Inflammatory biomarkers in asthma-COPD overlap syndrome

Kobayashi, Seiichi; Hanagama, Masakazu; Yamanda, Shinsuke; Ishida, Masatsugu; Yanai, Masaru

doi:10.2147/copd.s113647

Cited by 54 publications

(53 citation statements)

References 33 publications

(39 reference statements)

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“…This is consistent with a recent report in which higher concentrations of blood eosinophils were observed in ACOS patients 14. We could not find any significant difference in FeNO measurements between the groups, although the usefulness of FeNO in differentiating ACOS, asthma, and COPD was suggested in other studies 14–16.…”

Section: Discussionsupporting

confidence: 93%

Prevalence and characteristics of asthma–COPD overlap syndrome identified by a stepwise approach

Inoue¹,

Nagase²,

Morita³

et al. 2017

COPD

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Background and objectiveThere is increasing recognition of asthma–COPD overlap syndrome (ACOS), which shares some features of both asthma and COPD; however, the prevalence and characteristics of ACOS are not well understood. The aim of this study was to investigate the prevalence of ACOS among patients with COPD and its characteristics using a stepwise approach as stated in the recent report of the Global Initiative for Asthma (GINA) and the Global Initiative for Chronic Obstructive Lung Disease (GOLD).MethodsThis multicenter, cross-sectional, observational study enrolled outpatients who were receiving medical treatment for COPD. Clinical data, including spirometry results, were retrieved from medical records. For symptom assessment, patients were asked to complete the Clinical COPD questionnaire and the modified British Medical Research Council questionnaire.ResultsOf the 1,008 patients analyzed, 167 (16.6%) had syndromic features of ACOS. Of the total number of patients, 93 and 42 (9.2% and 4.2%) also had a predefined clinical variability of ≥12%/≥200 mL and ≥12%/≥400 mL in forced expiratory volume in 1 second (FEV1), respectively, and therefore were identified as having ACOS. Conversely, the number of patients who had either syndromic or spirometric feature of ACOS was 595 (59.0%, ≥12%/≥200 mL FEV1 clinical variability), and 328 patients (32.5%, ≥12%/≥400 mL FEV1 clinical variability) had both the features. Patients identified as having ACOS were of significantly younger age, had a shorter duration of COPD, lower number of pack-years, better lung function, milder dyspnea symptoms, and higher peripheral blood eosinophil values compared with patients with COPD alone. The rate of exacerbations in the previous year was not significantly different between the ACOS and COPD groups.ConclusionUsing a stepwise approach, as stated in the GINA/GOLD report, the proportions of patients identified as having ACOS were found to be 9.2% and 4.2% (depending on the FEV1 variability cutoff used) among the 1,008 outpatients medically treated for COPD in a real-life clinical setting.

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Section: Discussionsupporting

confidence: 93%

Prevalence and characteristics of asthma–COPD overlap syndrome identified by a stepwise approach

Inoue¹,

Nagase²,

Morita³

et al. 2017

COPD

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“…In a recent Japanese study, based on the definition of total IgE above 173 kU/L, one third of the COPD subjects were considered atopic [39]. Kobayashi et al identified participants with ACO as variable respiratory symptoms and variable expiratory airflow limitation and they found that about half of the ACO participants had a total serum IgE level above 173 kU/L [20]. The differences in prevalence of IgE sensitisation in our study might be due to different methodologies used to assess IgE sensitisation, type of patients included in the study and regional differences.…”

Section: Discussionmentioning

confidence: 99%

“…According to recent publications, both increased F E NO values [13,15,16], and non-increased F E NO values [17] are reported in ACO. IgE sensitisation is an important determinant of F E NO 50 both in population-based studies [18] and among subjects with asthma [19], yet it has been sparsely studied in COPD [20].…”

Section: Introductionmentioning

confidence: 99%

Different Relationships between F_ENO and COPD Characteristics in Smokers and Ex-Smokers

Högman

Thornadtsson

Bröms

et al. 2019

COPD: Journal of Chronic Obstructive Pulmonary Disease

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Exhaled nitric oxide (F E NO) is a marker of type-2 inflammation in asthma and is used in its management. However, smokers and ex-smokers have lower F E NO values, and the clinical use of F E NO values in COPD patients is unclear. Therefore, we investigated if F E NO had a relationship to different COPD characteristics in smoking and ex-smoking subjects. Patients with COPD (n ¼ 533, 58% females) were investigated while in stable condition. Measurements of F E NO 50 , blood cell counts, IgE sensitisation and lung function were performed. Medication reconciliation was used to establish medication usage. Smokers (n ¼ 150) had lower F E NO 50 9 (8, 10) ppb (geometric mean, 95% confidence interval) than ex-smokers did (n ¼ 383) 15 (14, 16) ppb, p < 0.001. F E NO 50 was not associated with blood eosinophil or neutrophil levels in smokers, but in ex-smokers significant associations were found (r ¼ 0.23, p < 0.001) and (r ¼ -0.18, p ¼ 0.001), respectively. Lower F E NO values were associated with lower FEV 1 % predicted in both smokers (r ¼ 0.17, p ¼ 0.040) and ex-smokers (r ¼ 0.20, p < 0.001). Neither the smokers nor ex-smokers with reported asthma or IgE sensitisation were linked to an increase in F E NO 50 . Ex-smokers treated with inhaled corticosteroids (ICS) had lower F E NO 50 14 (13, 15) ppb than non-treated ex-smokers 17 (15, 19) ppb, p ¼ 0.024. This was not found in smokers (p ¼ 0.325). F E NO is associated with eosinophil inflammation and the use of ICS in ex-smoking COPD subjects, but not in smoking subjects suggesting that the value of F E NO as an inflammatory marker is more limited in smoking subjects. The association found between low F E NO values and low lung function requires further investigation.

