Asthma and COPD "overlap": a treatable trait or common several treatable-traits?

Marques, João Gaspar; Lobato, Mariana; Pinto, Paula; Neuparth, Nuno; Carreiro‐Martins, Pedro

doi:10.23822/eurannaci.1764-1489.138

Cited by 12 publications

(14 citation statements)

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“…Moreover, Lin et al . detected decreased levels of ROBO2 and SLIT2 in chronic obstructive pulmonary disease (COPD) patients [ 58 ], a disease with underlying mechanisms shared with asthma [ 65 , 66 ].…”

Section: Discussionmentioning

confidence: 99%

Identification of ROBO2 as a Potential Locus Associated with Inhaled Corticosteroid Response in Childhood Asthma

Hernandez‐Pacheco

Gorenjak

et al. 2021

JPM

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Inhaled corticosteroids (ICS) are the most common asthma controller medication. An important contribution of genetic factors in ICS response has been evidenced. Here, we aimed to identify novel genetic markers involved in ICS response in asthma. A genome-wide association study (GWAS) of the change in lung function after 6 weeks of ICS treatment was performed in 166 asthma patients from the SLOVENIA study. Patients with an improvement in lung function ≥8% were considered as ICS responders. Suggestively associated variants (p-value ≤ 5 × 10−6) were evaluated in an independent study (n = 175). Validation of the association with asthma exacerbations despite ICS use was attempted in European (n = 2681) and admixed (n = 1347) populations. Variants previously associated with ICS response were also assessed for replication. As a result, the SNP rs1166980 from the ROBO2 gene was suggestively associated with the change in lung function (OR for G allele: 7.01, 95% CI: 3.29–14.93, p = 4.61 × 10−7), although this was not validated in CAMP. ROBO2 showed gene-level evidence of replication with asthma exacerbations despite ICS use in Europeans (minimum p-value = 1.44 × 10−5), but not in admixed individuals. The association of PDE10A-T with ICS response described by a previous study was validated. This study suggests that ROBO2 could be a potential novel locus for ICS response in Europeans.

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Section: Discussionmentioning

confidence: 99%

Identification of ROBO2 as a Potential Locus Associated with Inhaled Corticosteroid Response in Childhood Asthma

Hernandez‐Pacheco

Gorenjak

et al. 2021

JPM

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“… 29 Since ACO is characterized by low lung function, more suitable methods are required for different inhalers with distinct drug administration effects as a “treatable traits” option for patients with ACO. 7–11 Therefore, we conducted the present pilot study and clearly showed a beneficial effect of TIO add-on therapy via SMI to FP/FM via pMDI in patients with ACO, indicating the clinical efficacy of TIO add-on therapy to FP/FM as a “treatable traits” option for this phenotype.…”

Section: Discussionmentioning

confidence: 63%

“…Recently, the “treatable traits” strategy for patients with chronic inflammatory airway diseases, especially asthma and COPD, has been a focus of attention, because this clinically important approach implements precision and personalized medicine on the basis of genetic, biomarker, phenotypic, or psychosocial characteristics that distinguish a given patient from other patients with similar clinical presentations. 5 , 7 , 27 , 28 In the last decade, ACO has also been a focus of interest, because patients with ACO exhibit more rapid disease progression, worse health-related quality of life, more frequent respiratory exacerbation, decreased lung functions, increased comorbidities, and higher healthcare utilization than patients with asthma or COPD alone. 9–11 , 16 Therefore, ACO is an important phenotype involving both asthma and COPD.…”

Section: Discussionmentioning

confidence: 99%

“… 29 We therefore consider that TIO via SMI is a suitable potent bronchodilator agent in patients with ACO characterized by low lung functions. 7–11 …”

Section: Discussionmentioning

confidence: 99%

“…6 Recently, the “treatable traits” approach for chronic airway obstruction, mainly asthma and chronic obstructive pulmonary disease (COPD), has been a focus of interest, because personalized and precision medicine is important for these disease entities. 7 Asthma-COPD overlap (ACO) has also been a focus of interest, because this disease entity has an important phenotype involving both asthma and COPD and patients with ACO have worse health-related quality of life, more rapid disease progression, increased comorbidities, and greater healthcare utilization, conferring a greater socioeconomic burden than patients with asthma or COPD alone. 8–11 Therefore, it is important to determine a suitable treatment approach for ACO.…”

Section: Introductionmentioning

confidence: 99%

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Tiotropium Add-On and Treatable Traits in Asthma-COPD Overlap: A Real-World Pilot Study

