Yonsei Med J.  2014 Jul;55(4):980-986. 10.3349/ymj.2014.55.4.980.

Clinical Characteristics of Asthma Combined with COPD Feature

• Lee HY
• Kang JY
• Yoon HK
• Lee SY
• Kwon SS
• Kim YK
• Rhee CK

• KMID: 2130823
• DOI: http://doi.org/10.3349/ymj.2014.55.4.980

Abstract

PURPOSE
In clinical practice, some patients with asthma show incompletely reversible airflow obstruction, resembling chronic obstructive pulmonary disease (COPD). The aim of this study was to analyze this overlap phenotype of asthma with COPD feature.
MATERIALS AND METHODS
A total of 256 patients, over the age of 40 years or more with a diagnosis of asthma, based on either 1) positive response to bronchodilator: >200 mL forced expiratory volume in 1 s (FEV1) and >12% baseline or 2) positive methacholine or mannitol provocation test, were enrolled. Among the asthma patients, we defined the overlap group with incompletely reversible airflow obstruction [postbronchodilator FEV1/forced vital capacity (FVC) <70] at the initial time of admission and continuing airflow obstruction after at least 3 months follow up. We evaluated clinical features, serum eosinophil counts, serum total immunoglobulin (Ig) E with allergy skin prick test, spirometry, methacholine or mannitol provocation challenges and bronchodilator responses, based on their retrospective medical record data. All of the tests mentioned above were performed within one week.
RESULTS
The study population was divided into two groups: asthma only (62%, n=159, postbronchodilator FEV1/FVC > or =70) and overlap group (38%, n=97, postbronchodilator FEV1/FVC <70). The overlap group was older, and contained more males and a higher percentage of current or ex-smokers than the asthma only group. Significantly lower FEV1 and higher total lung capacity, functional residual capacity, and residual volume were observed in the overlap group. Finally, significantly lower serum eosinophil count and higher IgE were seen in the overlap group.
CONCLUSION
Our results showed that the overlap phenotype was older, male asthmatic patients who have a higher lifetime smoking intensity, more atopy and generally worse lung function.

Keyword

Asthma; chronic obstructive pulmonary disease; overlap; airway hyperresponsiveness

MeSH Terms

Adult
Age Factors
Aged
Asthma/epidemiology/*physiopathology
Female
Forced Expiratory Volume/physiology
Humans
Male
Middle Aged
Pulmonary Disease, Chronic Obstructive/epidemiology/*physiopathology
Retrospective Studies
Sex Factors

Figure

• 

  Fig. 1 The percentage of patients diagnosed with overlap in different age groups. The values above each bar represent the percentage of patients diagnosed with overlap in each age groups.

Reference

1. Soriano JB, Davis KJ, Coleman B, Visick G, Mannino D, Pride NB. The proportional Venn diagram of obstructive lung disease: two approximations from the United States and the United Kingdom. Chest. 2003; 124:474–481.

2. Gibson PG, Simpson JL. The overlap syndrome of asthma and COPD: what are its features and how important is it? Thorax. 2009; 64:728–735.

3. Hardin M, Silverman EK, Barr RG, Hansel NN, Schroeder JD, Make BJ, et al. The clinical features of the overlap between COPD and asthma. Respir Res. 2011; 12:127.

4. de Marco R, Pesce G, Marcon A, Accordini S, Antonicelli L, Bugiani M, et al. The coexistence of asthma and chronic obstructive pulmonary disease (COPD): prevalence and risk factors in young, middle-aged and elderly people from the general population. PLoS One. 2013; 8:e62985.

5. Janssens JP, Pache JC, Nicod LP. Physiological changes in respiratory function associated with ageing. Eur Respir J. 1999; 13:197–205.

6. Zeki AA, Schivo M, Chan A, Albertson TE, Louie S. The Asthma-COPD Overlap Syndrome: A Common Clinical Problem in the Elderly. J Allergy (Cairo). 2011; 2011:861926.

7. Enright PL. The diagnosis and management of asthma is much tougher in older patients. Curr Opin Allergy Clin Immunol. 2002; 2:175–181.

8. Orie NG. The dutch hypothesis. Chest. 2000; 117:5 Suppl 1. 299S.

9. Kauppi P, Kupiainen H, Lindqvist A, Tammilehto L, Kilpeläinen M, Kinnula VL, et al. Overlap syndrome of asthma and COPD predicts low quality of life. J Asthma. 2011; 48:279–285.

10. Miravitlles M, Soriano JB, Ancochea J, Muñoz L, Duran-Tauleria E, Sánchez G, et al. Characterisation of the overlap COPD-asthma phenotype. Focus on physical activity and health status. Respir Med. 2013; 107:1053–1060.

11. Soler-Cataluña JJ, Cosío B, Izquierdo JL, López-Campos JL, Marín JM, Agüero R, et al. Consensus document on the overlap phenotype COPD-asthma in COPD. Arch Bronconeumol. 2012; 48:331–337.

12. Vestbo J, Hurd SS, Agustí AG, Jones PW, Vogelmeier C, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2013; 187:347–365.

13. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005; 26:319–338.

14. Wanger J, Clausen JL, Coates A, Pedersen OF, Brusasco V, Burgos F, et al. Standardisation of the measurement of lung volumes. Eur Respir J. 2005; 26:511–522.

