The asthma-COPD overlap syndrome:how is it defined and what are its clinical implications?

It is increasingly recognized that both asthma and chronic obstructive pulmonary disease (COPD) are heterogeneous diseases with a large inter-individual variability with respect to their clinical expression, disease progression, and responsiveness to the available treatments. The introduction of asthma-COPD overlap syndrome (ACOS) may lead to a better clinical characterization and improved treatment of patients with obstructive airways disease. However, it is still in its early phase and several improvements will have to be made. First, a clear definition of ACOS and preferably also its sub-phenotypes, eg, asthma-ACOS and COPD-ACOS, is urgently needed. That would also allow researchers to design clinical studies in well-defined patients. The latter is important since the interpretation of clinical studies performed so far is hampered by the use of many different definitions of ACOS. Second, future studies are needed to investigate the role of state-of-the-art techniques such as computed tomography, genetics, and genomics in the phenotyping of patients with obstructive airways disease, ie, asthma, COPD, and ACOS. Third, longitudinal studies are now needed to better define the clinical implications of ACOS with respect to the long-term outcome and treatment of ACOS and its sub-phenotypes compared to only asthma or COPD.</p

Cardiac impact of inhaled therapy in the largest randomised placebo-controlled trial in COPD history

SUMMIT supports the efficiency and cardiovascular safety of LABA and ICS in COPD patients at cardiovascular risk http://ow.ly/p6Is300ffoc

Recent advances in chronic obstructive pulmonary disease pathogenesis : from disease mechanisms to precision medicine

Chronic obstructive pulmonary disease (COPD) is a devastating lung disease with a high personal and societal burden. Exposure to toxic particles and gases, including cigarette smoke, is the main risk factor for COPD. Together with smoking cessation, current treatment strategies of COPD aim to improve symptoms and prevent exacerbations, but there is no disease-modifying treatment. The biggest drawback of today's COPD treatment regimen is the 'one size fits all' pharmacological intervention, mainly based on disease severity and symptoms and not the individual's disease pathology. To halt the worrying increase in the burden of COPD, disease management needs to be advanced with a focus on personalized treatment. The main pathological feature of COPD includes a chronic and abnormal inflammatory response within the lungs, which results in airway and alveolar changes in the lung as reflected by (small) airways disease and emphysema. Here we discuss recent developments related to the abnormal inflammatory response, ECM and age-related changes, structural changes in the small airways and the role of sex-related differences, which are all relevant to explain the individual differences in the disease pathology of COPD and improve disease endotyping. Furthermore, we will discuss the most recent developments of new treatment strategies using biologicals to target specific pathological features or disease endotypes of COPD. (c) 2019 Authors. Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland

Is it difficult-to-treat asthma? Or another diagnosis?

BACKGROUND: When suspected of difficult-to-treat asthma, it is important to detect causal factors. Central airway malignancy should also be excluded in this group.CASE DESCRIPTION: We describe the case of a 23-year-old woman who came to the emergency room for shortness of breath and was subsequently admitted to the intensive care unit for respiratory failure, indicated by an asthma exacerbation. At an outpatient visit for dyspnea complaints, now with a stridor on physical examination, a chest CT was performed, which showed an occlusive lesion. Bronchoscopy turned out to be an endobronchial tumor. PA showed that it was a primary pulmonary myxoid sarcoma.CONCLUSION: The case above shows why it is important to consider rare pathologies, such as a central airway tumor, in asthma that is difficult to treat. A thorough history and physical examination is an important first step, especially the presence of a stridor.</p