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“… 8 – 11 Patients with ACOS tend to be younger, have a shorter smoking history, and use more respiratory medication, compared to patients with COPD. 12 The levels of IgE and antigen-specific IgE are higher among patients with ACOS than those with COPD. 12 In addition, the presence of peripheral eosinophilia (>300 eosinophils/μL or >5% leukocytes) and a prior history of atopy are considered characteristics of ACOS.…”

Section: Introductionmentioning

confidence: 97%

“… 12 The levels of IgE and antigen-specific IgE are higher among patients with ACOS than those with COPD. 12 In addition, the presence of peripheral eosinophilia (>300 eosinophils/μL or >5% leukocytes) and a prior history of atopy are considered characteristics of ACOS. 13 Traditionally, patients with the ACOS phenotype have been excluded from major clinical studies of asthma because of their smoking histories and from studies of COPD because of bronchodilator (BD)-mediated reversibility.…”

Section: Introductionmentioning

confidence: 97%

Effect of allergic phenotype on treatment response to inhaled bronchodilators with or without inhaled corticosteroids in patients with COPD

Cheng

Wang

Lin

2017

COPD

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BackgroundChronic obstructive pulmonary disease (COPD) is a heterogeneous disorder encompassing different phenotypes with different responses to treatment. The present 1-year, two-center hospital-based study investigated whether the plasma immunoglobulin E (IgE) level and/or eosinophil cell count could be used as biomarkers to stratify patients with COPD according to predicted responses to inhaled corticosteroids (ICS)-based therapy.MethodsA hospital-data based cohort study of COPD patients treated at two territory hospital centers was conducted for 1 year. Allergic biomarkers, including blood eosinophil counts and IgE levels, were assessed at baseline. Lung function parameters, including forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and the COPD Assessment Test (CAT), were also evaluated. The frequencies of acute exacerbation (AE) and pneumonia were also measured. Eosinophilia and a high IgE level were defined as >3% and 173 IU/mL, respectively.ResultsA total of 304 patients were included. Among patients with eosinophilia and high IgE levels, ICS-based therapy was associated with significant improvements in FEV1, FVC, and CAT scores, compared with bronchodilator (BD) therapy (P≤0.042). ICS-based therapy was also associated with a significantly lower incidence of AE vs BD-based therapy (11.7% vs 24.1%; P<0.008). Among patients with only eosinophilia, ICS-based therapy yielded significantly better CAT score results vs BD-based treatment (7 vs 13; P=0.032). A receiver operating characteristic curve analysis found that the combination of a high plasma IgE level and eosinophilia most sensitively and specifically identified patients who would benefit from the addition of ICS to BD therapy.ConclusionOur findings support the use of blood eosinophil cell counts plus IgE levels as predictive biomarkers of the ICS response in certain patients with COPD. Both biomarkers could potentially be used to stratify COPD patients regarding ICS-based therapy.

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Inflammatory biomarkers in asthma-COPD overlap syndrome

Cited by 54 publications

References 33 publications

Prevalence and characteristics of asthma–COPD overlap syndrome identified by a stepwise approach

Prevalence and characteristics of asthma–COPD overlap syndrome identified by a stepwise approach

Different Relationships between F_ENO and COPD Characteristics in Smokers and Ex-Smokers

Effect of allergic phenotype on treatment response to inhaled bronchodilators with or without inhaled corticosteroids in patients with COPD

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Inflammatory biomarkers in asthma-COPD overlap syndrome

Cited by 54 publications

References 33 publications

Prevalence and characteristics of asthma&ndash;COPD overlap syndrome identified by a stepwise approach

Prevalence and characteristics of asthma&ndash;COPD overlap syndrome identified by a stepwise approach

Different Relationships between FENO and COPD Characteristics in Smokers and Ex-Smokers

Effect of allergic phenotype on treatment response to inhaled bronchodilators with or without inhaled corticosteroids in patients with COPD

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Prevalence and characteristics of asthma–COPD overlap syndrome identified by a stepwise approach

Prevalence and characteristics of asthma–COPD overlap syndrome identified by a stepwise approach

Different Relationships between F_ENO and COPD Characteristics in Smokers and Ex-Smokers