The clinical features of the overlap between COPD and asthma

Respiratory Research

Craig P Hersh²  James D Crapo³  Barry J Make³  Joyce D Schroeder³  Nadia N Hansel⁴  R Graham Barr¹  Edwin K Silverman²  Megan Hardin² 

[1] Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA;Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA;Division of Pulmonary Sciences and Critical Care Medicine, National Jewish Health, Denver, CO, USA;Department of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA

关键词: Gas-trapping;    Exacerbation;    emphysema;    Chronic obstructive pulmonary disease;    asthma;    Airway hyperresponsiveness;   

Others  :  796795
DOI  :  10.1186/1465-9921-12-127

 received in 2011-05-26, accepted in 2011-09-27,  发布年份 2011

【 摘 要 】

Background

The coexistence of COPD and asthma is widely recognized but has not been well described. This study characterizes clinical features, spirometry, and chest CT scans of smoking subjects with both COPD and asthma.

Methods

We performed a cross-sectional study comparing subjects with COPD and asthma to subjects with COPD alone in the COPDGene Study.

Results

119 (13%) of 915 subjects with COPD reported a history of physician-diagnosed asthma. These subjects were younger (61.3 vs 64.7 years old, p = 0.0001) with lower lifetime smoking intensity (43.7 vs 55.1 pack years, p = 0.0001). More African-Americans reported a history of asthma (33.6% vs 15.6%, p < 0.0001). Subjects with COPD and asthma demonstrated worse disease-related quality of life, were more likely to have had a severe COPD exacerbation in the past year, and were more likely to experience frequent exacerbations (OR 3.55 [2.19, 5.75], p < 0.0001). Subjects with COPD and asthma demonstrated greater gas-trapping on chest CT. There were no differences in spirometry or CT measurements of emphysema or airway wall thickness.

Conclusion

Subjects with COPD and asthma represent a relevant clinical population, with worse health-related quality of life. They experience more frequent and severe respiratory exacerbations despite younger age and reduced lifetime smoking history.

