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

Tuberculosis and Respiratory Diseases

article

Jisoo Park¹  Eun-Kyung Kim¹  Mi-Ae Kim¹  Tae-Hyung Kim²  Jung Hyun Chang³  Yon Ju Ryu³  Sei Won Lee⁴  Yeon-Mok Oh⁴  Suk Joong Yong⁵  Won-Il Choi⁶  Kwang Ha Yoo⁷  Ji-Hyun Lee¹ 

[1] Division of Pulmonary, Department of Internal Medicine, CHA Bundang Medical Center, CHA University;Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Hanyang University Guri Hospital;Division of Pulmonary and Critical Care Medicine, Department of Medicine, Ewha Womans University College of Medicine;Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine;Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine;Department of Internal Medicine, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine;Department of Pulmonary and Critical Care Medicine, Konkuk University School of Medicine

关键词: Asthma;    Pulmonary Disease;    Chronic Obstructive;    Phenotype;   

DOI  :  10.4046/trd.2017.0064

学科分类：医学（综合）

来源: The Korean Academy of Tuberculosis and Respiratory Diseases

【 摘 要 】

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.

【 授权许可】

CC BY-NC