Pulmonary Function and Bronchial Hyper - Responsiveness Profile of Indonesian Patients with Asthma Chronic - Obstructive Pulmonary Disease Overlap Syndrome

Background: Asthma - chronic obstructive pulmonary disease (COPD)
overlap syndrome (ACOS) is characterized by a persistent airway obstruction
that has several features of asthma and several features of COPD. ACOS was
reported to have lower pulmonary function values compared to patients who
had only asthma or COPD. Bronchial hyper-responsiveness profile in ACOS
has also not been clearly determined.
Objective: The current study was conducted with the aimed to determine the
pulmonary function and bronchial hyper-responsiveness profile of ACOS.
Methodology: This study was a cross sectional study conducted at AsthmaCOPD Outpatient Clinic of national referral hospital for respiratory diseases,
the Persahabatan Hospital, Jakarta, Indonesia. ACOS diagnosis was made
using the modified 2017 Global Initiative for Asthma (GINA) and Global
Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Patients are
diagnosed with ACOS if they have at least three clinical features that support
asthma and COPD.
Results: The study involved 60 subjects. After bronchodilator (BD) test, the
mean or median forced vital capacity (FVC)% predicted, forced expiratory
volume within 1 second (FEV1)% predicted, FEV1/FVC ratio, FEV1 and the
percentage of FEV1 were increased of 853%, 76.4%, 67.8%, 158.3 mL, and
101% respectively. Positive methacholine challenge test was found in 97.1%
of ACOS patients. ACOS patients had mean post-BD FEV1/FVC of 67.7%,
median percentage of FEV1 increase of 10.1% and most of them had positive
methacholine challenge test.
Conclusion: The ACOS group had mean or median pre-BD VC% predicted,
FVC% predicted, FEV1% predicted and FEV1/FVC of 82.2%, 77.4%, 66% and
65.9%, respectively. After BD administration, ACOS group had mean or
median FVC% predicted, FEV1% predicted, FEV1/FVC, FEV1 increase and
percentage of FEV1 increase of 85.3%, 76.4%, 67.8%, 158.3 mL, and 10.1%,
respectively. Positive bronchial provocation test was found in 97.1% of ACOS
patients.