Differences between asthma–COPD overlap syndrome and adult-onset asthma

Abstract

Differences between asthma-COPD overlap syndrome (ACOS) and adult-onset asthma are poorly understood. This study aimed to evaluate these differences in a clinical cohort of patients with adult-onset asthma, as a part of the Seinäjoki Adult Asthma Study (SAAS).188 patients were diagnosed with adult-onset asthma and re-evaluated 12 years after diagnosis. They were divided into three groups based on smoking history and post bronchodilator spirometry values: 1) never- and ex-smokers with <10 smoked pack-years; 2) non-obstructive (forced expiratory volume in 1 s (FEV)/forced vital capacity (FVC) ≥0.7) patients with ≥10 pack-years; and 3) ACOS patients with ≥10 pack-years and FEV/FVC <0.7.ACOS patients had lower diffusing capacity (/V 86% predicted 98 or 96% predicted; p<0.001), higher blood neutrophil levels (4.50 3.60 or 3.85×10 L; p=0.008), and higher IL-6 levels (2.88 1.52 or 2.10 pg·mL, p<0.001) as compared to never- and ex-smokers with <10 pack-years, or non-obstructive patients with ≥10 pack-years smoking history, respectively. ACOS patients also showed reduced lung function, higher remaining bronchial reversibility and a higher number of comorbidities.This study shows distinct differences in diffusing capacity, blood neutrophil and IL-6 levels, bronchial reversibility, lung function and comorbidities between ACOS and adult-onset asthma. The present findings should be considered in the comprehensive assessment of adult asthma patients.

Daily physical activity and lung function decline in adult-onset asthma: a 12-year follow-up study

“…The patients were treated and monitored according to Finnish Asthma Program guidelines [19] either in the specialized care or in primary care. The collection of research data has been previously reported [7,9,10,20]. At diagnosis, data was collected on lung function, blood eosinophils, the initial pharmacotherapy, and asthma symptoms by Airways Questionnaire 20 (AQ20) [21].…”

“…Since the concept of adult-onset phenotypes is rather new, only few studies exist on it and there is no clear consensus on the best therapy for these patients. Occasionally, adult-onset asthma may also be difficult to distinguish from chronic obstructive pulmonary disease (COPD) due to the overlap of symptoms and risk factors [10]. …”

Nordic consensus statement on the systematic assessment and management of possible severe asthma in adults

“…However, it is also important to recognize that smoking per se does not preclude a diagnosis of asthma, and fixed airflow obstruction in severe asthma is not synonymous with COPD. Importantly, asthma patients who develop COPD appear to have a better prognosis than COPD patients without pre-existing asthma [50,51]. …”

Inhaled corticosteroids and asthma control in adult-onset asthma: 12-year follow-up study

“…Patients were followed up for 12 years (mean 12.2 years, range 10.8-13.9 years) after the diagnostic visit. From the original cohort of 257 patients, 203 returned to the 12-year control visit in which asthma status, medication, control, and lung function were evaluated [8,[23][24][25]. Asthma-related visits [24] and medication information were collected from the whole 12-year follow-up period from medical records ( Fig.…”