Upper Respiratory Symptoms Worsen over Time and Relate to Clinical Phenotype in Chronic Obstructive Pulmonary Disease

Huerta, Arturo; Donaldson, Gavin C.; Mackay, Alexander; Allinson, James P.; Brill, Simon; Kowlessar, Beverly; Torres, Antoni; Wedzicha, Jadwiga A.

doi:10.1513/annalsats.201408-359oc

Cited by 13 publications

(7 citation statements)

References 30 publications

(26 reference statements)

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“…This is although there were no statistically significant differences in parameters which could explain this phenomenon regarding lung function, age, BMI, or level of medication. We also found that UAS were not associated with disease severity assessed by GOLD class which was in contrast to a previous study, where UAS were linked to patients with frequent exacerbations [39].…”

Section: Discussioncontrasting

confidence: 99%

Upper airway symptoms associate with the eosinophilic phenotype of COPD

et al. 2021

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BackgroundThere is growing evidence that upper airway symptoms coexist with lower airway symptoms in Chronic Obstructive Pulmonary Disease (COPD). Still, the prevalence and impact of upper airway disease on the nature and course of COPD remain unclear. We aimed to describe this in a cross-sectional study.MethodsWe examined a cohort of COPD patients with pulmonary function tests, induced sputum, blood eosinophils, atopy tests, CT of the paranasal sinuses. Lower airway symptoms were assessed using the COPD assessment test (CAT), and upper airway symptoms were assessed using the nasal subdomain of the 22-item Sino Nasal Outcome Test (SNOT22nasal). We recruited patients from five sites in Denmark and Sweden. We excluded patients with a history of asthma.FindingsIn total, 180 patients (female 55%, age 67 (±8) years, FEV1% 52.4 (±16.6), GOLD stage: A:18%, B:54%, C:3%, D:25%) were included in the study. Seventy-four patients (41%) reported high upper airway symptoms (high UAS defined as SNOT22nasal≥6) with a median score of 10 (IQR 8–13). Patients with high UAS reported higher CAT scores (17.4 (±7.5) versus 14.9 ±6.6, p<0.05) and displayed higher fractions of eosinophils in blood (median 3.0% (IQR 1.6–4.2%) versus 2.3% (IQR 1.4–3.1), p<0.05) and in induced sputum (median 1.8% (IQR 0.3–7.1%) versus median 0.5% (IQR 0–1.7%), p<0.05). No differences in atopy, CT findings or exacerbation rates were observed.ConclusionCOPD patients with upper airway disease showed increased evidence of eosinophilic disease and increased lower airway symptom burden.

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Section: Discussioncontrasting

confidence: 99%

Upper airway symptoms associate with the eosinophilic phenotype of COPD

et al. 2021

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“…Upper airway symptoms worsen over the natural history of COPD, and are associated with lower airway symptoms and impaired quality of life . Sinonasal symptoms also feature prominently during COPD exacerbations, and are associated with frequent exacerbations as well as treatment failure of acute exacerbation of COPD …”

Section: Airway Inflammationmentioning

confidence: 99%

“…46 Although prevalence of sinonasal disease does not increase with declining FEV 1 , 44,45 the presence of sinonasal disease has profound effects on other important COPD-related outcomes such as symptom morbidity and exacerbations, which are known to be relatively independent of FEV 1 . Upper airway symptoms worsen over the natural history of COPD, 47 and are associated with lower airway symptoms 44 and impaired quality of life. 48 Sinonasal symptoms also feature prominently during COPD exacerbations, and are associated with frequent exacerbations 47 as well as treatment failure of acute exacerbation of COPD.…”

Section: Chronic Obstructive Pulmonary Diseasechronic Rhinosinusitismentioning

confidence: 99%

“…Upper airway symptoms worsen over the natural history of COPD, 47 and are associated with lower airway symptoms 44 and impaired quality of life. 48 Sinonasal symptoms also feature prominently during COPD exacerbations, and are associated with frequent exacerbations 47 as well as treatment failure of acute exacerbation of COPD. 49 Tobacco smoke forms the common link between COPD and CRS, 50 likely by inducing neutrophilic inflammation in the nasal and bronchial mucosa.…”

Section: Chronic Obstructive Pulmonary Diseasechronic Rhinosinusitismentioning

confidence: 99%

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Precision medicine in united airways disease: A “treatable traits” approach

Yii

Tay

Choo

et al. 2018

Allergy

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United airways disease (UAD) is the concept that the upper and lower airways, which are anatomically and immunologically related, form a single organ. According to this concept, upper and lower airway diseases are frequently comorbid because they reflect manifestations of a single underlying disease at different sites of the respiratory tract. Allergic asthma-allergic rhinitis is the archetypal UAD, but emerging data indicate that UAD is a heterogeneous condition and consists of multiple phenotypes (observable clinical characteristics) and endotypes (pathobiologic mechanisms). The UAD paradigm also extends to myriad sinonasal diseases (eg, chronic rhinosinusitis with or without nasal polyps) and lower airway diseases (eg, bronchiectasis, chronic obstructive pulmonary disease). Here, we review currently known phenoendotypes of UAD and propose a "treatable traits" approach for the classification and management of UAD, wherein pathophysiological mechanisms and factors contributing to disease are identified and targeted for treatment. Treatable traits in UAD can be analyzed according to a framework comprising airway inflammation (eosinophilic, neutrophilic), impaired airway mucosal defense (impaired mucociliary clearance, antibody deficiency), and exogenous cofactors (allergic sensitizers, tobacco smoke, microbes). Appreciation of treatable traits is necessary in advancing the effort to deliver precise treatments and achieve better outcomes in patients with UAD.

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“…In recent years the role of upper airway symptomology in obstructive lung disease has received added attention, and several studies have documented that COPD patients report symptoms from the upper airways [4,5]. The pathophysiology behind these symptoms is less well studied, and although some smaller studies have found some evidence of increased levels of inflammatory markers (IL-6+IL-8) in the upper airway of COPD patients both in stable COPD and during acute exacerbations [6,7], there has to date not be a study looking at this inflammation in detail.…”

Section: Introductionmentioning

confidence: 99%