Asthma-like Features and Clinical Course of Chronic Obstructive Pulmonary Disease. An Analysis from the Hokkaido COPD Cohort Study.

Abstract

RATIONALE:

Some patients with chronic obstructive pulmonary disease (COPD) have asthma-like features, such as significant bronchodilator reversibility, blood eosinophilia, and/or atopy, even if they are not clinically diagnosed as having asthma. However, the clinical significance of asthma-like features overlapping with COPD remains unclear.

OBJECTIVES:

The aim of this study was to assess the effect of asthma-like features on the clinical course of patients with COPD who were adequately treated and followed-up over 10 years.

METHODS:

A total of 268 patients with COPD who had been clinically considered as not having asthma by respiratory specialists were included in this study. The asthma-like features included in this study were bronchodilator reversibility (ΔFEV1, ≥12% and ≥200 ml), blood eosinophilia (≥300 cells/μl), and atopy (positive specific IgE for any inhaled antigen). The annual changes in post-bronchodilator FEV1 and COPD exacerbations were monitored during the first 5 years, and mortality was followed during the entire 10 years of the study.

MEASUREMENTS AND MAIN RESULTS:

Fifty-seven subjects (21%) had bronchodilator reversibility, 52 (19%) had blood eosinophilia, and 67 (25%) had atopy. Subjects with blood eosinophilia had significantly slower annual post-bronchodilator FEV1 decline; bronchodilator reversibility and atopy did not affect the annual post-bronchodilator FEV1 decline, and none of the asthma-like features was associated with development of COPD exacerbation. Even if subjects had two or more asthma-like features, they displayed annual post-bronchodilator FEV1 declines and exacerbation rates similar to those of subjects with one or zero asthma-like features, as well as a lower 10-year mortality rate (P = 0.02).

CONCLUSIONS:

The presence of asthma-like features was associated with better clinical course in patients with COPD receiving appropriate treatment.

• Authors: Masaru Suzuki, Hironi Makita, Satoshi Konno, Kaoruko Shimizu, Hiroki Kimura, Hirokazu Kimura, Masaharu Nishimura, Hokkaido COPD Cohort Study Investigators
• Journal: American journal of respiratory and critical care medicine (Am J Respir Crit Care Med) Vol. 194 Issue 11 Pg. 1358-1365 (12 01 2016) ISSN: 1535-4970 [Electronic] United States
• PMID: 27224255 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Asthma (complications, physiopathology)
• Cohort Studies
• Eosinophilia (blood, physiopathology)
• Female
• Follow-Up Studies
• Forced Expiratory Volume (physiology)
• Humans
• Japan
• Male
• Pulmonary Disease, Chronic Obstructive (complications, physiopathology)
• Syndrome