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

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posted on 2023-05-21, 14:32 authored by Dey, S, Wenying LuWenying Lu, Heinrich WeberHeinrich Weber, Young, S, Josie LarbyJosie Larby, Chia, C, Haug, G, Samuel BrakeSamuel Brake, Stephen MyersStephen Myers, Archana GaikwadArchana Gaikwad, Prem BhattaraiPrem Bhattarai, Pathinayake, PS, Wark, PAB, Mathew Eapen, Sukhwinder SohalSukhwinder Sohal
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.


Clifford Craig Foundation


Publication title

American Journal of Physiology










School of Health Sciences


Amer Physiological Soc

Place of publication

9650 Rockville Pike, Bethesda, USA, Md, 20814

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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.

Repository Status

  • Open

Socio-economic Objectives

Diagnosis of human diseases and conditions

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