Síndrome de sobreposição asma e DPOC
Asthma-COPD overlap syndrome
Ataualpa Pereira dos Reis; Roberto Stirbulov
Resumo
Asma e doença pulmonar obstrutiva crônica (DPOC) são doenças crônicas altamente prevalentes na população geral. Ambas são caracterizadas por inflamação crônica heterogênea e obstrução das vias aéreas. Em ambas as condições, a inflamação crônica afeta todo o trato respiratório das grandes e pequenas vias aéreas, com recrutamento de diferentes células e com diferentes mediadores produzidos. A obstrução das vias aéreas é tipicamente intermitente e reversível na asma, mas é progressiva e frequentemente irreversível na DPOC. Quando asma e DPOC ocorrem juntas, o termo síndrome de sobreposição asma e DPOC tem sido usado. Realizou-se revisão de artigos originais, revisões e publicações indexadas nos bancos de dados PubMed, MEDLINE, LILACS e SciELO nos últimos 20 anos. Uma forma prática de diagnóstico da Síndrome de sobreposição asma e DPOC é incluir pacientes com diagnóstico de DPOC pelo critério do GOLD (Global Initiative for Chronic Obstructive Lung Disease) e da Asma pelo critério do GINA (Global Initiative for Asthma). Assim, a síndrome inclui pacientes que preenchem os critérios de DPOC (obstrução fixa das vias aéreas) e que também têm típicos achados de asma (sibilância, atopia, eosinofilia e resposta positiva a broncodilatador). A presença de diferentes fenótipos ou componentes das doenças aéreas obstrutivas crônicas necessita ser analisada para individualizar e otimizar o tratamento para se alcançar os melhores resultados. Embora intervenções específicas variem conforme a doença, o objetivo do tratamento para as doenças obstrutivas respiratórias é semelhante e dirigido primariamente para a necessidade de controlar os sintomas, otimizar a saúde geral, e prevenir exacerbações.
Palavras-chave
Abstract
Asthma and chronic obstructive pulmonary disease (COPD) are highly prevalent chronic diseases in the general population. Both conditions are characterized by heterogeneous chronic airway inflammation and airway obstruction. In both cases, chronic inflammation affects the whole respiratory tract, from central to peripheral airways, with different inflammatory cells recruited and different mediators produced. Airway obstruction is typically intermittent and reversible in asthma, but it is progressive and largely irreversible in COPD. When asthma and COPD co-occur, the term asthma-COPD overlap syndrome has been applied. This paper presents a review of original articles, reviews and other materials indexed in the PubMed, MEDLINE, LILACS, and SciELO databases and published over the last 20 years. A practical approach to diagnosis of the asthma-COPD overlap syndrome has been to include patients with a diagnosis of COPD according to GOLD criteria (Global Initiative for Chronic Obstructive Lung Disease) and of asthma according to GINA criteria (Global Initiative for Asthma). Therefore, the combined syndrome includes patients who meet criteria for COPD (fixed airflow obstruction) and also have typical features of asthma (wheezing, atopy, eosinophilia, and positive bronchodilator response). The presence of different phenotypes or components of obstructive airway diseases needs to be analyzed so that treatment can be individualized and optimized to achieve the best results for each patient. Even though specific interventions vary by disease, treatment goals for patients with obstructive airway diseases are similar and driven primarily by the need to control symptoms, optimize health status, and prevent exacerbations.
Keywords
References
1. Fabbri LM, Romagnoli M, Corbetta L, et al. Differences in airway inflammation in patients with chronic fixed airflow obstruction due to asthma or chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2003;167:418-24.
2. Miravitlles M, Soler-Cataluña JJ, Calle M, et al. Spanish COPD Guidelines (GesEPOC): pharmacological treatment of stable COPD. Aten Primaria. 2012;44:425-37.
3. Global Initiative for Asthma, Global initiative for chronic Obstructive Lung Disease (GOLD) Asthma, COPD, and asthma-COPD overlap syndrome. 2014. Disponível em: http://www.goldcopd.org/asthmacopd-overlap.html . Acessado em 05/fevereiro/2014.
4. From the Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015. Disponível em: http://www.ginasthma.org/
5. Xavier Soler X, Ramsdell JW. Are Asthma and COPD a continuum of the same disease? J Allergy Clin Immunol Pract. 2015;3:489‑95.
6. Chalmers GW, Macleod KJ, Little SA, Thomson LJ, McSharry CP, Thomson NC. Influence of cigarette smoking on inhaled corticosteroid treatment in mild asthma. Thorax. 2002;57:226-30.
