Heterogeneity of asthma–COPD overlap syndrome

Figures & data

Figure 1 Four phenotype groups of ACOS.

Notes: Group A: patients who smoked <10 Pyrs and had blood eosinophil counts ≥300; group B: patients who smoked <10 Pyrs and had blood eosinophil counts <300; group C: patients who smoked <10 Pyrs and had blood eosinophil counts ≥300; and group D: patients who smoked <10 Pyrs and had blood eosinophil counts <300.
Abbreviations: ACOS, asthma–COPD overlap syndrome; E, blood eosinophil count; Pyrs, pack years.

Table 1 Characteristics of the ACOS phenotype groups

Characteristics	ACOS phenotype groups				P-value
	A	B	C	D
Age	59.0±3.1	62.3±2.7	68.5±1.7	70.1±2.7	0.005
Smoking (never/ex/current)	19/4/1 (79.1%/16.7%/4.1%)	14/4/0 (77.8%/22.2%/0.0%)	0/28/12 (0.0%/70.0%/30.0%)	0/16/5 (0.0%/76.2%/23.8%)	<0.001
Pyrs	0.5±0.3	0.9±0.5	49.1±5.4	38.9±4.1	<0.001
BMI	22.7±0.8	23.9±0.9	23.1±0.5	22.9±0.7	0.669
Lung function (pBD)
FVC (L)	2.9±0.2	2.5±0.2	3.6±0.1	3.5±0.1	<0.001
FVC (%)	81.6±4.1	73.4±5.9	87.4±2.6	81.0±5.8	0.122
FEV1 (L)	1.8±0.1	1.5±0.2	1.8±0.1	1.9±0.1	0.160
FEV1 (%)	67.1±3.8	58.9±5.7	62.8±2.4	61.9±5.4	0.613
FEV1/FVC (%)	63.1±2.6	62.5±3.9	51.5±1.9	53.8±3.0	0.003
CAT	12.6±1.9	7.8±1.0	17.3±2.3	14.0±2.7	0.085

Notes: Group A: patients who smoked <10 Pyrs and had blood eosinophil counts ≥300; group B: patients who smoked <10 Pyrs and had blood eosinophil counts <300; group C: patients who smoked <10 Pyrs and had blood eosinophil counts ≥300; and group D: patients who smoked ≥10 Pyrs and had blood eosinophil counts <300.

Abbreviations: ACOS, asthma–COPD overlap syndrome; BMI, body mass index; CAT, COPD assessment test; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; pBD, post-bronchodilator; Pyrs, pack years.

Figure 2 Flow diagram for subject enrollment.

Notes: Group A: patients who smoked <10 Pyrs and had blood eosinophil counts ≥300; group B: patients who smoked <10 Pyrs and had blood eosinophil counts <300; group C: patients who smoked ≥10 Pyrs and had blood eosinophil counts ≥300; and group D: patients who smoked ≥10 Pyrs and had blood eosinophil counts <300.

Abbreviations: BDR, bronchodilator response; BHR, bronchial hyperresponsiveness.

Figure 3 Distribution of patients into four phenotype groups of ACOS.

Notes: The size of the circle represents the number of patients in each group. Group A: patients who smoked <10 Pyrs and had blood eosinophil counts ≥300; group B: patients who smoked <10 Pyrs and had blood eosinophil counts <300; group C: patients who smoked <10 Pyrs and had blood eosinophil counts ≥300; and group D: patients who smoked ≥10 Pyrs and had blood eosinophil counts <300.

Abbreviations: ACOS, asthma–COPD overlap syndrome; E, blood eosinophil count; Pyrs, pack years.

Figure 4 Gender distribution according to four phenotype groups of ACOS.

Notes: The size of the circle represents the number of patients in each group. Group A: patients who smoked <10 Pyrs and had blood eosinophil counts ≥300; group B: patients who smoked <10 Pyrs and had blood eosinophil counts <300; group C: patients who smoked <10 Pyrs and had blood eosinophil counts <300; and group D: patients who smoked ≥10 Pyrs and had blood eosinophil counts ≥300.
Abbreviations: ACOS, asthma -COPD overlap syndrome; E, blood eosinophil count; Pyrs, pack years.

Figure 5 Pattern of medication prescription among four phenotype groups of ACOS.

Notes: Group A: patients who smoked <10 Pyrs and had blood eosinophil counts ≥300; group B: patients who smoked <10 Pyrs and had blood eosinophil counts <300; group C: patients who smoked <10 Pyrs and had blood eosinophil counts <300; and group D: patients who smoked ≥10 Pyrs and had blood eosinophil counts ≥300.
Abbreviations: ACOS, asthma -COPD overlap syndrome; E, blood eosinophil count; ICS, inhaled corticosteroid; LABA, long-acting beta agonist; LAMA, long-acting muscarinic antagonist; LTRA, leukotriene receptor antagonist; PDE4I, phosphodiesterase 4 inhibitor.

Figure 6 The proportion of patients free of severe exacerbation.

Notes: Group A: patients who smoked <10 Pyrs and had blood eosinophil counts ≥300; group B: patients who smoked <10 Pyrs and had blood eosinophil counts <300; group C: patients who smoked <10 Pyrs and had blood eosinophil counts <300; and group D: patients who smoked ≥10 Pyrs and had blood eosinophil counts ≥300.