Smoking history and emphysema in asthma–COPD overlap

Abstract

BackgroundEmphysema is a distinct feature for classifying COPD, and smoking history (≥10 pack-years) is one of several newly proposed criteria for asthma–COPD overlap (ACO). We studied whether or not a smoking history (≥10 pack-years) and emphysema are useful markers for classifying ACO and differentiating it from asthma with chronic airflow obstruction (CAO).MethodsWe retrospectively studied the mortalities and frequencies of exacerbation in 256 consecutive patients with ACO (161 with emphysema and 95 without emphysema) who had ≥10 pack-years smoking history, 64 asthma patients with CAO but less of a smoking history (<10 pack-years) and 537 consecutive patients with COPD (452 with emphysema and 85 without emphysema) from 2000 to 2016. In the patients with emergent admission, the causes were classified into COPD exacerbation, asthma attack, and others.ResultsNo asthma patients with CAO had emphysema according to computed tomography findings. The prognoses were significantly better in patients with asthma and CAO than in those with ACO and COPD and better in those with ACO than in those with COPD. In both ACO and COPD patients, the prognoses were better in patients without emphysema than in those with it (P=0.027 and P=0.023, respectively). The frequencies of emergent admission were higher in COPD patients than in ACO patients, and higher in patients with emphysema than in patients without emphysema. ACO/emphysema (+) patients experienced more frequent admission due to COPD exacerbation (P<0.001), while ACO/emphysema (−) patients experienced more frequent admission due to asthma attack (P=0.014).ConclusionA smoking history (≥10 pack-years) was found to be a useful marker for differentiating ACO and asthma with CAO, and emphysema was a useful marker for classifying ACO. These markers are useful for predicting the overall survival and frequency of exacerbation.

Documento de consenso sobre asma y tabaquismo del Foro Autonómico de Asma de la SEPAR

“…Se ha evaluado la mortalidad y la frecuencia de exacerbaciones en pacientes con ACO comparado con pacientes con asma y obstrucción al flujo aéreo y pacientes con EPOC (Kurashima et al, 2017). Como resultado, se obtuvo un mejor pronóstico en pacientes con asma y obstrucción al flujo aéreo que en pacientes con ACO y pacientes con EPOC, siendo mejor en pacientes ACO que en pacientes con EPOC.…”

Common manifestation of airway diseases: chronic obstructive pulmonary disease and asthma bronchiale

“…Clinical symptoms can hardly differentiate COPD and asthma bronchial. [1][2][3][4][5][6][7][8] Significant smoking anamnesis can support COPD origin, but some asthma bronchialetic patients are smoker, also. 9 Most of the asthma bronchialetic patients have paroxismatic dyspnoic wheezing in the early morning or after exercise.…”

“…9 Most of the asthma bronchialetic patients have paroxismatic dyspnoic wheezing in the early morning or after exercise. [1][2][3][4][5][6][7][8][9] In COPD, the dyspnoea is progressive and it is manifested during exercise at first. Hey fever with obstructive pulmonary disease support the definition of allergic asthma bronchiale bronchiale, but there is a significant portion of COPD patients with hey fever as co-morbidity.…”

“…10 Asthma bronchiale and COPD together show similar clinical feature as asthma bronchiale. [1][2][3][4][5][6][7][8] Lung function is crucial for differentiation. In asthma bronchiale, most of the cases have reversible airway obstruction, lung function goes to normal values.…”

A retrospective study of smoking cessation intervention among university students

“…[ 1 ] It is one of the most important preventable factors of ill health and death. [ 2 , 3 ] It has been reported that tobacco can increase the incidence of respiratory symptoms and cardiovascular diseases. [ 4 – 6 ] Specifically, as for men, it can increase the risk of erectile dysfunction.…”