Analysis of clinical features and inflammatory factors in induced sputum in common phenotypes of COPD with frequent exacerbations / 中国综合临床

Objective To compare the clinical characteristics of chronic bronchitis ( CB),emphysema (EM ), asthma - chronic obstructive pulmonary disease overlapping syndrome ( ACOS ) with frequent exacerbations ( FE ) or infrequent exacerbations ( iFE ) and induced sputum inflammatory cells and the heterogeneity of the transmitter. Methods Ninety-one cases of chronic obstructive pulmonary disease( COPD) with acute exacerbation were divided into CB,EM or ACOS phenotype,among which 44 were frequent,and 47 were non frequent. The clinical data,induced sputum inflammatory cells,interferon-γ(IFN-γ),tumor necrosis factor-α ( TNF-α ), interleukin ( IL )-4, IL-13 were analyzed. Results The FEV1% was ( 47 ± 13. 1 )%, significantly lower than that of non frequent episodes (( 56. 2 ± 10. 2)%),and the difference was statistically significant(P＝0.049).The FEV1/FVC% was (54.3±9.3)%,significantly lower than that of non frequent episodes (60. 1±7. 3)%,and there was a significant difference between them ( P＝0. 001) . The proportion of patients with GOLD III and IV,the percentage of neutrophils in induced sputum,tumor necrosis factor -α(TNF-α) and interferon-γin the patients with frequent episodes were significantly higher than those with non frequent episodes (P＜0. 05). Among them,FEV1/FVC% and TNF-αwere independent risk factors for COPD patients (P＝0. 032, 0. 021) . The FEV1% of patients with CB phenotypic frequent episodes were ( 47. 9 ± 14. 9 )%, significantly lower than that of non frequent episodes ((57. 2±10. 9)%)(P＝0. 000),and FEV1/FVC% was (53. 4± 9. 5)% in patients with CB frequent episodes,significantly lower than that of non frequent episodes ((60. 3±6. 9)%),and the difference was statistically significant (P＝0. 022),while the level of N%,TNF-α in induced sputum were significantly higher in CB phenotype subjects with FE than those in subjects with iFE(P＜0. 01). Patients with frequent episodes of emphysema had longer duration of disease (P＜0. 05),lower FEV1%and FEV1/FVC%(P＜0. 05),the proportion of GOLD III patients and the induced sputum TNF-αwere higher, but there was no significant difference in the number and proportion of phlegm inflammatory cells,interferon-γ, interleukin 4 and interleukin 3. The level of GOLD III and the IL-13 level of induced sputum in patients with frequent ACOS phenotype were significantly higher than those in patients with non frequent episodes (P＜0. 05) . Conclusion The lung function,the severity of the disease,the course of the disease,and the percentage of sputum neutrophils,tumor necrosis factor-α,or interleukin 13 are helpful in diagnosing patients with high risk of frequent episodes.

Síndrome de sobreposição asma e DPOC / Asthma-COPD overlap syndrome

Asma e doença pulmonar obstrutiva crônica (DPOC) são doenças crônicas altamente prevalentes na população geral. Ambas são caracterizadas por inflamação crônica heterogênea e obstrução das vias aéreas. Em ambas as condições, a inflamação crônica afeta todo o trato respiratório das grandes e pequenas vias aéreas, com recrutamento de diferentes células e com diferentes mediadores produzidos. A obstrução das vias aéreas é tipicamente intermitente e reversível na asma, mas é progressiva e frequentemente irreversível na DPOC. Quando asma e DPOC ocorrem juntas, o termo síndrome de sobreposição asma e DPOC tem sido usado. Realizou-se revisão de artigos originais, revisões e publicações indexadas nos bancos de dados PubMed, MEDLINE, LILACS e SciELO nos últimos 20 anos. Uma forma prática de diagnóstico da Síndrome de sobreposição asma e DPOC é incluir pacientes com diagnóstico de DPOC pelo critério do GOLD (Global Initiative for Chronic Obstructive Lung Disease) e da Asma pelo critério do GINA (Global Initiative for Asthma). Assim, a síndrome inclui pacientes que preenchem os critérios de DPOC (obstrução fixa das vias aéreas) e que também têm típicos achados de asma (sibilância, atopia, eosinofilia e resposta positiva a broncodilatador). A presença de diferentes fenótipos ou componentes das doenças aéreas obstrutivas crônicas necessita ser analisada para individualizar e otimizar o tratamento para se alcançar os melhores resultados. Embora intervenções específicas variem conforme a doença, o objetivo do tratamento para as doenças obstrutivas respiratórias é semelhante e dirigido primariamente para a necessidade de controlar os sintomas, otimizar a saúde geral, e prevenir exacerbações.

