Relationship between Peak Inspiratory Flow and Expiratory Flows in Patients with Asthma and Chronic Obstructive Pulmonary Disease and its Relationship with Eosinophilia
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Abstract
Introduction: The objective is to determine differences in spirometry between patients with COPD and asthma by comparing the relationships between maximum inspiratory flow and maximum expiratory flows, at 75%, 50% and 25%; and to evaluate whether there are differences according to the levels of eosinophils in peripheral blood in COPD patients.
Materials and methods: Prospective study, from January 2021 to December 2022. Spirometries that met obstruction criteria in patients with COPD and asthma were included. The ratio between peak inspiratory flow (PIF) and peak expiratory flow (MEF), the ratio between PIF and MEF at 75% (MEF75), 50% (MEF50) and 25% (MEF25) were obtained and compared between patients with asthma and COPD. COPD patients were divided into three groups according to blood eosinophil levels: <100/mm3, between 101 and 299/mm3, and >300/mm3; functional variables were compared between the three groups and with asthmatic patients.
Results: A total of 187 spirometries were analyzed, 97 asthmatics, 88 COPD and 6 asthma-COPD overlap. When evaluating the PIF/MEF75 ratio, higher values were found in the COPD group (p<0.001), as well as PIF/MEF50 (p<0.001). The same was observed in the PIF/MEF25 ratio (p<0.001). COPD patients with more than 100 eosinophils/mm³ behaved similarly to asthmatic patients.
Conclusions: The PIF/MEF75, PIF/MEF50 and PIF/MEF25 ratios could be used to differentiate these two pathologies, except in COPD with eosinophils >100/mm3.
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The Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management and Prevention of COPD. 2020 report. [Internet]. [Consultado 3 mar 2025]. Disponible en: https://goldcopd.org/2020
García Río F, Lores V, Rojo B. Evaluación funcional respiratoria (obstrucción y atrapamiento) Arch Bronconeumol 2007;43(Supl 3):8-14. https://doi.org/10.1016/S0300-2896(07)71180-8
Corne S, Anthonisen NR. Lung-function testing in chronic obstructive pulmonary disease. Chronic obstructive pulmonary disease. Massachusetts: Blackwell Publishing; 2007. pp. 256-69.
Hogg JC, Macklem PT, Thurlbeck WM. Site and nature of airway obstruction in chronic obstructive lung disease. N Engl J Med 1968;278:1355-60. https://doi.org/10.1056/nejm196806202782501
Plaza V, Álvarez F, Calle M et al. Guía española para el manejo del asma. GEMA 5.0. Sociedad Española de Neumología y Cirugía de Torácica. 2020. Arch Bronconeumol 2020;56(Suppl 1):1-24.
Al-Muhsen S, Johnson JR, Hamid Q. Remodeling in asthma. J Allergy Clin Immunol 2011;128:451-62. https://doi.org/10.1016/j.jaci.2011.04.047
Kuwano K, Bosken CH, Pare PD et al. Small airways dimensions in asthma and in chronic obstructive pulmonary disease. Am Rev Respir Dis1993;148(5):1220–1225. https://doi.org/10.1164/ajrccm/148.5.1220
Hogg JC. Pathophysiology of airflow limitation in chronic obstructive pulmonary disease. Lancet 2004;364(9435):709–721. https://doi.org/10.1016/s0140-6736(04)16900-6
Okazawa M, Imaizumi K, Mieno Y et al. Ratio of Maximal Inspiratory to Expiratory Floy Aids in the Separation of COPD from Asthma. COPD 2020;17(3):230–239. https://doi.org/10.1080/15412555.2020.1742679
Global Initiative for Asthma. Global strategy for asthma management and prevetion 2020 update. [Internet]. [Consultado 3 mar 2025]. Disponible en: https://ginasthma.org
Miller MR, Hankinson J, Brusasco V et al. Standardisation of spirometry. Eur Respir J 2005;26(2):319–338. https://doi.org/10.1183/09031936.05.00034805
Bonten T, Kasteleyn M, Mutsert R et al. Defining asthma–COPD overlap syndrome: a population-based study. Eur Respir J 2017;49:1602008. https://doi.org/10.1183/13993003.02008-2016
Don DS, Miravitlles M, Mannino M et al. What is asthma−COPD overlap syndrome? Eur Respir J 2016;48(3):664-73. https://doi.org/10.1183/13993003.00436-2016
Brusasco V, Barisione G, Crimi E. Pulmonary physiology: Future directions for lung function testing in COPD. Respirology 2015;20: 209–218. https://doi.org/10.1111/resp.12388
Puebla M, García Río F. Fisiología y fisiopatología de la vía aérea pequeña en el asma. Arch Bronconeumol 2011;47(Supl 2):10-16. https://doi.org/10.1016/S0300-2896(11)70015-1
Bosse Y, Pare PD, Seow CY. Airway wall remodeling in asthma: from the epithelial layer to the adventitia. Curr Allergy Asthma Rep 2008;8(4):357–366. https://doi.org/10.1007/s11882-008-0056-0
Nakano Y, Van Tho N, Yamada H et al. Radiological approach to asthma and COPD the role of computed tomography. AllergolInt 2009;58(3):323331. https://doi.org/10.2332/allergolint.09-rai-0124
Peces-Barba Romero. Fisiopatología del atrapamiento aéreo en la EPOC. Rev Patol Respir 2005; 8(SUPL. 2): 255-261.
Kurosawa H, Kohzuki M. Dynamic airway narrowing. N Engl J Med 2004;350(10):1036–1036. https://doi.org/10.1056/nejmicm030626
Cerveri I, Dore R, Corsico A et al. Assessment of emphysema in COPD: a functional and radiologic study. Chest 2004;125(5):1714–1718. https://doi.org/10.1378/chest.125.5.1714
Barnes N, Sharma R, Lettis S et al. Blood eosinophils as a marker of response to inhaled corticosteroids in COPD. Eur Respir J 2016;47:1374–1382. https://doi.org/10.1183/13993003.01370-2015
Bafadhel M, McKenna S, Terry S et al. Acute exacerbations of chronic obstructive pulmonary disease: identification of biologic clusters and their biomarkers. Am J Respir Crit Care Med 2011;184(6):662–671. https://doi.org/10.1164/rccm.201104-0597oc
Dunican E, Elicker B, Gierada D et al. Mucus plugs in patients with asthma linked to eosinophilia and airflow obstruction. Clin Invest 2018;128(3):997–1009. https://doi.org/10.1172/jci95693
Chan R, Duraikannu C, Lipworth B. Clinical Associations of Mucus Plugging in Moderate to Severe Asthma. J Allergy Clin Immunol Pract 2023;11:195-9. https://doi.org/10.1016/j.jaip.2022.09.008