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Multicenter Study
. 2018 Oct 18:13:3411-3417.
doi: 10.2147/COPD.S174545. eCollection 2018.

Decreased serum club cell secretory protein in asthma and chronic obstructive pulmonary disease overlap: a pilot study

Jee Youn Oh  1 , Young Seok Lee  1 , Kyung Hoon Min  1 , Gyu Young Hur  1 , Sung Yong Lee  1 , Kyung Ho Kang  1 , Chin Kook Rhee  2 , Seoung Ju Park  3 , Jae Jeong Shim  1
Affiliations
Multicenter Study

Decreased serum club cell secretory protein in asthma and chronic obstructive pulmonary disease overlap: a pilot study

Jee Youn Oh et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Purpose: Improvement in the diagnosis of asthma and chronic obstructive pulmonary disease (COPD) overlap (ACO), and identification of biomarkers for phenotype recognition will encourage good patient care by providing optimal therapy. We investigated club cell secretory protein (CC-16), a protective and anti-inflammatory mediator, as a new candidate biomarker for diagnosing ACO.

Patients and methods: We performed a multicenter cohort study. A total of 107 patients were divided into three groups - asthma, COPD, and ACO - according to the Spanish guidelines algorithm, and enrolled into the study. Serum CC-16 levels were measured using commercial ELISA kits.

Results: Serum CC-16 levels were the lowest in patients with ACO. Low serum CC-16 levels were a significant marker for the ACO even after adjustment for age, sex, and smoking intensity. Serum CC-16 levels were positively correlated with forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), forced expiratory flow at 25%-75% of FVC, FEV1/FVC, vital capacity, and diffusing capacity of the lung for carbon monoxide, and were negatively correlated with smoking amount (pack-years), bronchodilator response, fractional residual capacity, residual volume, and number of exacerbations per year. FEV1 and serum CC-16 levels were significantly lower in patients with frequent exacerbations.

Conclusion: Serum CC-16 has the potential to be a biomarker for ACO diagnosis and also treat frequent exacerbations in patients with chronic inflammatory airway diseases.

Keywords: ACO; COPD; asthma; club cell secretory protein-16; exacerbation; smoking.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Serum CC-16 levels in chronic inflammatory airway diseases according to disease classification. Notes: (A) Serum CC-16 levels in patients with asthma, COPD, or ACO (asthma vs COPD, P=0.006; asthma vs ACO, P<0.001; COPD vs ACO, P=0.012); (B) Serum CC-16 levels in patients with asthma, COPD, smoking-related obstructive asthma, or COPD with a very positive BDR and/or eosinophilia (asthma vs COPD, P=0.006; asthma vs smoking-related obstructive asthma, P<0.001; asthma vs COPD with a very positive BDR and/or blood eosinophilia, P<0.001; COPD vs smoking related obstructive asthma, P=0.036; COPD vs COPD with a very positive BDR and/or blood eosinophilia, P=0.011; smoking-related obstructive asthma vs COPD with a very positive BDR and/or blood eosinophilia, P=0.248). Abbreviations: ACO, asthma–COPD overlap; BDR, bronchodilator response; CC, club cell secretory protein; COPD, chronic obstructive pulmonary disease.
Figure 2
Figure 2
Correlation between serum CC-16 levels and parameters. Notes: (A) Correlation between serum CC-16 levels and FEV1 (R=0.423; P<0.001); (B) Correlation between serum CC-16 levels and FVC (R=0.192; P=0.047); (C) Correlation between serum CC-16 levels and FEV1/FVC (R=0.397; P<0.001); (D) Correlation between serum CC-16 levels and DLCO (R=0.255; P=0.008); (E) Correlation between serum CC-16 levels and smoking amount (R=−0.258; P=0.007); (F) Correlation between serum CC-16 levels and BDR (R=−0.313; P=0.001). Abbreviations: BDR, bronchodilator response; CC, club cell secretory protein; DLCO, diffusing capacity of the lung for carbon monoxide; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity.
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