Tuberc Respir Dis.  2018 Oct;81(4):289-298. 10.4046/trd.2017.0064.

Increased Risk of Exacerbation in Asthma Predominant Asthma–Chronic Obstructive Pulmonary Disease Overlap Syndrome

• Park J
• Kim EK
• Kim MA
• Kim TH
• Chang JH
• Ryu YJ
• Lee SW
• Oh YM
• Yong SJ
• Choi WI
• Yoo KH
• Lee JH

• KMID: 2420562
• DOI: http://doi.org/10.4046/trd.2017.0064

Abstract

BACKGROUND
Obstructive airway disease patients with increased variability of airflow and incompletely reversible airflow obstruction are often categorized as having asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS). ACOS is heterogeneous with two sub-phenotypes: asthma-ACOS and COPD-ACOS. The objective of this study was to determine the difference in risk of exacerbation between the two sub-phenotypes of ACOS.
METHODS
A total of 223 patients exhibiting incompletely reversible airflow obstruction with increased variability (spirometrically defined ACOS) were enrolled. These patients were divided into asthma-ACOS and COPD-ACOS according to their physician's diagnosis and smoking history of 10 pack-years. Within-group comparisons were made for asthma-ACOS versus COPD-ACOS and light smokers versus heavy smokers.
RESULTS
Compared to patients with COPD-ACOS, patients with asthma-ACOS experienced exacerbation more often despite their younger age, history of light smoking, and better lung function. While the light-smoking group showed better lung function, they made unscheduled outpatient clinic visits more frequently. On multivariate analysis, asthma-ACOS and poor inhaler compliance were significantly associated with more than two unscheduled clinic visits during the previous year.
CONCLUSION
Spirometrically defined ACOS includes heterogeneous subgroups with different clinical features. Phenotyping of ACOS by physician's diagnosis could be significant in predicting future risk of exacerbation.

Keyword

Asthma; Pulmonary Disease, Chronic Obstructive; Phenotype

MeSH Terms

Ambulatory Care
Ambulatory Care Facilities
Asthma*
Compliance
Diagnosis
Humans
Lung
Lung Diseases, Obstructive*
Multivariate Analysis
Nebulizers and Vaporizers
Phenotype
Pulmonary Disease, Chronic Obstructive
Smoke
Smoking
Smoke

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