Questionnaire for diagnosing asthma-COPD overlap in COPD: Development of ACO screening questionnaire (ACO-Q).

BACKGROUND: The considerable prevalence and worse outcomes of asthma-COPD overlap (ACO) in COPD have been reported, and optimal introduction of ICS is essential for ACO. However, diagnostic criteria for ACO consist of multiple laboratory tests, which is challenging during this COVID-19 era. The purpose of this study was to create a simple questionnaire to diagnose ACO in patients with COPD. METHODS: Among 100 COPD patients, 53 were diagnosed with ACO based on the Japanese Respiratory Society Guidelines for ACO. Firstly, 10 candidate questionnaire items were generated and further selected by a logistic regression model. An integer-based scoring system was generated based on the scaled estimates of items. RESULTS: Five items, namely a history of asthma, wheezing, dyspnea at rest, nocturnal awakening, and weather- or season-dependent symptoms, contributed significantly to the diagnosis of ACO in COPD. History of asthma was related to FeNO >35 ppb. Two points were assigned to history of asthma and 1 point to other items in the ACO screening questionnaire (ACO-Q), and the area under the receiver operating characteristic curve was 0.883 (95% CI: 0.806-0.933). The best cutoff point was 1 point, and the positive predictive value was 100% at a cutoff of 3 points or higher. The result was reproducible in the validation cohort of 53 patients with COPD. CONCLUSIONS: A simple questionnaire, ACO-Q, was developed. Patients with scores ≥3 could be reasonably recommended to be treated as ACO, and additional laboratory testing would be recommended for patients with 1 and 2 points.

Moment Theory of Chromatography for the Analysis of Reaction Kinetics of Intermolecular Interactions.

Moment theory was applied to the kinetic study of intermolecular interactions. The association equilibrium constant (KA) and association (ka) and dissociation (kd) rate constants of chemical reactions were analytically determined on the basis of the moment theory from elution peak profiles measured by high-performance liquid chromatography (HPLC). The HPLC data were measured under the conditions that neither immobilization nor fluorescence labeling of solute and ligand molecules is required. These are the advantages of the moment analysis method for determining accurate values of KA, ka, and kd. Moment equations were developed on the basis of the Einstein equation for diffusion, the random walk model, and the general rate model of chromatography. The moment analysis method was applied to the inclusion complex formation system between dibenzo-18-crown-6 or dibenzo-15-crown-5 and alkali metal cations. It was demonstrated that the values of KA, ka, and kd can be determined on the assumption that the stoichiometry between crown ethers and cations is 1:1 or 2:1. The influence of the difference in the size between the inner cavity of crown ethers and cations on the association and dissociation of the inclusion complex was considered. The moment analysis method using HPLC is effective for analyzing intermolecular interactions from various perspectives because it is based on the separation technique and has different characteristics from other methods such as spectroscopy. The results of this study contribute to the dissemination of an opportunity for studying intermolecular interactions from equilibrium and kinetic points of view to many researchers because HPLC is widespread.