American Thoracic Society/National Heart, Lung, and Blood Institute Asthma–Chronic Obstructive Pulmonary Disease Overlap Workshop Report

Woodruff, Prescott G.; Berge, Maarten van den; Boucher, Richard C.; Brightling, Christopher E.; Burchard, Esteban G.; Christenson, Stephanie A.; Han, MeiLan K.; Holtzman, Michael J.; Kraft, Monica; Lynch, David A.; Martínez, Fernando D.; Reddel, Helen K.; Sin, Don D.; Washko, George R.; Wenzel, Sally E.; Punturieri, Antonello; Freemer, Michelle; Wise, Robert A.

doi:10.1164/rccm.201705-0973ws

Cited by 92 publications

(78 citation statements)

References 62 publications

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“…It is well known that a differential diagnosis of asthma from COPD is clinically difficult at times, which may lead to an overlap of these disorders. In some patients with chronic asthma, a distinct diagnosis of COPD is not possible even using the current physiological testing and imaging techniques, and it is possible that asthma and COPD may coexist 1,34…”

Section: Discussionmentioning

confidence: 99%

COPD uncovered: a cross-sectional study to assess the socioeconomic burden of COPD in Japan

Igarashi¹,

Fukuchi²,

Hirata³

et al. 2018

COPD

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BackgroundCOPD remains a major health problem in Japan. Patients with COPD experience a reduced quality of life (QoL) and have a higher chance of work impairment and productivity loss. However, there is a lack of data on the impact of COPD in terms of QoL and work activity impairment in Japan. This study assessed the socioeconomic burden of COPD in Japan and the impact it may have on the working age population.Patients and methodsThis was a 2-year retrospective chart review in COPD patients aged ≥40 years, with at least one health care visit to clinic or hospital in the previous 12 months. Patients were required to have available medical charts for at least the previous 24 months. Symptoms were assessed using COPD assessment test score; EuroQoL Group 5 Dimension (EQ-5D-5L) and work productivity and activity impairment general health questionnaires were used to evaluate health-related QoL and work productivity, and health care resource utilization data were obtained from clinical charts.ResultsIn total, 71 patients aged <65 years, and 151 patients aged ≥65 years were included; the majority of patients had moderate or severe airflow limitation. Exacerbations (moderate or severe) were reported by ~35% of patients in both age groups; 52.1% and 62.9% of patients in the <65-year and ≥65-year age groups had COPD assessment test scores ≥10. EQ-5D-5L index scores in the <65-year and ≥65-year age groups were 0.79 and 0.77, respectively. Work productivity and activity impairment scores were higher in <65-year age group. Annual costs of health care resource use per patient in the <65-year and ≥65-year age groups were ¥438,975 (US$4,389) and ¥467,871 (US$4,678), respectively. Costs due to productivity loss were estimated to be ¥5,287,024 (US$52,870) in the <65-year age group and ¥3,018,974 (US$30,187) in the ≥65-year age group.ConclusionCOPD represents a significant socioeconomic burden in Japan. Patients with COPD report significant use of health care resources. Higher impact on work impairment and productivity loss was observed frequently in the working age population.

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Section: Discussionmentioning

confidence: 99%

COPD uncovered: a cross-sectional study to assess the socioeconomic burden of COPD in Japan

Igarashi¹,

Fukuchi²,

Hirata³

et al. 2018

COPD

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“…Self-monitoring of lung function by measuring the peak expiratory flow (PEF) and forced expiratory volume in one second (FEV1) is often recommended for children and adults with persistent asthma [8]. These lung function parameters are indicators of airflow obstruction and provide useful information about the patient's asthma severity [9] .…”

Section: Introductionmentioning

confidence: 99%

A Review of Portable Electronic Spirometers: Implications for Asthma Self-Management

Carpenter

Jurdi

Roberts

et al. 2018

Curr Allergy Asthma Rep

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All devices (N = 16) allowed for monitoring of basic lung function parameters, but only 31% provided in-app videos on how to perform breathing maneuvers. Most devices (63%) provided graphical representations of lung function results, but only 44% gave immediate feedback on the quality of the breathing maneuver. Several devices (25%) were FDA-approved and cost ranged from US$99 to $1390. Information on data security (63%), measurement accuracy (50%), and association with patient outcomes (0%) was commonly limited. This review found that providers' ability to make informed decisions about whether asthma patients may benefit from portable electronic spirometers is limited due to lack of patient outcome data.

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“…In this study, we also aimed to define the relationship of STAT1 function and any change in acute illness to the development of chronic lung disease as a model of viral induction, exacerbation, and/or progression of the chronic airway disease. As noted above, this issue is particularly relevant to the viruslinked airway disease found in humans with asthma, COPD, or asthma-COPD overlap syndrome (32,33). Accordingly, we focused on the cardinal features of this type of disease (i.e., airway inflammation [marked by immune cell infiltration], mucus production, [marked by mucin Muc5ac expression], hyperreactivity [marked by baseline and methacholine-induced lung resistance], and fibrosis [marked by trichrome staining] as relevant endpoints that might develop as a consequence of viral infection).…”

mentioning

confidence: 99%

Respiratory Enterovirus (like Parainfluenza Virus) Can Cause Chronic Lung Disease if Protection by Airway Epithelial STAT1 Is Lost

Zhang

Mao

Keeler

et al. 2019

The Journal of Immunology

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Epithelial barrier cells are proposed to be critical for host defense, and airway epithelial cell capacity for IFN signal transduction is presumed to protect against respiratory viral infection. However, it has been difficult to fully test these concepts given the absence of tools to analyze IFN signaling specific to airway epithelial cells in vivo. To address these issues, we generated a new line of transgenic mice with Cre-driver genes (Foxj1 and Scgb1a1) for a floxed-Stat1 allele (designated Foxj1-Scgb1a1-Cre-Stat1f/f mice) to target the master IFN signal regulator STAT1 in airway epithelial cells and tested these mice for control of infection because of mouse parainfluenza (Sendai) virus and human enterovirus D68 (EV-D68). Indeed, both types of infections showed increases in viral titers and severity of acute illness in Foxj1-Scgb1a1-Cre-Stat1f/f mice and conventional Stat1−/− mice compared with wild-type mice. In concert, the chronic lung disease that develops after Sendai virus infection was also increased in Foxj1-Scgb1a1-Cre-Stat1f/f and Stat1–/– mice, marked by airway and adjacent parenchymal immune cell infiltration and mucus production for at least 7 wk postinfection. Unexpectedly, relatively mild EV-D68 infection also progressed to chronic lung disease in Foxj1-Scgb1a1-Cre-Stat1f/f and Stat1−/− mice but was limited (like viral replication) to airways. The results thereby provide proof-of-concept for a critical role of barrier epithelial cells in protection from acute illness and chronic disease after viral infection and suggest a specific role for airway epithelial cells given the limitation of EV-D68 replication and acute and chronic manifestations of disease primarily to airway tissue.

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American Thoracic Society/National Heart, Lung, and Blood Institute Asthma–Chronic Obstructive Pulmonary Disease Overlap Workshop Report

Cited by 92 publications

References 62 publications

COPD uncovered: a cross-sectional study to assess the socioeconomic burden of COPD in Japan

COPD uncovered: a cross-sectional study to assess the socioeconomic burden of COPD in Japan

A Review of Portable Electronic Spirometers: Implications for Asthma Self-Management

Respiratory Enterovirus (like Parainfluenza Virus) Can Cause Chronic Lung Disease if Protection by Airway Epithelial STAT1 Is Lost

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