Networks: Omega-3s, reflux, OLDs, and OSA
Dr. Hassan Bencheqroun, FCCP
Steering Committee Member
Bibliography
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Puisieux F, D’Andra C, Baconnier P, et al. Swallowing disorders, pneumonia and respiratory tract infections disease in the elderly. Rev Mal Respir. 2011;28(8):e76-93.
Clinical Pulmonary Medicine
On obstructive lung disease and obstructive sleep apnea: time to revisit nosologies?
Obstructive lung diseases (OLDs), such as asthma, chronic bronchitis, emphysema, or COPD are very prevalent conditions. OLD definitions: (1) span distinct domains (clinical, functional, anatomical, tomographic, etc); (2) frequently overlap; and (3) are defined functionally by either pre- or postbronchodilator FEV1/FVC ratio (R). Fixed (0.70) vs lower-limit-of-normal R thresholds could either underestimate or overestimate OLD prevalence; similarly, postbronchodilator (vs pre-bronchodilator) R may also underestimate prevalence of COPD, especially in younger subjects. Several recent and promising attempts proposed to explore OLD phenotypes with newer methodologies (eg, cluster analysis, genomics, metabolomics, proteomics, etc), which do not rely on a priori assumptions on best-split levels for different OLD categories.
OSA is also a common condition which features bidirectional interactions with OLDs. They share several risk factors, such as obesity, smoking, nasal disease, increased airway resistance, and local and systemic inflammation. OSA is associated with worse clinical outcomes in patients with OLD, while positive airway pressure therapy seems to have beneficial effects in this setting.
While the term "overlap syndrome" has been used before for the comorbid association of COPD and OSA, we recently proposed the term "alternative overlap syndrome" for asthma and OSA. In an effort to further encourage investigations in this area, we also proposed an integrated, lumping nomenclature for OSA in the setting of OLD, "OLDOSA" (obstructive lung disease and obstructive sleep apnea) syndrome.1 In the future, this relumping approach will hopefully become productive by generating more refined and robust phenotypic or nosologic characterizations.
Octavian C. Ioachimescu, MD, PhD
Vice-Chair
Reference
1. Ioachimescu OC, Teodorescu M. Integrating the overlap of obstructive lung disease and obstructive sleep apnea: OLDOSA syndrome. Respirology. 2013;18(3):421-431.
