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Differential airway remodeling changes were observed in patients with asthma COPD overlap compared to patients with asthma and COPD alone


Dey, S and Lu, W and Weber, HC and Young, S and Larby, J and Chia, C and Haug, G and Brake, SJ and Myers, S and Gaikwad, AV and Bhattarai, P and Pathinayake, PS and Wark, PAB and Eapen, MS and Sohal, SS, Differential airway remodeling changes were observed in patients with asthma COPD overlap compared to patients with asthma and COPD alone, American Journal of Physiology, 323, (4) pp. 473-483. ISSN 1040-0605 (2022) [Refereed Article]

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Copyright 2022 The Authors. This is an open access article under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) License, ( which permits use, distribution and reproduction in any medium, provided the original work is properly sited.

DOI: doi:10.1152/ajplung.00137.2022


Management of patients with asthma COPD overlap (ACO) is clinically challenging due to insufficient evidence of pathological changes in these patients. In this cross-sectional study, we evaluated airway remodeling in endobronchial biopsies from a total of 90 subjects, which included 12 ACO, 14 patients with asthma, 12 COPD exsmokers (ES), 11 current smokers (CS), 28 healthy controls (HC), and 13 normal lung function smokers (NLFS). Tissue was stained with Masson's trichrome. Epithelium, goblet cells, reticular basement membrane (RBM), cellularity, lamina propria (LP), and smooth muscle (SM) changes were measured using Image-Pro Plus v7 software. Differential airway remodeling pattern was seen in patients with ACO. A limited change was noted in the ACO epithelium compared with other pathological groups. RBM was substantially thicker in patients with ACO than in HC (P < 0.0002) and tended to be thicker than in patients with asthma and NLFS. The total RBM cells were higher in ACO than in the HC (P < 0.0001), COPD-CS (P = 0.0559), -ES (P = 0.0345), and NLFS (P< 0.0002), but did not differ from patients with asthma. Goblet cells were higher in the ACO than in the HC (P = 0.0028) and COPD-ES (P = 0.0081). The total LP cells in ACO appeared to be higher than in HC, COPD-CS, and NLFS but appeared to be lower than in patients with asthma. Finally, SM area was significantly lower in the ACO than in patients with asthma (P = 0.001), COPD-CS (=0.0290), and NLFS (P = 0.0011). This first comprehensive study suggests that patients with ACO had distinguishable tissue remodeling that appeared to be more severe than patients with asthma and COPD. This study will help in informed decision-making for better patient management in clinical practice.

Item Details

Item Type:Refereed Article
Keywords:COPD, asthma, airway remodelling, fibrosis, Inflammation, lung
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiology (incl. cardiovascular diseases)
Objective Division:Health
Objective Group:Clinical health
Objective Field:Diagnosis of human diseases and conditions
UTAS Author:Dey, S (Mr Surajit Dey)
UTAS Author:Lu, W (Dr Monica Lu)
UTAS Author:Weber, HC (Associate Professor Heinrich Weber)
UTAS Author:Larby, J (Dr Josie Larby)
UTAS Author:Haug, G (Dr Greg Haug)
UTAS Author:Brake, SJ (Mr Sam Brake)
UTAS Author:Myers, S (Dr Stephen Myers)
UTAS Author:Gaikwad, AV (Ms Archana Gaikwad)
UTAS Author:Bhattarai, P (Mr Prem Bhattarai)
UTAS Author:Eapen, MS (Dr Mathew Eapen)
UTAS Author:Sohal, SS (Dr Sukhwinder Sohal)
ID Code:154003
Year Published:2022
Deposited By:Health Sciences
Deposited On:2022-10-21
Last Modified:2023-01-04
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