Asia Pac Allergy.  2017 Oct;7(4):227-233. 10.5415/apallergy.2017.7.4.227.

The asthma and chronic obstructive pulmonary disease overlap syndrome in tertiary care setting Thailand

• Kawamatawong T
• Charoenniwassakul S
• Rerkpattanapipat T

• KMID: 2410217
• DOI: http://doi.org/10.5415/apallergy.2017.7.4.227

Abstract

BACKGROUND
Asthma and chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) is an increasingly recognized clinical entity. ACOS significantly impacts on patient outcome compared to isolated asthma or COPD. However, ACOS definition and diagnosis criteria have not been well standardized. ACOS prevalence and clinical features in Thailand has never been studied. Objective: To investigate the prevalence and clinical features of ACOS compared to isolated asthma or COPD among patients with clinician-diagnosis of obstructive airway diseases.
OBJECTIVE
To investigate the prevalence and clinical features of ACOS compared to isolated asthma or COPD among patients with clinician-diagnosis of obstructive airway diseases.
METHODS
Spirometry, skin prick test (SPT) and allergens specific IgE (sIgE) were done. Serum total IgE, exhaled nitric oxide (FeNO) and blood eosinophils were measured. High resolution computed tomography (HRCT) was performed. Smoking history, pollution, biomass exposure and symptoms (Asthma Control Test [ACT], COPD assessment test [CAT], Modified Medical Research Council Dyspnea Scale [MMCR]) were assessed. Patients were classified to isolated asthma, COPD or ACOS according to predefined definitions for this study.
RESULTS
A total 92 patients were enrolled: 58 patients with clinician-diagnosed of late onset asthma and 34 with clinician-diagnosed COPD. The mean age was 67.4 years. Thirty-four asthma patients (58.6%) were considered to have ACOS with postbronchodilator forced expiratory volume in 1 second (FEV₁)/forced vital capacity ratio <0.7 and/or presence of emphysema on HRCT. In addition, 10 COPD patients (28.6%) were classified as ACOS if they had bronchodilator reversibility (FEV₁≥ 12% and ≥ 200 mL) and positive SPT or sIgE. Hence, total of 44 from 92 patients (47.8%) with obstructive airway diseases were found to have ACOS, while isolated asthma and COPD were found in 24 patients equally. No difference in symptoms assessed by CAT, ACT, or MMRC was found between 3 groups of patients. Neither serum total IgE nor blood eosinophils counts distinguished ACOS from asthma and COPD (p = 0.83 and p = 0.40). FeNO was higher in pure COPD than ACOS and asthma (p = 0.03).
CONCLUSION
ACOS is prevalent in late-onset asthma or clinician-diagnosed COPD who were treated in tertiary care clinic. However, we found no difference in symptoms, blood eosinophils or serum total IgE between groups.

Keyword

Asthma and chronic obstructive pulmonary disease overlap syndrome; Prevalence; Tertiary care centers; Clinical features; Thailand

MeSH Terms

Allergens
Animals
Asthma*
Biomass
Cats
Diagnosis
Dyspnea
Emphysema
Eosinophils
Forced Expiratory Volume
Humans
Immunoglobulin E
Nitric Oxide
Prevalence
Pulmonary Disease, Chronic Obstructive*
Skin
Smoke
Smoking
Spirometry
Tertiary Care Centers
Tertiary Healthcare*
Thailand*
Vital Capacity
Allergens
Immunoglobulin E
Nitric Oxide
Smoke

Figure

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  Fig. 1 Diagram classifying patients with isolated (pure) asthma, isolated (pure) COPD and ACOS according to study definition. COPD, chronic obstructive pulmonary disease; ACOS, asthma and COPD overlap syndrome; BD, bronchodilator; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity.

Reference

1. 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.

2. Louie S, Zeki AA, Schivo M, Chan AL, Yoneda KY, Avdalovic M, Morrissey BM, Albertson TE. The asthma-chronic obstructive pulmonary disease overlap syndrome: pharmacotherapeutic considerations. Expert Rev Clin Pharmacol. 2013; 6:197–219.

3. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease [Internet]. place unknown: Global Initiative for Chronic Obstructive Lung Disease;2014. cited 2014 Sep 1. Available from: http://goldcopd.org/global-strategy-diagnosis-management-prevention-copd.

