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We aim to test the hypothesis that the non\u2010emphysematous patients are distinct from the main body of<jats:styled-content style=\"fixed-case\">COPD<\/jats:styled-content>and are more akin to asthmatic patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We studied 54 patients with<jats:styled-content style=\"fixed-case\">COPD<\/jats:styled-content>. Emphysema was measured by Goddard's visual scoring of<jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>scan and the carbon monoxide transfer coefficient (<jats:styled-content style=\"fixed-case\">KCO<\/jats:styled-content>). Bronchial biopsy was offered for thickness of basement membrane (<jats:styled-content style=\"fixed-case\">BM<\/jats:styled-content>) (\u22657 \u00b5m) as a marker of remodelling in irreversible asthma. Spirometry was repeated after therapy with Budesonide\/Formoterol for 1 year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The non\u2010emphysematous phenotype were 24 of 54 patients (44%) by<jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>scan and 23 of 54 patients (43%) by<jats:styled-content style=\"fixed-case\">KCO<\/jats:styled-content>, showing agreement in 53 out of 54 patients. The non\u2010emphysematous patients were younger, had higher forced expiratory volume in 1 s (<jats:styled-content style=\"fixed-case\">FEV<jats:sub>1<\/jats:sub><\/jats:styled-content>) (median 61% vs 49.7%), greater prevalence of hypertrophy of nasal turbinates and higher serum<jats:styled-content style=\"fixed-case\">IgE<\/jats:styled-content>. The emphysematous phenotype had lower<jats:styled-content style=\"fixed-case\">BMI<\/jats:styled-content>and greater dyspnoea score. The<jats:styled-content style=\"fixed-case\">BM<\/jats:styled-content>was thickened in 11 of 14 and 0 of 10 patients in the non\u2010emphysematous and emphysematous groups, respectively. Three patients without emphysema and a normal<jats:styled-content style=\"fixed-case\">BM<\/jats:styled-content>normalized their<jats:styled-content style=\"fixed-case\">FEV<jats:sub>1<\/jats:sub><\/jats:styled-content>upon receiving inhaled corticosteroid (<jats:styled-content style=\"fixed-case\">ICS<\/jats:styled-content>)\/long\u2010acting \u03b22 agonist (<jats:styled-content style=\"fixed-case\">LABA<\/jats:styled-content>). All the non\u2010emphysematous improved their<jats:styled-content style=\"fixed-case\">FEV<jats:sub>1<\/jats:sub><\/jats:styled-content>after<jats:styled-content style=\"fixed-case\">ICS<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">LABA<\/jats:styled-content>(median = 215 mL). The median decline in the emphysematous was \u221265 mL.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The non\u2010emphysematous phenotype of<jats:styled-content style=\"fixed-case\">COPD<\/jats:styled-content>displays important features of asthma: clinical picture, histology and response to<jats:styled-content style=\"fixed-case\">ICS<\/jats:styled-content>.<jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>and<jats:styled-content style=\"fixed-case\">KCO<\/jats:styled-content>can predict spirometric response to<jats:styled-content style=\"fixed-case\">ICS<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">LABA<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/resp.12902","type":"journal-article","created":{"date-parts":[[2016,9,14]],"date-time":"2016-09-14T00:36:40Z","timestamp":1473813400000},"page":"322-328","source":"Crossref","is-referenced-by-count":10,"title":["Can computed tomography and carbon monoxide transfer coefficient diagnose an asthma\u2010like phenotype in COPD?"],"prefix":"10.1111","volume":"22","author":[{"given":"Feisal A.","family":"Al\u2010Kassimi","sequence":"first","affiliation":[{"name":"Department of Medicine King Saud University Riyadh Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esam H.","family":"Alhamad","sequence":"additional","affiliation":[{"name":"Department of Medicine King Saud University Riyadh Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed S.","family":"Al\u2010Hajjaj","sequence":"additional","affiliation":[{"name":"Department of Medicine King Saud University Riyadh Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emad","family":"Raddaoui","sequence":"additional","affiliation":[{"name":"Department of Pathology Alfaisal University Riyadh Saudi Arabia"},{"name":"Department of Pathology King Saud University Riyadh Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdulaziz H.","family":"Alzeer","sequence":"additional","affiliation":[{"name":"Critical Care Department King Saud University Riyadh Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmad A.","family":"Alboukai","sequence":"additional","affiliation":[{"name":"Department of Radiology King Saud University Riyadh Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali M.","family":"Somily","sequence":"additional","affiliation":[{"name":"Department of Pathology King Saud University Riyadh Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph G.","family":"Cal","sequence":"additional","affiliation":[{"name":"Department of Medicine King Saud University Riyadh Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdalla F.","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Department of Medicine King Saud University Riyadh Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaffi A.","family":"Shaik","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine King Saud University Riyadh Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,9,13]]},"reference":[{"key":"e_1_2_7_2_1","first-page":"3","article-title":"The history of COPD","volume":"1","author":"Petty TL","year":"2006","journal-title":"Int. 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