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Asthma and chronic obstructive pulmonary disease

Guerra, Stefano

Current Opinion in Allergy and Clinical Immunology: October 2009 - Volume 9 - Issue 5 - p 409–416
doi: 10.1097/ACI.0b013e3283300baf
Genetics and epidemiology: Edited by Michael Kabesch

Purpose of review In the clinical setting, patients who present with a combination of asthma and chronic obstructive pulmonary disease (COPD)-related traits are not uncommon. This review discusses recent advances in the characterization of the natural course, phenotypes, and molecular markers of cases with coexisting asthma and COPD and in the understanding of the nature of the link between these two conditions.

Recent findings Recent epidemiological evidence indicates that asthma accounts for a substantial proportion of cases of irreversible airflow limitation in the general population and that, in addition to the critical role of environmental exposures in adult age, alterations of developmental processes in childhood may also predispose patients with asthma to COPD later in life. Findings from clinical and experimental studies emphasize the existence of remarkable heterogeneity within the group of patients with coexisting asthma and COPD in terms of natural history of lung function, risk factors for disease progression, lung structural changes, and immunological profiles.

Summary The phenotypic complexity of cases with coexisting asthma and COPD challenges a rigid categorization of patients into existing diagnostic labels and suggests the importance of integrating clinical, functional, morphologic, immunological, and molecular assessments to tailor and optimize prevention and treatment.

aCentre for Research in Environmental Epidemiology (CREAL), IMIM-Hospital del Mar, CIBERESP, Barcelona, Spain

bArizona Respiratory Center, University of Arizona, Tucson, Arizona, USA

Correspondence to Stefano Guerra, MD, PhD, Centre for Research in Environmental Epidemiology (CREAL), C. Doctor Aiguader, 88, Barcelona 08003, Spain Tel: +34 93 214 7329; fax: +34 93 214 7302; e-mail:

Copyright © 2009 Wolters Kluwer Health, Inc. All rights reserved.