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http://dx.doi.org/10.4046/trd.2017.0064

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

Park, Jisoo (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, CHA Bundang Medical Center CHA University)
Kim, Eun-Kyung (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, CHA Bundang Medical Center CHA University)
Kim, Mi-Ae (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, CHA Bundang Medical Center CHA University)
Kim, Tae-Hyung (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Hanyang University Guri Hospital)
Chang, Jung Hyun (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Ewha Womans University College of Medicine)
Ryu, Yon Ju (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Ewha Womans University College of Medicine)
Lee, Sei Won (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine)
Oh, Yeon-Mok (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine)
Yong, Suk Joong (Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine)
Choi, Won-Il (Department of Internal Medicine, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine)
Yoo, Kwang Ha (Department of Pulmonary and Critical Care Medicine, Konkuk University School of Medicine)
Lee, Ji-Hyun (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, CHA Bundang Medical Center CHA University)
Publication Information
Tuberculosis and Respiratory Diseases / v.81, no.4, 2018 , pp. 289-298 More about this Journal
Abstract
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.
Keywords
Asthma; Pulmonary Disease, Chronic Obstructive; Phenotype;
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