Predictors of lung function decline in adults with uncontrolled asthma with chronic obstructive pulmonary disease

Sanjay Mehta; A. Reddy; A. Mehta

doi:10.5281/zenodo.22815218

Authors

Sanjay Mehta Division of Respiratory Care, Amur Research Center for Respiratory Care Author https://orcid.org/4151-6714-8086-7056
A. Reddy Division of Respiratory Care, Amur Research Center for Respiratory Care Author https://orcid.org/4496-1570-5648-0650
A. Mehta Division of Respiratory Care, Thames Institute of Respiratory Care Author https://orcid.org/7057-2808-9728-6078

DOI:

https://doi.org/10.5281/zenodo.22815218

Keywords:

asthma-COPD overlap, lung function decline, FEV1 trajectory, eosinophilic inflammation, exacerbations

Abstract

Graphical abstract

Background: Patients whose airway disease combines features of asthma and COPD, termed asthma-COPD overlap, lose lung function faster and carry a heavier exacerbation burden than patients with either disease alone, yet the factors identifying which patients decline fastest remain incompletely defined.

Objective: This review synthesizes the published evidence on clinical, physiological, inflammatory, and behavioral predictors of accelerated lung function decline in adults with uncontrolled asthma coexisting with chronic obstructive pulmonary disease.

Methods: We reviewed longitudinal cohort studies, systematic reviews, and major society statements addressing overlap definitions, smoking exposure, airway inflammation, exacerbation frequency, childhood lung trajectories, and treatment-related determinants of FEV1 decline.

Findings: Continued smoking, low baseline FEV1, frequent exacerbations, eosinophilia, poor bronchodilator reversibility, and childhood asthma with reduced early-life lung trajectory each independently predict faster decline, while inhaled corticosteroid therapy and smoking cessation appear to slow it.

Conclusions: Predictors cluster into fixed early-life and modifiable adult-life domains; incorporating exacerbation history, eosinophil counts, and smoking status into routine assessment could help identify patients needing earlier, more intensive intervention.

References

Postma, D.S., Rabe, K.F. (2015) The Asthma-COPD Overlap Syndrome. New England Journal of Medicine, 373(13): 1241-1249. DOI: 10.1056/NEJMra1411863

Gibson, P.G., McDonald, V.M. (2015) Asthma-COPD overlap 2015: now we are six. Thorax, 70(7): 683-691. DOI: 10.1136/thoraxjnl-2014-206740

Global Initiative for Asthma, Global Initiative for Chronic Obstructive Lung Disease (2017) Diagnosis and Initial Treatment of Asthma, COPD and Asthma-COPD Overlap. GINA/GOLD Joint Report.

Menezes, A.M.B., Montes de Oca, M., Perez-Padilla, R., Nadeau, G., Wehrmeister, F.C., Lopez-Varela, M.V., et al. (2014) Increased risk of exacerbation and hospitalization in subjects with an overlap phenotype: COPD-asthma. Chest, 145(2): 297-304. DOI: 10.1378/chest.13-0622

Kauppi, P., Kupiainen, H., Lindqvist, A., Tammilehto, L., Kilpelainen, M., Kinnula, V.L., et al. (2011) Overlap syndrome of asthma and COPD predicts low quality of life. Journal of Asthma, 48(3): 279-285. DOI: 10.3109/02770903.2011.555035

Cosio, B.G., Soriano, J.B., Lopez-Campos, J.L., Calle-Rubio, M., Soler-Cataluna, J.J., de-Torres, J.P., et al. (2016) Defining the asthma-COPD overlap syndrome in a COPD cohort. Chest, 149(1): 45-52. DOI: 10.1378/chest.15-1055

Alshabanat, A., Zafari, Z., Albanyan, O., Dairi, M., FitzGerald, J.M. (2015) Asthma and COPD overlap syndrome (ACOS): a systematic review and meta analysis. PLoS ONE, 10(9): e0136065. DOI: 10.1371/journal.pone.0136065

Fletcher, C., Peto, R. (1977) The natural history of chronic airflow obstruction. British Medical Journal, 1(6077): 1645-1648. DOI: 10.1136/bmj.1.6077.1645

Lange, P., Celli, B., Agusti, A., Boje Jensen, G., Divo, M., Faner, R., et al. (2015) Lung-function trajectories leading to chronic obstructive pulmonary disease. New England Journal of Medicine, 373(2): 111-122. DOI: 10.1056/NEJMoa1411532

Barnes, P.J. (2016) Asthma-COPD overlap. Chest, 149(1): 7-8. DOI: 10.1016/j.chest.2015.08.017

Bui, D.S., Lodge, C.J., Burgess, J.A., Lowe, A.J., Perret, J., Bui, M.Q., et al. (2018) Childhood predictors of lung function trajectories and future COPD risk: a prospective cohort study from the first to the sixth decade of life. Lancet Respiratory Medicine, 6(7): 535-544. DOI: 10.1016/S2213-2600(18)30100-0

Tai, A., Tran, H., Roberts, M., Clarke, N., Wilson, J., Robertson, C.F. (2014) The association between childhood asthma and adult chronic obstructive pulmonary disease. Thorax, 69(9): 805-810. DOI: 10.1136/thoraxjnl-2013-204815

Silva, G.E., Sherrill, D.L., Guerra, S., Barbee, R.A. (2004) Asthma as a risk factor for COPD in a longitudinal study. Chest, 126(1): 59-65. DOI: 10.1378/chest.126.1.59

