Understanding the pathophysiology of the asthma-chronic obstructive pulmonary disease overlap syndrome

被引:14
作者
Gelb, Arthur F. [1 ,2 ]
Christenson, Stephanie A. [3 ,4 ]
Nadel, Jay A. [4 ,5 ,6 ,7 ]
机构
[1] Lakewood Reg Med Ctr, Dept Med, Div Pulm, Lakewood, CA USA
[2] Univ Calif Los Angeles, Geffen Sch Med, Med Ctr, 3650 E South St,Suite 308 Lakewood, Los Angeles, CA 90712 USA
[3] Univ Calif San Francisco, Dept Med, Div Pulm Crit Care Allergy & Sleep, San Francisco, CA USA
[4] Univ Calif San Francisco, Cardiovasc Res Inst, San Francisco, CA USA
[5] Univ Calif San Francisco, Dept Med, San Francisco, CA USA
[6] Univ Calif San Francisco, Dept Physiol, Box 0444, San Francisco, CA USA
[7] Univ Calif San Francisco, Dept Radiol, San Francisco, CA USA
关键词
asthma; asthma-chronic obstructive pulmonary disease overlap syndrome; emphysema; RANDOMIZED CONTROLLED-TRIAL; SHORT-TERM RESPONSE; COPD OVERLAP; SPUTUM-EOSINOPHILIA; DUTCH HYPOTHESIS; FATAL ASTHMA; ALVEOLAR ATTACHMENTS; ELASTIC RECOIL; LUNG; EMPHYSEMA;
D O I
10.1097/MCP.0000000000000236
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
Purpose of reviewThe review will provide an update on the pathophysiology and studies of inflammation associated with the asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) and the mechanism(s) responsible for persistent expiratory airflow limitation in never-smoked asthma patients who develop loss of lung elastic recoil consistent with an asthma-COPD clinical phenotype (ACOS in nonsmokers).Recent findingsPatients with a clinical diagnosis of ACOS have more frequent respiratory exacerbations and hospitalizations than COPD patients without ACOS. ACOS patients should be treated with inhaled corticosteroids, short and long-acting (2)-agonist, and long-acting muscarinic receptor antagonist. Biomarker work suggests that a molecular phenotype of ACOS (e.g., elevated markers of eosinophilic or type 2 inflammation) incompletely corresponds to clinical phenotypes. Recently, we reported sentinel observation of unsuspected mild diffuse centrilobular emphysema in never-smoked asthma patients at autopsy, despite mild changes in lung computed tomography and normal diffusing capacity.SummaryRecent studies have shown that subgroups of COPD and asthma patients may have overlapping immune responses. Never-smoked asthma patients may have persistent expiratory airflow limitation because of loss of lung elastic recoil. This may be because of unsuspected centrilobular emphysema detected at autopsy, and not easily diagnosed on lung computed tomography and diffusing capacity.
引用
收藏
页码:100 / 105
页数:6
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