ERS 2019 – Asthma and COPD comorbidities

  • Eliana Mesa
  • Conference Reports
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There is currently no established diagnostic test to objectively assess cough hypersensitivity syndrome (CHS). One study compared mannitol and citric acid as a cough provocation test with comparable results. Mannitol does not require pre-test preparation so may become useful for identifying CHS.

In a cohort study of never-smokers with chronic obstructive pulmonary disease (COPD) who were followed up for 11 years (n=338,548), the risk of lung cancer was similar to, or higher than, ever-smokers without COPD. COPD was found to be a strong independent risk factor for lung cancer. Patients with COPD could be considered candidates for lung cancer screening, irrespective of smoking status.

In a retrospective study of patients subjected to surgery for lung cancer (n=208), 75 had COPD (44% were diagnosed with cancer at the same time as COPD). The most frequent histological diagnosis was adenocarcinoma (48%) and secondly epidermoid carcinoma (37%). In COPD, the predominant phenotype was emphysema (71%). The study revealed that the presence of COPD in patients undergoing lung resection due to cancer had a higher percentage of recurrences, mortality and epidermoid carcinomas, compared to those without COPD.

To evaluate the impact of COPD on sleep quality, the CASIS (COPD and Asthma Sleep Impact Scale) questionnaire was used in an observational multicentre study (n= 2,654). The quality of sleep in COPD patients was inversely related to respiratory symptoms, poor lung function, exacerbations within the previous year and the presence of depression.

Low serum levels of vitamin D have been linked to impaired lung function and the anti-inflammatory effects of vitamin D may affect the course of asthma. A study with 35 healthy controls and 60 patients evaluated the effect of vitamin D replacement on asthma control and pulmonary function tests. The results suggested its positive effects although future, larger, prospective studies are needed to confirm these results.

There is a relationship between COPD, osteoporosis (OP) and generalised periodontitis (GP). COPD patients (n=63) and matched people (n=30) without somatic pathology were evaluated. Systemic pathological changes in bone tissue were revealed by densitometry in 62 (98.4%) COPD patients. The study concluded that the probability of OP and GP occurrence increases with the COPD duration, tobacco smoking and bronchial obstruction progression.

Stable COPD patients were studied (n=70) to evaluate whether salivation, systemic inflammatory markers, salivary oxidative stress markers, sarcopenia and periodontal disease (PD) are related to COPD. Resorptive-destructive processes of bone tissue were present in 98.4%, of whom 26.9% were diagnosed with osteopenia and 69.8% had osteoporosis (6 times more than individuals without somatic pathology). The probability of osteoporosis is increased with the duration of the underlying disease, tobacco smoking and the progression of the bronchial obstruction.