Clinically relevant subgroups in COPD and asthma

Abstract

As knowledge of airways disease has grown, it has become apparent that neither chronic obstructive pulmonary disease (COPD) nor asthma is a simple, easily defined disease. In the past, treatment options for both diseases were limited; thus, there was less need to define subgroups. As treatment options have grown, so has our need to predict who will respond to new drugs. To date, identifying subgroups has been largely reported by detailed clinical characterisation or differences in pathobiology. These subgroups are commonly called "phenotypes"; however, the problem of defining what constitutes a phenotype, whether this should include comorbid diseases and how to handle changes over time has led to the term being used loosely.In this review, we describe subgroups of COPD and asthma patients whose clinical characteristics we believe have therapeutic or major prognostic implications specific to the lung, and whether these subgroups are constant over time. Finally, we will discuss whether the subgroups we describe are common to both asthma and COPD, and give some examples of how treatment might be tailored in patients where the subgroup is clear, but the label of asthma or COPD is not. @ERSpublications Summary of subgroups of airways disease that can be found in COPD and asthma, and their management

Hospitalization due to exacerbation of COPD: "Real-life" outcomes

“…Some studies found that 55% of COPD patients over 50 years of age had asthma, whereas in other studies the prevalence of asthma--COPD overlap syndrome ranged from 13 to 19%. 23 Patients hospitalized with eCOPD had 4.2±2.2 comorbidities, which is consistent with reports in the medical literature that these are more frequent in patients with COPD than in the general population. 24 Some comorbidities present in patients with COPD affect the prognosis, as described by Divo and Cote.…”

“…21,22 The coexistence of these conditions is called asma-COPD overlap syndrome. 23 With increasing age, there is an increase in the proportion of patients with this syndrome. Some studies found that 55% of COPD patients over 50 years of age had asthma, whereas in other studies the prevalence of asthma--COPD overlap syndrome ranged from 13 to 19%.…”

TIPE2 is negatively correlated with tissue factor and thrombospondin-1 expression in patients with bronchial asthma

“…Asthma is chronic inflammatory disease of the airways (2). It has been demonstrated that patients with bronchial asthma also develop hyper-coagulation (4).…”

“…Bronchial asthma is a chronic inflammatory disease of the airways affecting millions of people worldwide; there are currently ~300,000,000 patients with asthma (1,2). It has been demonstrated in a rat model of asthma that the interaction between inflammation and hypercoagulable state aggravates the severity of asthma and contributes to airway remodeling (3).…”

“…In humans, lung inflammation in asthma is accompanied by a pulmonary procoagulant and antifibrinolytic environment (4). A number of cells, including eosinophilia, mastocytes, T lymphocytes, neutrophils and airway epithelium cells contribute to the development of chronic airway inflammation in asthma (2). Levels of coagulation parameters, platelets, fibrinogen, tissue factor, thromboxane A2, thrombin and activated protein C may reflect thrombosis formation during the pathophysiological process of asthma (5,6).…”