4. The Global Initiative for Asthma. GINA Report, Global strategy for asthma management and prevention. Revised 2014 [Internet]. The Global Initiative for Asthma;c2014. cited 2014 Jan 1. Available from: http://ginasthma.org/archived-reports/.

5. Cosio BG, Soriano JB, López-Campos JL, Calle-Rubio M, Soler-Cataluna JJ, de-Torres JP, Marín JM, Martínez-Gonzalez C, de Lucas P, Mir I, Peces-Barba G, Feu-Collado N, Solanes I, Alfageme I, Casanova C. CHAIN Study. Defining the asthma-COPD overlap syndrome in a COPD cohort. Chest. 2016; 149:45–52.

6. Sin DD, Miravitlles M, Mannino DM, Soriano JB, Price D, Celli BR, Leung JM, Nakano Y, Park HY, Wark PA, Wechsler ME. What is asthma-COPD overlap syndrome? Towards a consensus definition from a round table discussion. Eur Respir J. 2016; 48:664–673.

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

8. Hardin M, Silverman EK, Barr RG, Hansel NN, Schroeder JD, Make BJ, Crapo JD, Hersh CP. COPDGene Investigators. The clinical features of the overlap between COPD and asthma. Respir Res. 2011; 12:127.

9. Menezes AMB, Montes de Oca M, Pérez-Padilla R, Nadeau G, Wehrmeister FC, Lopez-Varela MV, Muiño A, Jardim JRB, Valdivia G, Tálamo C. PLATINO Team. Increased risk of exacerbation and hospitalization in subjects with an overlap phenotype: COPD-asthma. Chest. 2014; 145:297–304.

10. Standardization of Spirometry, 1994 Update. American Thoracic Society. Am J Respir Crit Care Med. 1995; 152:1107–1136.

11. Pisi R, Aiello M, Tzani P, Marangio E, Olivieri D, Chetta A. Measurement of fractional exhaled nitric oxide by a new portable device: comparison with the standard technique. J Asthma. 2010; 47:805–809.

12. Dweik RA, Boggs PB, Erzurum SC, Irvin CG, Leigh MW, Lundberg JO, Olin AC, Plummer AL, Taylor DR. American Thoracic Society Committee on Interpretation of Exhaled Nitric Oxide Levels (FENO) for Clinical Applications. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO) for clinical applications. Am J Respir Crit Care Med. 2011; 184:602–615.

13. Chiriac AM, Bousquet J, Demoly P. In vivo methods for the study and diagnosis of allergy. In : Adkinson NF, Bochner BS, Burks AW, Busse WW, Holgate ST, Lemanske RF, O'Hehir RE, editors. Middleton's allergy: principles & practice. 8th ed. Philadelphia (PA): Elsevier Saunders;2014. p. 1119–1132.

14. Andersén H, Lampela P, Nevanlinna A, Säynäjäkangas O, Keistinen T. High hospital burden in overlap syndrome of asthma and COPD. Clin Respir J. 2013; 7:342–346.

15. Fu JJ, Gibson PG, Simpson JL, McDonald VM. Longitudinal changes in clinical outcomes in older patients with asthma, COPD and asthma-COPD overlap syndrome. Respiration. 2014; 87:63–74.

16. 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.

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

18. Tálamo C, de Oca MM, Halbert R, Perez-Padilla R, Jardim JR, Muiño A, Lopez MV, Valdivia G, Pertuzé J, Moreno D, Menezes AM. PLATINO team. Diagnostic labeling of COPD in five Latin American cities. Chest. 2007; 131:60–67.

19. Kiljander T, Helin T, Venho K, Jaakkola A, Lehtimäki L. Prevalence of asthma-COPD overlap syndrome among primary care asthmatics with a smoking history: a cross-sectional study. NPJ Prim Care Respir Med. 2015; 25:15047.

20. Lee HY, Kang JY, Yoon HK, Lee SY, Kwon SS, Kim YK, Rhee CK. Clinical characteristics of asthma combined with COPD feature. Yonsei Med J. 2014; 55:980–986.

21. Tamada T, Sugiura H, Takahashi T, Matsunaga K, Kimura K, Katsumata U, Takekoshi D, Kikuchi T, Ohta K, Ichinose M. Biomarker-based detection of asthma-COPD overlap syndrome in COPD populations. Int J Chron Obstruct Pulmon Dis. 2015; 10:2169–2176.