Trial registration

ClinicalTrials.gov: NCT00608764

【 授权许可】

   
2011 Hardin et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Minino AM, Xu J, Kochanek KD: Deaths: Preliminary data for 2008. National Vital Statistics Reports 2010, 59(2):1-71.
• [2]Mannino DM, Homa DM, Akinbami LJ, Ford ES, Ress SC: Chronic obstructive pulmonary disease surveillance - United States, 1971-2000. MMWR Surveill Summ 2002, 51:1-16.
• [3]Jemel A, Ward E, Hao Y, Thun M: Trends in the leading causes of death in the United States, 1970-2002. JAMA 2005, 294:1255-1259.
• [4][http://www.goldcopd.org] webciteFrom the Global Strategy for the Diagnosis, Management and Prevention of COPD. 2010. Global Initiative for Chronic Obstructive Lung Disease (GOLD)
• [5]Hersh CP, Jacobsen FL, Gill R, Silverman EK: Computed tomography phenotypes in severe, early-onset chronic obstructive pulmonary disease. COPD 2007, 4:331-337.
• [6]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.
• [7]Rijcken B, Schouten JP, XU X, Rosner B, Weiss ST: Airway hyperresponsiveness to histamine associated with accelerated decline in FEV1. Am J Respir Crit Care Med 1995, 151(5):1377-1382.
• [8]Tashkin DP, Altose MD, COnnett JE, Kanner RE, Lee WW, Wise RA: Methacholine reactivity predicts changes in lung function over time in smokers with early chronic obstructive pulmonary disease. The lung health study research group. Am J Respir Crit Care Med 1996, 153(6Pt1):1802-1811.
• [9]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(17):1194-1200.
• [10]Silva GE, Sherrill DL, Guerra S, Barbee RA: Asthma as a risk factor for COPD in a longitudinal study. Chest 2004, 126(1):59-65.
• [11]Hospers JJ, Postma DS, Jijcken B, Weiss ST, Schouten JP: Histamine airway hyper-responsiveness and mortality from chronic obstructive pulmonary disease: a cohort study. Lancet 2000, 356(9238):1313-1317.
• [12]Soriano JB, Visick GT, Muellerova H, Payvandi N, Hansell AL: Patterns of comorbidities in newly diagnosed COPD and asthma in primary care. Chest 2005, 128(4):2099-2107.
• [13]Shaya FT, Dongyi D, Akazawa MO, Blanchette CM, Wang J, Mapel DW, Dalal A, Scharf SM: Burden of concomitant Asthma and COPD in a medicaid population. Chest 2008, 134:14-19.
• [14]Kraft M: Asthma and chronic obstructive pulmonary disease exhibit common origins in any country! Am J Respir Crit Care Med 2006, 174(3):238-244.
• [15]Regan EA, Hokanson JE, Murphy JR, Make B, Lynch DA, Beaty TH, Curran-Everett D, Silverman EK, Crapo JD, the COPDGene Investigators: Genetic epidemiology of COPD (COPDGene) study design. COPD 2010, 7(1):32-43.
• [16]Jones PW, Quirk FH, Baveystock CM, Littlejohns P: A self-complete measure of health status for chronic airflow limitation. The St. George's Respiratory Questionnaire. Am Rev Respir Dis 1992, 145(6):1321-1327.
• [17]Celli BR, Cote CG, Marin JM, Casanova C, Montes de Oca M, Mendez RA, Pinto Plata V, Cabral HJ: The body-mass index, airflow obstruction, dyspnea, and exercise Capacity Index in Chronic Obstructive Pulmonary Disease. N Engl J Med 2004, 350:1005-1012.
• [18]Hurst JR, Vestbo J, Anzueto A: Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med 2010, 363(12):1128-1138.
• [19]American Thoracic Society: Standardization of spirometry, 1994 Update. Am J Respir Crit Care Med 1995, 152(3):1107-1136.
• [20]ATS Committee on Proficiency Standards for Clinical Pulmonary Funciton Laboratories: ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002, 166:111-117.
• [21]Nakano Y, Muller NL, King GG, Niimi A, Kalloger SE, Mishima M, Pare PD: Quantitative assessment of airway remodeling using high-resolution CT. Chest 2002, 122:271S-275S.
• [22]Hasegawa M, Nasuhara Y, Onodera Y, Makita H, Nagai K, Fuke S, Ito Y, Betsuyaku T, Nishimura M: Airflow limitation and airway dimensions in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2006, 173(12):1309-1315.
• [23]Hoffman EA, Gnanaprakasam D, Gupta KB, Hoford JD, Kugelmass SD, Kulawiec RS: VIDA: An Environment for multidimensional image display and analysis. SPIE Proc 1992, 1660:694-711.
• [24]Hankinson JL, Odencrantz JR, Fedan KB: Spirometric reference values from a sample of the general U.S. population. Am J Respir Crit Care Med 1999, 159(1):179-187.
• [25]Seemungal TA, Donaldson GC, Paul EA, Bestall JC, Jeffries DJ, Wedzicha JA: Effect of Exacerbation on Quality of Life in Patients with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 1998, 157(5pt1):1418-1422.
• [26]Soler-Cataluna JJ, Martinez-Garcia MA, Roman Sanchez P, Salcedo E, Navarro M, Ochando R: Severe Acute Exacerbations and Mortality in Patients with Chronic Obstructive Pulmonary Disease. Thorax 2005, 60(11):925-931.
• [27]Gono H, Fujimoto K, Kawakami S, Kubo K: Evaluation of Airway Wall Thickness and Air Trapping by HRCT in Asymptomatic Asthma. Eur Respir J 2003, 22(6):965-971.
• [28]Moorman JE, Zahran H, Truman BI, Molla MT: "MMWR; Current Asthma Prevalence: United States". MMWR 2011, 60(01):84-86.
• [29]Chapman KR, Tashkin DP, Pye DJ: Gender Bias in the Diagnosis of COPD. Chest 2001, 119:1691-1695.
• [30]Busse WW, Wanner A, Adams K, Reynolds HY, Castro M, Chowdhury B, Kraft M, Levine RJ, Peters SP, Sullivan EJ: Investigative Bronchoprovocation and Bronchoscopy in Airway Diseases. Am J Respir Crit Care Med 2005, 172:807-816.