Keiji Kimura

Biomarker-based detection of asthma–COPD overlap syndrome in COPD populations

Asthma–chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) was proposed by the science committees of both Global Initiative for Asthma (GINA) and Global Initiative for Chronic Obstructive Lung Disease (GOLD). However, the definition of ACOS has remained unclear all over the world, and the prevalence rate of ACOS is basically dependent on the patient’s symptoms or the physician’s opinion, based on questionnaire testing. In the current case report, we investigated the prevalence rate of COPD patients with high levels of fractional exhaled nitric oxide (FENO) or immunoglobulin E (IgE) as candidate markers of ACOS in COPD, as a multicenter, cross-sectional study. Outpatients with COPD were enrolled from Tohoku University Hospital, Sendai, Japan, and five hospitals (Tohoku University Hospital, Sendai, Japan; NTT East Tohoku Hospital, Sendai, Japan; Wakayama Medical University Hospital, Kimiidera, Japan; Hiraka General Hospital, Yokote, Japan; Iwate Prefectural Isawa Hospital, Oshu, Japan) with pulmonary physicians from March 1, 2013 to February 28, 2014. When they were estimated using 35 ppb as the cutoff value of FENO, the prevalence rate of ACOS was 16.3% in COPD. When estimated by both FENO and IgE, the high-FENO/high-IgE group was 7.8% in COPD. To the best of our knowledge, this study is the first to detect the prevalence rate of ACOS in COPD populations by using objective biomarkers. The results from the current study should be useful to identify the subgroup requiring early intervention by inhaled corticosteroids/long-acting beta agonist combination in COPD in order to improve the long-term management for ACOS.

Coexisting COPD in elderly asthma with fixed airflow limitation: assessment by DLco %predicted and HRCT

ABSTRACT Background: Asthma patients with fixed airflow limitation (FL) are theoretically classified into two phenotypes, that is, coexisting chronic obstructive pulmonary disease (COPD) and asthmatic airway remodeling. However, the precise percentages of such patients are not known. Objective: To assess the prevalence of patients with both FL and COPD components in elderly asthma. Methods: We evaluated patients by lung diffusion impairment and emphysematous findings in high-resolution computed tomography (HRCT) as candidates for COPD components, as a multicenter, cross-sectional survey. Asthma outpatients ≥ 50 years of age were enrolled from Tohoku University Hospital, Sendai, Japan, and four hospitals (Tohoku Medical and Pharmaceutical University Wakabayashi Hospital, Sendai, JAPAN; Wakayama Medical University Hospital, Kimiidera, Japan; Hiraka General Hospital, Yokote, Japan; Iwate Prefectural Isawa Hospital, Oshu, Japan) with pulmonary physicians from March 1, 2013 to November 30, 2014. Results: The prevalence of patients with FEV1/FVC <70% was 31.0% of those in their 50s, 40.2% of those in their 60s and 61.9% of those in their 70s or older. The prevalence of those patients with lung diffusion impairment (i.e. the percent predicted values of diffusing capacity of the lung for carbon monoxide (DLco %predicted) <80%) or emphysematous findings in HRCT (i.e. the appearance of low attenuation area (LAA)) was 18.3% of those in their 50s, 13.8% of those in their 60s and 35.7% of those in their 70s or older. Conclusions: Nearly half of the patients with FL in elderly asthma show coexisting COPD components when assessed by DLco %predicted and LAA in HRCT.

Stratifying the risk of COPD exacerbation using the modified Medical Research Council scale: A multicenter cross-sectional CAP study

1016/j.resinv.2014.10.006 he Japanese Respiratory Society. Published by Else of Internal Medicine, Wakayama Medical Universit n; c National Hospital Organization Wakayama Hos raduate School of Medicine, Japan; f Kamei Respirator al, Japan; i NTT East Tohoku Hospital, Japan; j Hirosh spital, Japan; l Minami Tokushima Clinic, Japan; m Hir n; o Tohoku Rosai Hospital, Japan. uthor. Tel.: þ81 73 441 0619; fax: þ81 73 447 2201. kazmatsu@wakayama-med.ac.jp (K. Matsunaga) a-med.ac.jp (K. Akamatsu), tsuna@wakayama-m .pikara.ne.jp (T. Kamei), tsudat@k-you.or.jp (T. Ts i@east.ntt.co.jp (T. Takahashi), hozawa@vesta.ocn ikara.ne.jp (Y. Sakamoto), hrkjmsom@air.ocn.ne.j izusawa.iwate.jp (U. Katsumata), mmiura@tohok hoku.ac.jp (M. Ichinose). by physicians is limited [3], and there is a need for a simple assessment tool that can be used in everyday practice [4]. The modified Medical Research Council (mMRC) scale is a wellvalidated questionnaire that uses a simple grading system to quantify disability associated with breathlessness [5], and current guidelines advocate the use of this scale to assess