title: Old dilemma: asthma with irreversible airway obstruction or COPD.
abstract: Older asthmatic patients may develop fixed airway obstruction and clinical signs of chronic obstructive pulmonary disease (COPD). We investigated the added value of pathological evaluation of bronchial biopsies to help differentiate asthma from COPD, taking into account smoking, age, and inhaled corticosteroid (ICS) use. Asthma and COPD patients (24 of each category) were matched for ICS use, age, FEV(1), and smoking habits. Five pulmonary and five general pathologists examined bronchial biopsies using an interactive website, without knowing patient information. They were asked to diagnose asthma or COPD on biopsy findings in both a pairwise and randomly mixed order of cases during four different phases, with intervals of 4-6 weeks, covering a maximal period of 36 weeks. Clinically concordant diagnoses of asthma or COPD varied between 63 %-73 %, without important differences between pairwise vs randomly mixed examination or between general vs pulmonary pathologists. The highest percentage of concordant diagnoses was in young asthmatic patients without ICS use and in COPD patients with ICS use. In non ICS users with fixed airway obstruction, a COPD diagnosis was favored if abnormal presence of glands, squamous metaplasia, and submucosal infiltrate was present and an asthma diagnosis in case of abnormal presence of goblet cells. In ICS users with fixed airway obstruction, abnormal presence of submucosal infiltrates, basement membrane thickening, eosinophils, and glands was associated with asthma. Histological characteristics in bronchial biopsies are reproducibly recognized by pathologists, yet the differentiation by histopathology between asthma and COPD is difficult without information about ICS use.
authors.affiliation: Department of Pulmonology, University of Groningen, University Medical Center Groningen, PO Box 196, 9700 AD, Groningen, The Netherlands. f.fattahi@umcg.nl.|Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. f.fattahi@umcg.nl.|Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. f.fattahi@umcg.nl.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Fattahi
authors.affiliation: Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. j.m.vonk@umcg.nl.|Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. j.m.vonk@umcg.nl.
authors.forename: Judith M
authors.initials: JM
authors.lastname: Vonk
authors.affiliation: Department of Pathology, Spaarne Gasthuis Haarlem-Zuid, Haarlem, The Netherlands. n.bulkmans@kg.nl.
authors.forename: Nicole
authors.initials: N
authors.lastname: Bulkmans
authors.affiliation: Department of Pathology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands. r.fleischeuer@elisabeth.nl.
authors.forename: Ruth
authors.initials: R
authors.lastname: Fleischeuer
authors.affiliation: Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. a.s.h.gouw@umcg.nl.|Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. a.s.h.gouw@umcg.nl.
authors.forename: Annette
authors.initials: A
authors.lastname: Gouw
authors.affiliation: Department of Pathology, VU Medical Center, Amsterdam, The Netherlands. k.grunberg@vumc.nl.
authors.forename: Katrien
authors.initials: K
authors.lastname: Grünberg
authors.affiliation: Department of Pathology, Sao Paulo University, Sao Paulo, Brazil. tmauad@usp.br.
authors.forename: Thais
authors.initials: T
authors.lastname: Mauad
authors.affiliation: Institute of Pathology, Research Unit Molecular Lung and Pleura Pathology, Medical University Graz, Graz, Austria. helmut.popper@medunigraz.at.
authors.forename: Helmut
authors.initials: H
authors.lastname: Popper
authors.affiliation: Department of Pathology, Sao Paulo University, Sao Paulo, Brazil. aloisio_silva@ig.com.br.
authors.forename: Aloisio
authors.initials: A
authors.lastname: Felipe-Silva
authors.affiliation: Department of Surgical Pathology, University of Zurich, Zurich, Switzerland. bart.vrugt@usz.ch.
authors.forename: Bart
authors.initials: B
authors.lastname: Vrugt
authors.affiliation: Department Pathology, University of British Columbia, Vancouver, B.C., Canada. jlwright@mail.ubc.ca.
authors.forename: Joanne L
authors.initials: JL
authors.lastname: Wright
authors.affiliation: Department Pathology, University of British Columbia, Vancouver, B.C., Canada. huiminyang@hotmail.com.
authors.forename: Hui-Min
authors.initials: HM
authors.lastname: Yang
authors.affiliation: Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. j.w.h.kocks@umcg.nl.|Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. j.w.h.kocks@umcg.nl.
authors.forename: Janwillem W H
authors.initials: JW
authors.lastname: Kocks
authors.affiliation: Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. m.n.hylkema@umcg.nl.|Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. m.n.hylkema@umcg.nl.
authors.forename: Machteld N
authors.initials: MN
authors.lastname: Hylkema
authors.affiliation: Department of Pulmonology, University of Groningen, University Medical Center Groningen, PO Box 196, 9700 AD, Groningen, The Netherlands. d.s.postma@umcg.nl.|Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. d.s.postma@umcg.nl.
authors.forename: Dirkje S
authors.initials: DS
authors.lastname: Postma
authors.affiliation: Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. w.timens@umcg.nl.|Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. w.timens@umcg.nl.
authors.forename: Wim
authors.initials: W
authors.lastname: Timens
authors.affiliation: Department of Pulmonology, University of Groningen, University Medical Center Groningen, PO Box 196, 9700 AD, Groningen, The Netherlands. n.h.t.ten.hacken@umcg.nl.|Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. n.h.t.ten.hacken@umcg.nl.
authors.forename: Nick H T
authors.initials: NH
authors.lastname: Ten Hacken
mesh_terms: D000368:Aged; D001249:Asthma / Q000150:complications / Q000473:pathology*; D003937:Diagnosis, Differential; D004804:Eosinophils / Q000473:pathology; D005260:Female; D006801:Humans; D008168:Lung; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000473:pathology*; D012907:Smoking / Q000009:adverse effects
keywords: Asthma; Asthma COPD Overlap Syndrome; COPD; Pathology