot study showed that allergic polysensitization, using readily available qualitative and quantitative in vitro sensitization data, largely ignored in cluster analyses to date, may add further clinical precision in cluster analyses of asthma. We suggest the methods used here can be applied and tested using larger databases and aeroallergens present in diverse geographic regions.

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“…Because there is no consensus diagnostic criteria of COPD in asthma (ACO), 13,14 we made the diagnosis of concomitant of ACO with post‐bronchodilator FEV1/FVC < 0.7 and smoking history of ≥10 pack‐year in ≥40‐year‐old subjects. Smoking history of ≥10 pack‐year in ≥40‐year‐old was chosen based on previous studies 13,14 …”

Section: Methodsmentioning

confidence: 99%

“…Smoking history of ≥10 pack-year in ≥40-year-old was chosen based on previous studies. 13,14 Data are presented as median (range) unless otherwise specified. JMP version 11 software (SAS Institute, Cary, NC, USA) was used for all statistical analyses.…”

Section: Methodsmentioning

confidence: 99%

Clinical features of asthma with connective tissue diseases

Watanabe

Horita

Hara

et al. 2023

Clinical Respiratory J

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Background The clinical features of asthma with connective tissue diseases (CTDs) are not well‐known. This study therefore aimed to investigate the clinical characteristics of asthma with CTDs. Methods We retrospectively examined the records of adults (≥18 years old) with asthma followed up between January 2010 and December 2019. We then compared the clinical features of asthma with and without CTDs. Results Among 568 subjects with asthma, 42 subjects (7.4%) had CTDs. The most frequent concomitant CTD was rheumatoid arthritis ( n = 23, 54.8%), followed by systemic lupus erythematosus ( n = 6, 14.3%). The proportion of women (with vs. without CTDs, 85.7% vs. 56.5%, p < 0.001) and Global Initiative for Asthma step were higher (Step 4 or 5, with vs. without CTDs, 81.0% vs. 62.0%, p = 0.01) in asthma with CTDs, whereas frequency of allergic rhinitis was higher in asthma without CTDs (with vs. without CTDs, 7.1% vs. 26.1%, p = 0.005). Eosinophil ratio (with vs. without CTDs, 2.1% vs. 3.5%, p = 0.009) and total immunoglobulin E level (with vs. without CTDs, 43 IU/mL vs. 237 IU/mL, p = 0.002) were lower in asthma with CTDs. In terms of lung function, percentage predicted forced vital capacity (with vs. without CTDs, 86.7% vs. 99.7%, p = 0.008) and percentage predicted forced expiratory volume in 1 s (%FEV1) (with vs. without CTDs, 77.2% vs. 88.4%, p = 0.02) were all lower in asthma with CTDs. With multivariable analysis, CTDs (odds ratio [OR] 2.8, 95%CI 1.3–6.0; p = 0.008), chronic obstructive pulmonary disease (OR 3.8, 95%CI 2.1–6.7; p < 0.001) and asthma onset at <20 years old (OR 1.8, 95%CI 1.1–3.2; p = 0.03) were associated with low FEV1 (defined as %FEV1 < 80%) in asthma. Conclusions Asthma with CTDs was related to lower lung function and low‐T2 inflammation asthma.

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Asthma-COPD Overlap

Cited by 35 publications

References 86 publications

Frailty in asthma-COPD overlap: a cross-sectional study of association and risk factors in the NHANES database

Frailty in asthma-COPD overlap: a cross-sectional study of association and risk factors in the NHANES database

Allergic Polysensitization Clusters: Newly Recognized Severity Marker in Urban Asthmatic Adults

Clinical features of asthma with connective tissue diseases

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