Tuberculosis and Respiratory Diseases

  • 제81권4호
  • /
  • Pages.289-298
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  • 2018
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  • 1738-3536(pISSN)
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  • 2005-6184(eISSN)
대한결핵및호흡기학회 (The Korean Academy of Tuberculosis and Respiratory Diseases)
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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)
  • 투고 : 2017.05.23
  • 심사 : 2018.01.02
  • 발행 : 2018.10.31
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초록

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.

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