Airway remodelling augmented in patients with asthma COPD overlap (ACO) compared to asthma and COPD

Background: Management of ACO is clinically challenging due to insufficient evidence on pathological changes in these patients. Aim: To evaluate large airway remodelling changes in patients with ACO compared to asthma, COPD ex-smokers (ES) and current smokers (CS), non-smoking normal controls (NC), and normal lung function smokers (NLFS). Methods: Endobronchial biopsy tissue from 12 ACO, 14 asthmatics, 12 COPD‑ES, 11 CS, 28 NC, and 13 NLFS were stained with Masson’s trichrome. Epithelial and goblet cells/mm reticular basement membrane (RBM); total lamina propria (LP) cells/mm2 up to 120 µm deep were enumerated for the area surveyed; RBM, epithelial, and smooth muscle (SM) thickness were analysed using imaging software ImageProPlus V7.0. Results: Compared to asthma and COPD, ACO showed differential remodelling pattern. The RBM was significantly thicker in ACO than asthmatics (p Conclusions: Our findings suggest that ACO patients had severe tissue remodelling changes than asthmatics and COPD patients.