Perret, J.L., Dharmage, S.C., Matheson, M.C., Johns, D.P., Gurrin, L.C., Burgess, J.A., et al. (2013) The interplay between the effects of lifetime asthma, smoking, and atopy on fixed airflow obstruction in middle age. American Journal of Respiratory and Critical Care Medicine, 187(1): 42-48. DOI: 10.1164/rccm.201205-0788OC

James, A.L., Palmer, L.J., Kicic, E., Maxwell, P.S., Lagan, S.E., Ryan, G.F., et al. (2005) Decline in lung function in the Busselton Health Study: the effects of asthma and cigarette smoking. American Journal of Respiratory and Critical Care Medicine, 171(2): 109-114. DOI: 10.1164/rccm.200402-230OC

Anthonisen, N.R., Connett, J.E., Kiley, J.P., Altose, M.D., Bailey, W.C., Buist, A.S., et al. (1994) Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. The Lung Health Study. JAMA, 272(19): 1497-1505. DOI: 10.1001/jama.1994.03520190043033

Scanlon, P.D., Connett, J.E., Waller, L.A., Altose, M.D., Bailey, W.C., Buist, A.S., et al. (2000) Smoking cessation and lung function in mild-to-moderate chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine, 161(2): 381-390. DOI: 10.1164/ajrccm.161.2.9901044

Chalmers, G.W., Macleod, K.J., Little, S.A., Thomson, L.J., McSharry, C.P., Thomson, N.C. (2001) Influence of cigarette smoking on inhaled corticosteroid treatment in mild asthma. Thorax, 57(3): 226-230. DOI: 10.1136/thorax.57.3.226

Thomson, N.C. (2017) Asthma and smoking-induced airway disease without spirometric COPD. European Respiratory Journal, 49(5): 1602061. DOI: 10.1183/13993003.02061-2016

Kitaguchi, Y., Komatsu, Y., Fujimoto, K., Hanaoka, M., Kubo, K. (2012) Sputum eosinophilia can predict responsiveness to inhaled corticosteroid treatment in patients with overlap syndrome of COPD and asthma. International Journal of Chronic Obstructive Pulmonary Disease, 7: 283-289. DOI: 10.2147/COPD.S30651

Fu, J.J., Gibson, P.G., Simpson, J.L., McDonald, V.M. (2014) Systemic inflammation in older adults with asthma-COPD overlap syndrome. Allergy, Asthma and Immunology Research, 6(4): 316-324. DOI: 10.4168/aair.2014.6.4.316

Hardin, M., Silverman, E.K., Barr, R.G., Hansel, N.N., Schroeder, J.D., Make, B.J., et al. (2011) The clinical features of the overlap between COPD and asthma. Respiratory Research, 12: 127. DOI: 10.1186/1465-9921-12-127

Leung, J.M., Sin, D.D. (2017) Asthma-COPD overlap syndrome: pathogenesis, clinical features, and therapeutic targets. BMJ, 358: j3772. DOI: 10.1136/bmj.j3772

Rhee, C.K. (2015) Phenotype of asthma-chronic obstructive pulmonary disease overlap syndrome. Korean Journal of Internal Medicine, 30(4): 443-449. DOI: 10.3904/kjim.2015.30.4.443

Piorunek, T., Kostrzewska, M., Cofta, S., Batura-Gabryel, H., Andrzejczak, P. (2016) Exacerbation frequency and disease progression in overlapping asthma-COPD. Advances in Experimental Medicine and Biology, 921: 1-7. DOI: 10.1007/5584_2016_222

Kumbhare, S., Pleasants, R., Ohar, J.A., Strange, C. (2016) Characteristics and prevalence of asthma/chronic obstructive pulmonary disease overlap in the United States. Annals of the American Thoracic Society, 13(6): 803-810. DOI: 10.1513/AnnalsATS.201508-554OC

van Boven, J.F.M., Roman-Rodriguez, M., Palmer, J.F., Toledo-Pons, N., Cosio, B.G., Soriano, J.B. (2016) Comorbidome, pattern, and impact of asthma-COPD overlap syndrome in real life. Chest, 149(4): 1011-1020. DOI: 10.1016/j.chest.2015.12.002

Zeki, A.A., Schivo, M., Chan, A., Albertson, T.E., Louie, S. (2011) The asthma-COPD overlap syndrome: a common clinical problem in the elderly. Journal of Allergy, 2011: 861926. DOI: 10.1155/2011/861926

Barrecheguren, M., Esquinas, C., Miravitlles, M. (2015) The asthma-COPD overlap syndrome: opportunities and challenges. Current Opinion in Pulmonary Medicine, 21(1): 74-79. DOI: 10.1097/MCP.0000000000000118

Mannino, D.M., Gagnon, R.C., Petty, T.L., Lydick, E. (2000) Obstructive lung disease and low lung function in adults in the United States: data from the National Health and Nutrition Examination Survey, 1988-1994. Archives of Internal Medicine, 160(11): 1683-1689. DOI: 10.1001/archinte.160.11.1683

Brzostek, D., Kokot, M. (2014) Asthma-chronic obstructive pulmonary disease overlap syndrome in Poland. Findings of an epidemiological study. Postepy Dermatologii i Alergologii, 31(6): 372-379. DOI: 10.5114/pdia.2014.47121