Asthma and chronic obstructive pulmonary disease (COPD) are highly prevalent chronic diseases in the general population. Both conditions are characterized by heterogeneous chronic airway inflammation and airway obstruction. In both cases, chronic inflammation affects the whole respiratory tract, from central to peripheral airways, with different inflammatory cells recruited and different mediators produced. Airway obstruction is typically intermittent and reversible in asthma, but it is progressive and largely irreversible in COPD. When asthma and COPD co-occur, the term asthma-COPD overlap syndrome has been applied. This paper presents a review of original articles, reviews and other materials indexed in the PubMed, MEDLINE, LILACS, and SciELO databases and published over the last 20 years. A practical approach to diagnosis of the asthma-COPD overlap syndrome has been to include patients with a diagnosis of COPD according to GOLD criteria (Global Initiative for Chronic Obstructive Lung Disease) and of asthma according to GINA criteria (Global Initiative for Asthma). Therefore, the combined syndrome includes patients who meet criteria for COPD (fixed airflow obstruction) and also have typical features of asthma (wheezing, atopy, eosinophilia, and positive bronchodilator response). The presence of different phenotypes or components of obstructive airway diseases needs to be analyzed so that treatment can be individualized and optimized to achieve the best results for each patient. Even though specific interventions vary by disease, treatment goals for patients with obstructive airway diseases are similar and driven primarily by the need to control symptoms, optimize health status, and prevent exacerbations.

Tiotropium bromide combined with salmeterol/fluticasone on the treatment of 122 cases with asthma COPD overlap syndrome / 中国生化药物杂志

Objective To evaluate the clinical efficacy of tiotropium combined with salmeterol/fluticasone on the treatment of the patients with asthma COPD overlap syndrome. Methods 122 patients with asthma COPD overlap syndrome were divided into 2 groups by randomized envelope, the experimental group and the control group. The experimental group were given tiotropium bromide combined with salmeterol/fluticasone. The control group were received compound ipratropium bromide combined with salmeterol/fluticasone. The clinical effect was observed. Results Before treatment, there was no significant difference in lung function between the two groups. After treatment, the improvement of pulmonary function indexes in the experimental group was significantly higher than that in the control group (P<0.05). And the number of acute attack and attack time in the experimental group were also better than those in the control group (P<0.05). Conclusion Tiotropium combined with Shah Mette Lo/fluticasone is effective on the treatment of asthma COPD overlap syndrome, and has some clinical advantages in improving lung function and reducing the frequency of attack.

The short-term efficacy of inhaled steroids combined with long-acting beta2-agonists for asthma-COPD overlap syndrome / 实用医学杂志

Objective To evaluate the short-term efficacy of inhaled corticosteroids(ICS)combined with long-acting beta2-agonists(LABA)for asthma-COPD overlap syndrome(ACOS). Methods The patients with stable COPD or ACOS who had been treated during the period of March 2012 to March 2015 were selected and divided into COPD group(88 patients)and ACOS group(36 patients). Pulmonary function,chest X-ray,and blood eosinophil count were detected;and mMRC scale was measured. Both groups received ICS combined with for 3 months. ACOS was defined as the patients had a self-reported survey and positive responses on bronchodilator. Results After a 3-month treatment with ICS and LABA ,an increase in forced expiratory volume in 1 second (FEV1)was significantly greater in ACOS patients than in those with COPD alone(250 ± 42.9 and 63.1 ± 25.3, P=0.003). According to the severity of baseline FEV1,the ACOS group showed a significant difference in patients with severe to very severe airflow limitation. Conclusions Inhaled steroids combined with long-acting beta2-agonists is more efficacious in the treatment of ACOS than COPD. Lung function improves more evidently in ACOS patients with mild-to-moderate airflow limitation after treatment.

The value of fractional exhale nitric oxide in diagnosis and management of asthma-COPD overlap syndrome / 中华急诊医学杂志

Objective To explore the value of fractional exhaled nitric oxide (FeNO) in diagnosis and treatment of asthma-COPD overlap syndrome (ACOS).Methods A total of 195 patients categorized into elderly ACOS,asthma,COPD and chronic cough groups were consecutively admitted from September 2013 to June 2014 in our hospital.All patients were examined with chest imaging,fractional exhaled nitric oxide (FeNO) test,and pulmonary function tests to analyze the differences in FeNO,FEV1/pred％ and FEV1/FVC among four groups,and to detect the relevance of FeNO to FEV1/pred％ and FEV1/FVC within each group.Results Both of the ACOS and asthma groups had higher FeNO values than the COPD and control groups [(30.9 ± 27.8,34.5 ± 29.4) vs.(17.3 ± 9.9,16.1 ± 8.6),P ＜ 0.05],while the values of FEV1/pred％ and FEV1/FVC in the ACOS and COPD groups were significantly lower than those in the other twogroups [FEV1/pred％,(52.9±8.4,53.5 ±9.6) vs.(81.1 ±5.9,85.7 ±7.1),allP＜0.05; FEV1/FVC,(51.9 ± 7.2,50.7 ± 7.1) vs.(79.2 ± 4.8,81.0 ± 5.9),all P ＜ 0.05].Although FeNO was directly related to FEV1/pred％ in the control group,there were no significant correlation between FeNO and FEV1/pred％ (or FEV1/FVC) in the other three groups [ACOS group,r =0.115,-0.007 (P =0.464,0.963) ; asthma group,r =0.038,0.045 (P =0.772,0.733) ; COPD group,r =0.097,0.010(P=0.498,0.944); control group,r =0.315,0.091 (P =0.045,0.571)].Conclusions The combination of FeNO and pulmonary function tests can facilitate the differential diagnosis of ACOS and other chronic obstructive airways disorders.For the elderly COPD patients with higher FeNO values,it should be noted whether they were complicated by ACOS or not.Furthermore,the inhalation of corticosteroid can be used to reduce the airway inflammation in these patients.