Mixed Th2 and non-Th2 inflammatory pattern in the asthma-COPD overlap: A network approach

Luis Pérez de Llano, Borja G. Cosío, Amanda Iglesias, Natividad de Las Cuevas, Juan Jose Soler-Cataluña, Jose Luis Izquierdo, Jose Luis López-Campos, Carmen Calero, Vicente Plaza, Marc Miravitlles, Alfons Torrego, Eva Martinez-Moragon, Joan B. Soriano, Antolin Lopez Viña, Irina Bobolea

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33 Citations (Scopus)


© 2018 Pérez de Llano et al. Introduction: The asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) is a clinical condition that combines features of those two diseases, and that is difficult to define due to the lack of understanding of the underlying mechanisms. Determining systemic mediators may help clarify the nature of inflammation in patients with ACO. Objectives: We aimed at investigating the role and interaction of common markers of systemic inflammation (IL-6, IL-8, and tumor necrosis factor-α), Th2-related markers (periostin, IL-5, and IL-13), and IL-17 in asthma, COPD, and ACO. Methods: This is a cross-sectional study of patients aged ≥40 years with a post-bronchodilator forced expiratory volume in the first second/forced vital capacity <0.70 recruited from outpatient clinics in tertiary hospitals with a clinical diagnosis of asthma, COPD, or ACO. ACO was defined by a history of smoking >10 pack-years in a patient with a previous diagnosis of asthma or by the presence of eosinophilia in a patient with a previous diagnosis of COPD. Clinical, functional, and inflammatory parameters were compared between categories using discriminant and network analysis. Results: In total, 109 ACO, 89 COPD, and 94 asthma patients were included. Serum levels (median [interquartile range]) of IL-5 were higher in asthma patients than in COPD patients (2.09 [0.61-3.57] vs 1.11 [0.12-2.42] pg/mL, respectively; p=0.03), and IL-8 levels (median [interquartile range]) were higher in COPD patients than in asthma patients (9.45 [6.61-13.12] vs 7.03 [4.69-10.44] pg/mL, respectively; p<0.001). Their values in ACO were intermediate between those in asthma and in COPD. Principal component and network analysis showed a mixed inflammatory pattern in ACO in between asthma and COPD. IL-13 was the most connected node in the network, with different weights among the three conditions. Conclusion: Asthma and COPD are two different inflammatory conditions that may overlap in some patients, leading to a mixed inflammatory pattern. IL-13 could be central to the regulation of inflammation in these conditions.
Original languageEnglish
Pages (from-to)591-601
JournalInternational Journal of COPD
Publication statusPublished - 12 Feb 2018


  • COPD mechanisms
  • IL-13
  • Inflammatory cytokines
  • Network analysis
  • Overlap
  • asthma mechanisms


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