7. Chaudhuri R, Livingston E,MacMahon AD, Thomson L,Borland W, Thonsom NC. Cigarette smoking impairs the therapeutic response to oral corticosteroids in chronic asthma. Am J Respir Crit Care Med. 2003;168:1308-11.
8. Saha S. Brightling CE. Eosinophilic airway inflammation in COPD Int J Chron Obstruct Pulmon Dis. 2006 Mar;1(1):39-47.
9. O`Byrne PM, Pedersen S, Lamm CJ. Busse WW. Start Investigation Group. Severe exacerbations and decline in lung function in asthma. Am J Respir Crit Care Med. 2009;179:19-24.
10. Sapey E, Stockley RA. COPD exacerbation: aetiology. Thorax. 2006;61:250-8.
11. Hamid Q, Tulic MK. New insights into the pathophysiology of the small airways in asthma. Ann Thorac Med. 2007;2:28-33.
12. Reis AP, Cruz AA. Doença das pequenas vias aéreas na asma: revisão Braz J Allergy Immunol. 2013;1(6):313-8.
13. Hogg JC, Chu F, Utokaparch S, Woods R, Elliot M, Buzatu L et als. The Nature of Small-Airway Obstruction in Chronic Obstructive Pulmonary Disease. N Engl J Med. 2004; 350:2645-53.
14. Skold CM. Remodeling in asthma and COPD - differences and similarities. Clin Respir J. 2010;4(Suppl 1):20-7.
15. Postma DS, Kerstjens HAM. Characteristics of Airway Hyperresponsiveness in Asthma and Chronic Obstructive Pulmonary Disease. 13TH Transatlantic Airway Conference. Am J Resp Crit Care Med. 1998;158:S187-S192.
16. Scichilone N, Battaglia S, La Sala A,Bellia V. Clinical implications of airway hyper-responsiveness in COPD. Int J Chron Obstruct Pulmon Dis. 2006;1(1):49-60.
17. Brutsche MH, Downs SH, Schindler C. Bronchial hyperresponsiveness and the development of asthma and COPD in asymptomatic individuals: SAPALDIA Cohort Study.Thorax. 2006;61:671-7.
18. Gibson PG, Simpson JL. The overlap syndrome of asthma and COPD: what are its features and how important is it? Thorax 2009;64:728-35.
19. Fabbri LM, Romagnoli M, Corbetta L. Differences in airway inflammation in patients with fixed airflow obstruction due to asthma or chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2003;167:418-24.
20. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program.Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood.
21. Panettieri RA JR, Covar R,Grant E,Hillyer EV,Bacharier L. Natural history of asthma: persistence versus progression-does the beginning predict the end? J Allergy Clin Immunol. 2008;121:607‑13.
22. Rasmussen FD, Taylor DR, Flannery EM, Cowan JO, Greene JM, Herbison GP, et al. Risk factors for airway remodeling in asthma manifested by a low postbronchodilator FEV1/vital capacity ratio. Am J Respir Cri Care Med. 2002;165:1480‑8.
23. O r i e N G M . T h e D u t c h H y p o t h e s i s . C h e s t . 2000;117(5 suppl 1):299S.
24. Vercelli D. Discovering susceptibility genes for asthma and allergy. Nat Rev Immunol. 2008;8:169-82.
25. Reihsaus E, Innis M, MacIntyre N, Liggett SB. Mutations in the gene encoding for the beta 2-adrenergic receptor in normal and asthmatic subjects. Am J Respir Cell Mol Biol. 1993;8:334-9.
26. Barnes PJ. Immunology of asthma and chronic obstructive pulmonary disease. Nat Rev Immunol. 2008;8:183-92.
27. Castaldi PJ, Dy J, Ross J, Chang Y, Washko GR, Curran-Everett D, et al. Cluster analysis in the COPDGene study identifies subtypes of smokers with distinct patterns of airway disease and emphysema. Thorax. 2014;69:415-22.
28. Stockley RA. Alpha1-antitrypsin review. Clin Chest Med. 2014;35:39‑50.
29. Lee JH, Cho MH, Hersh CP, MacDonald MLN, Crap JD , Bakke PS, et al. and on behalf of the COPDGene and ECLIPSE Investigators. Genetic susceptibility for chronic bronchitis in chronic obstructive pulmonary disease. Respir Res. 2014;15(1):113-33.
30. Castaldi PJ, Dy J, Ross J, Chang Y, Washko GR, Curran-Everett D, et al. Cluster analysis in the COPDGene study identifies subtypes of smokers with distinct patterns of airway disease and emphysema. Thorax. 2014;69:415-22.
31. Hardin M, Cho M, McDonald ML, Beaty T, Ramsdell J, Bhatt S, et al. The clinical and genetic features of COPD-asthma overlap syndrome. Eur Respir J. 2014;44:341-50.