15. Macintyre N, Crapo RO, Viegi G, Johnson DC, van der Grinten CP, Brusasco V, et al. Standardisation of the single-breath determination of carbon monoxide uptake in the lung. Eur Respir J. 2005; 26:720–735.

16. Crapo RO, Casaburi R, Coates AL, Enright PL, Hankinson JL, Irvin CG, et al. Guidelines for methacholine and exercise challenge testing-1999. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. Am J Respir Crit Care Med. 2000; 161:309–329.

17. Brannan JD, Anderson SD, Perry CP, Freed-Martens R, Lassig AR, Charlton B, et al. The safety and efficacy of inhaled dry powder mannitol as a bronchial provocation test for airway hyperresponsiveness: a phase 3 comparison study with hypertonic (4.5%) saline. Respir Res. 2005; 6:144.

18. Anderson SD, Charlton B, Weiler JM, Nichols S, Spector SL, Pearlman DS, et al. Comparison of mannitol and methacholine to predict exercise-induced bronchoconstriction and a clinical diagnosis of asthma. Respir Res. 2009; 10:4.

19. Bernstein IL, Li JT, Bernstein DI, Hamilton R, Spector SL, Tan R, et al. Allergy diagnostic testing: an updated practice parameter. Ann Allergy Asthma Immunol. 2008; 100:3 Suppl 3. S1–S148.

20. Kim TB, Oh YM, Chang YS, Cho YS, Jang AS, Cho SH, et al. The reality of an intermediate type between asthma and COPD in practice. Respir Care. 2012; 57:1248–1253.

21. Silva GE, Sherrill DL, Guerra S, Barbee RA. Asthma as a risk factor for COPD in a longitudinal study. Chest. 2004; 126:59–65.

22. Lee JH, Haselkorn T, Borish L, Rasouliyan L, Chipps BE, Wenzel SE. Risk factors associated with persistent airflow limitation in severe or difficult-to-treat asthma: insights from the TENOR study. Chest. 2007; 132:1882–1889.

23. Wenzel SE, Szefler SJ, Leung DY, Sloan SI, Rex MD, Martin RJ. Bronchoscopic evaluation of severe asthma. Persistent inflammation associated with high dose glucocorticoids. Am J Respir Crit Care Med. 1997; 156(3 Pt 1):737–743.

24. Louis R, Lau LC, Bron AO, Roldaan AC, Radermecker M, Djukanović R. The relationship between airways inflammation and asthma severity. Am J Respir Crit Care Med. 2000; 161:9–16.

25. Schmidt CD, Dickman ML, Gardner RM, Brough FK. Spirometric standards for healthy elderly men and women. 532 subjects, ages 55 through 94 years. Am Rev Respir Dis. 1973; 108:933–939.

26. Gould HJ, Sutton BJ, Beavil AJ, Beavil RL, McCloskey N, Coker HA, et al. The biology of IGE and the basis of allergic disease. Annu Rev Immunol. 2003; 21:579–628.

27. Wickman M. Experience with quantitative IgE antibody analysis in relation to allergic disease within the BAMSE birth cohort--towards an improved diagnostic process. Allergy. 2004; 59:Suppl 78. 30–31.

28. Sears MR, Burrows B, Flannery EM, Herbison GP, Hewitt CJ, Holdaway MD. Relation between airway responsiveness and serum IgE in children with asthma and in apparently normal children. N Engl J Med. 1991; 325:1067–1071.

29. Lange P, Parner J, Vestbo J, Schnohr P, Jensen G. A 15-year follow-up study of ventilatory function in adults with asthma. N Engl J Med. 1998; 339:1194–1200.

30. Anthonisen NR, Connett JE, Murray RP. Smoking and lung function of Lung Health Study participants after 11 years. Am J Respir Crit Care Med. 2002; 166:675–679.

31. Chaudhuri R, Livingston E, McMahon AD, Thomson L, Borland W, Thomson NC. Cigarette smoking impairs the therapeutic response to oral corticosteroids in chronic asthma. Am J Respir Crit Care Med. 2003; 168:1308–1311.

32. Thomson NC, Chaudhuri R, Livingston E. Active cigarette smoking and asthma. Clin Exp Allergy. 2003; 33:1471–1475.

33. Althuis MD, Sexton M, Prybylski D. Cigarette smoking and asthma symptom severity among adult asthmatics. J Asthma. 1999; 36:257–264.

34. Siroux V, Pin I, Oryszczyn MP, Le Moual N, Kauffmann F. Relationships of active smoking to asthma and asthma severity in the EGEA study. Epidemiological study on the Genetics and Environment of Asthma. Eur Respir J. 2000; 15:470–477.

35. ten Brinke A, Zwinderman AH, Sterk PJ, Rabe KF, Bel EH. Factors associated with persistent airflow limitation in severe asthma. Am J Respir Crit Care Med. 2001; 164:744–748.

36. Bai TR, Vonk JM, Postma DS, Boezen HM. Severe exacerbations predict excess lung function decline in asthma. Eur Respir J. 2007; 30:452–456.

37. van Veen IH, Ten Brinke A, Sterk PJ, Sont JK, Gauw SA, Rabe KF, et al. Exhaled nitric oxide predicts lung function decline in difficult-to-treat asthma. Eur Respir J. 2008; 32:344–349.