Clinical, functional and biomarkers criteria for the diagnosis of asthma-chronic obstructive pulmonary diseases overlap (ACO)

master's thesis

• Title (croatian): Klinički, funkcijski i biomarkerski kriteriji dijagnoze astme i kronične opstruktivne plućne bolesti
• Author: Lilach Yael Ben Porath
• Mentor: Sanja Popović-Grle (mentor)
• Committee member: Sanja Popović-Grle (predsjednik povjerenstva)
• Committee member: Andrea Vukić Dugac (član povjerenstva)
• Committee member: Marko Jakopović (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2021-07-16, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Asthma and chronic obstructive pulmonary disease (COPD) are two very common chronic lung diseases in the general population and are traditionally viewed as two distinct disease entities that can be easily differentiated by clinicians in the majority of cases. Both of them are characterized by a combination of multifactorial inflammatory processes and airway obstruction. In both diseases, the complexity of inflammatory processes affects the variable response to the given treatment among and scientific community, there is no doubt that despite the similarity between the two diseases and their affiliation with the group of obstructive lung diseases, the asthma treatment is different from COPD since the bronchoconstriction is usually reversible in asthma when on the other hand, COPD is characterized by progressive deterioration toward constant obstruction. Lack of distinction between these two diseases can lead to incorrect treatment that may even cause harm. In recent years, the understanding has begun to form that there is a significant overlap in both the pathological and functional aspects of asthma and COPD, especially among the elderly population where characteristics of the two diseases can be found simultaneously and thus the concept of Asthma COPD overlap (ACO) was born as a new diagnosis. ACO patients have been shown to experience higher rates of exacerbations, higher healthcare utilization, and worse health-related quality of life but unfortunately, the systematic exclusion of patients who did not meet the criteria for pure asthma or COPD from the clinical trials has resulted in the fact that the information which available today regarding prevention, the understanding of risk factors and prediction for the development of ACO among patients with long term and uncontrolled asthma, is limited. As a result, the adjustment of treatment for these patients is not optimal. Due to the facts outlined above, the purpose of this review is to summarize the main points of the most updated information that have concluded based on oriented studies that have been done with the ACO population of patients and to suggest additional lines of thought to cover the information gaps based on available data about asthma and COPD patients who share similar criteria to ACO patient. In hope that this paper will serve effectively every physician who might need to provide care for this spectrum of patients.

Abstract (croatian)

Astma i kronična opstruktivna plućna bolest (KOPB) dvije su vrlo česte kronične bolesti pluća u opće populacije te se tradicionalno smatraju dvjema zasebnim bolestima koje kliničari u većini slučajeva mogu lako razlikovati. Obje su karakterizirane kombinacijom višefaktorskih upalnih procesa i opstrukcije dišnih putova. Kod obje bolesti složenost upalnih procesa utječe na varijabilni odgovor na dani tretman te među znanstvenom zajednicom nema sumnje da se - usprkos sličnosti dviju bolesti i njihovoj povezanosti s grupom opstruktivnih plućnih bolesti - liječenje astme razlikuje od KOPB-a jer je bronhokonstrikcija obično reverzibilna kod astme, dok s druge strane KOPB karakterizira progresivno pogoršanje prema stalnoj opstrukciji. Manjak razlike između ove dvije bolesti može dovesti do pogrešnog liječenja koje čak može naštetiti. Posljednjih godina došlo je do razumijevanja da postoji značajno preklapanje i u patološkom i u funkcionalnom aspektu astme i KOPB-a, posebno među starijom populacijom gdje se karakteristike dviju bolesti mogu pronaći istovremeno, a time je i sindrom preklapanja astme i KOPB-a (ACO) rođen kao nova dijagnoza. Pokazalo se da ACO pacijenti imaju veću stopu pogoršanja, veću upotrebu zdravstvene zaštite i lošiju kvalitetu života povezanu sa zdravljem, ali nažalost, sustavno izuzeće bolesnika koji nisu udovoljili kriterijima za čistu astmu ili KOPB iz kliničkih ispitivanja rezultiralo je činjenicom da su danas dostupne informacije o prevenciji, razumijevanju čimbenika rizika i predviđanju razvoja ACO među pacijentima s dugotrajnom i nekontroliranom astmom ograničene. Kao rezultat, prilagodba liječenja za te bolesnike nije optimalna. Zbog gore navedenih činjenica, svrha ovog pregleda je sažeti glavne točke najnovijih informacija zaključenih na temelju orijentiranih studija koje su rađene s ACO populacijom pacijenata i predložiti dodatne linije razmišljanja kako bi se obuhvatilo praznine u informacijama na temelju dostupnih podataka o bolesnicima s astmom i KOPB-om koji dijele slične kriterije kao i pacijenti s ACO-om, a u nadi da će ovaj rad učinkovito služiti svakom liječniku koji će možda morati pružiti skrb za ovaj spektar pacijenata.

• Keywords: chronic lung disease; asthma; chronic obstructive pulmonary disease (COPD); asthma-COPD overlap syndrome (ACO)
• Keywords (croatian): kronične bolesti pluća; astma; kronična opstruktivna plućna bolest (KOPB); sindrom preklapanja astme i KOPB-a (ACO)
• Language: english
• URN:NBN: urn:nbn:hr:105:231721
• Study programme: Title: Medicine (in English language); Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-12-16 11:07:28