32. Vanfleteren LE, Kocks JW, Stone IS, Breyer-Kohansal R, Greulich T, Lacedonia D, et al. Moving from the Oslerian paradigm to the post-genomic era: are asthma and COPD outdated terms? Thorax. 2014;69:72-9.
33. Nakawah MO, Hawkins C, Barbandi F. Asthma, chronic obstructive pulmonary disease (COPD), and the overlap syndrome. J Am Board Fam Med. 2013;26:470-7.
34. Louie S, Zeki AA, Schivo M, Chan AL, Yoneda KY, Avdalovic M, et al. The asthma-chronic obstructive pulmonary disease overlap syndrome: pharmacotherapeutic considerations. Expert Rev Clin Pharmacol. 2013;6:197-219.
35. Chaudhuri R, Livingston E, McMahon AD, Lafferty J, Fraser I, Spears M, et al. Effects of smoking cessation on lung function and airway inflammation in smokers with asthma. Am J Respir Cri Care Med. 2006;174:127-33.
36. Diaz-Guzman E, Mannino DM. Airway obstructive diseases in older adults: from detection to treatment. J Allergy Clin Immunol. 2010;126:702-9.
37. Nici L, Donner C, Wouters E, Zuwallack R, Ambrosino N, Bourbeau J, et al. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med. 2006;173:1390-413.
38. Montuschi P, Malerba M, Santini G, Miravitlles M. Pharmacological treatment of chronic obstructive pulmonary disease: from evidence-based medicine to phenotyping. Drug Discov Today. 2014;19:1928‑35.
39. Welte T, Miravitlles M, Hernandez P, Eriksson G, Peterson S, Polanowski T, et al. Efficacy and tolerability of budesonide/formoterol added to tiotropium in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2009;180:741‑50.
40. Magnussen H, Bugnas B, van Noord J, Schmidt P, Gerken F, Kesten S. Improvements with tiotropium in COPD patients with concomitant asthma. Respir Med. 2008;102:50‑6.
41. Peters SP, Kunselman SJ, Icitovic N, Moore WC, Pascual R, Ameredes BT, et al. Tiotropium bromide step-up therapy for adults with uncontrolled asthma. N Engl J Med. 2010; 363:1715‑26.
42. Fahy JV. Type 2 inflammation in asthma is present in most, absent in many. Nat Rev Immunol. 2015;15:57-65.
43. Wouters EF, Postma DS, Fokkens B, Hop WC, Prins J, Kuipers AF, et al, COSMIC (COPD and Seretide: a Multi-Center Intervention and Characterization) Study Group. Withdrawal of fluticasone propionate from combined salmeterol/ luticasone treatment in patients with COPD causes immediate and sustained disease deterioration: a randomised controlled trial. Thorax. 2005;60:480-7.
44. Miravitlles M, Soler-Cataluna JJ, Calle M, Soriano JB. Treatment of COPD by clinical phenotypes: putting old evidence into clinical practice. Eur Respir J. 2013;41:1252‑6.
45. Leigh R, Pizzichini MM, Morris MM, Maltais F, Hargreave FE, Pizzichini E. Stable COPD: predicting benefit from high-dose inhaled corticosteroid treatment. Eur Respir J. 2006;27:964‑71.
46. Chanez P, Vignola AM, O’Shaugnessy T, Enander I, Li D, Jeffery PK, Bousquet J. Corticosteroid reversibility in COPD is related to features of asthma. Am J Respir Crit Care Med. 1997;155:1529‑34.
47. Bellia V, Pistelli R, Catalano F, Antonelli-Incalzi R, Grassi V, Melillo G, et al. Quality control of spirometry in the elderly. The SA.R.A. study. Am J Respor Crit Care Med. 2000;161:1094‑100.
48. Gibson PG, McDonald VM, Marks GB. Asthma in older adults. Lancet. 2010;376:803‑13.
49. McDonald VM, Higgins I, Gibson PG. Managing older patients with coexistent asthma and chronic obstructive pulmonary disease: diagnostic and therapeutic challenges. Drugs Aging. 2013;30:1‑17.
50. Asthma Stats: percentage of people with asthma who smoke. http.www.cdc.gov/astma/asthma_stats/asthma_stats_fact.sheet.pdf.
51. Baldassari SR, Toll BA, Leone FT. A comprehensive approach to tobacco dependence interventions. J Allergy Clin Immunol Pract. 2015;3:481-8.
Submitted date:
04/17/2017
Accepted date:
05/03/2017
Facebook
LinkedIn
Mendeley
StumbleUpon
Reddit
Email