Ishiura¹,

Fujimura²,

Ohkura³

et al. 2022

JAA

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Purpose The ‘treatable traits’ strategy for patients with chronic inflammatory airway diseases, especially asthma and chronic obstructive pulmonary disease (COPD), is a focus of interest, because it implements precision and personalized medicine. Asthma-COPD overlap (ACO), a phenotype involving both asthma and COPD, is an important disease entity because patients with ACO have significantly worse outcomes, conferring greater economical and social burdens. Some guidelines for ACO recommend add-on therapy of long-acting muscarinic antagonists to inhaled corticosteroids and long-acting β 2 agonists. However, this approach is based on extrapolation from patients with asthma or COPD alone. Consequently, a ‘treatable traits’ approach suitable for ACO remains obscure. Methods A 12-week open-label cross-over pilot study was conducted in patients with ACO to investigate the effect of tiotropium bromide (TIO) 5 µg/day add-on therapy to fluticasone propionate/formoterol fumarate (FP/FM) 500/20 µg/day compared with FP/FM 500/20 µg/day alone. A 4-week run-in period and two 4-week treatment periods were included. Results A total of 18 male patients with stable ACO participated in this pilot study. All patients were ex-smokers. Mean values ± standard deviation (SD) for forced expiratory volume in 1 second (FEV 1 ) were 1.21 ± 0.49 L after the run-in period, 1.20 ± 0.51 L after the FP/FM combination therapy period, and 1.30 ± 0.48 L after the TIO add-on therapy to FP/FM period. FEV 1 values after the TIO add-on therapy FP/FM period were significantly higher than those after the run-in period ( p < 0.01). Conclusion TIO add-on therapy to FP/FM in patients with ACO, considered difficult to treat because of the presence of both asthma and COPD, resulted in improvements in lung function parameters in this real-world pilot study, indicating the potential value of TIO add-on therapy as a “treatable traits” option for standard treatment for ACO.

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Asthma and Chronic Obstructive Pulmonary Disease Overlap According to the Japanese Respiratory Society Diagnostic Criteria: The Prospective, Observational ACO Japan Cohort Study

et al. 2020

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Introduction Patients with asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) present with chronic respiratory symptoms with features of both asthma and COPD. New ACO diagnostic criteria (2018) were suggested by the Japanese Respiratory Society (JRS). This prospective, multicenter, observational cohort study was conducted to investigate the proportion of patients who meet the JRS ACO diagnostic criteria among COPD patients in clinical practice. Methods This 2-year ongoing study enrolled consecutive outpatients aged ≥ 40 years with COPD who visited one of 27 Japanese centers at which the medical examinations/tests required for ACO diagnosis were routinely conducted. At registration, the proportion of ACO or non-ACO patients was determined using the JRS diagnostic criteria, and the characteristics of the two groups were compared using analysis of variance and chi-square test. Results Of 708 COPD patients analyzed at registration, 396 (55.9%) had the data necessary for ACO diagnosis to be conducted, and 312 (44.1%) were lacking these data. Of the 396 patients who had the data necessary for ACO diagnosis, 101 (25.5%) met the diagnostic criteria for ACO, and 295 (74.5%) did not (non-ACO patients). ACO patients were younger, had a greater rate of asthma based on a physician’s diagnosis, and used more medications, including inhaled corticosteroids ( p < 0.05), compared with non-ACO patients. Conclusions We have determined the proportion of patients with the data necessary to diagnose ACO using the JRS criteria, and the proportion of these who met the ACO criteria among the COPD population at the time of registration. Patients, including those lacking necessary examination/test data at registration, will continue to undergo follow-up to explore changes in their testing and ACO diagnostic status over time. Analyses of study data over 2 years will provide relevant information on the ACO symptoms, clinical course, and real-world treatment patterns. Trial registration ClinicalTrials.gov identifier, NCT03577795. Electronic supplementary material The online version of this article (10.1007/s12325-020-01573-x) contains supplementary material, which is available to authorized users.

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Asthma and COPD "overlap": a treatable trait or common several treatable-traits?

Cited by 12 publications

References 0 publications

Identification of ROBO2 as a Potential Locus Associated with Inhaled Corticosteroid Response in Childhood Asthma

Identification of ROBO2 as a Potential Locus Associated with Inhaled Corticosteroid Response in Childhood Asthma

Tiotropium Add-On and Treatable Traits in Asthma-COPD Overlap: A Real-World Pilot Study

Asthma and Chronic Obstructive Pulmonary Disease Overlap According to the Japanese Respiratory Society Diagnostic Criteria: The Prospective, Observational ACO Japan Cohort Study

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