Astım-KOAH overlap sendromu

Elif ŞEN, (Ankara Üniversitesi, Tıp Fakültesi, Göğüs Hastalıkları Anabilim Dalı, Ankara, Türkiye)
İPEK KIVILCIM OĞUZÜLGEN, (Gazi Üniversitesi, Tıp Fakültesi, Çocuk Göğüs Hastalıkları Anabilim Dalı, Ankara, Türkiye)
Sevim BAVBEK, (Ankara Üniversitesi, Tıp Fakültesi, Göğüs Hastalıkları Anabilim Dalı, İmmünoloji ve Allerji Hastalıkları Bilim Dalı, Ankara, Türkiye)
Hakan GÜNEN, (SB Süreyyapaşa Göğüs Hastalıkları ve Göğüs Cerrahisi Eğitim ve Araştırma Hastanesi, Gögüs Hastalıkları Bölümü, İstanbul, Türkiye)
Esen KIYAN, (İstanbul Üniversitesi, İstanbul Tıp Fakültesi, Göğüs Hastalıkları Anabilim Dalı, İstanbul, Türkiye)
Haluk TÜRKTAŞ, (Gazi Üniversitesi, Tıp Fakültesi, Çocuk Göğüs Hastalıkları Anabilim Dalı, Ankara, Türkiye)
Arzu YORGANCIOĞLU, (Celal Bayar Üniversitesi, Tıp Fakültesi, Göğüs Hastalıkları Anabilim Dalı, Manisa, Türkiye)
Mehmet POLATLI, (Adnan Menderes Üniversitesi, Tıp Fakültesi, Göğüs Cerrahisi Anabilim Dalı, Aydın, Türkiye)
Füsun YILDIZ, (Kocaeli Üniversitesi, Tıp Fakültesi, Göğüs Hastalıkları Anabilim Dalı, Kocaeli, Türkiye)
Gülfem ÇELİK, (Ankara Üniversitesi, Tıp Fakültesi, Göğüs Hastalıkları Anabilim Dalı, İmmünoloji ve Allerji Hastalıkları Bilim Dalı, Ankara, Türkiye)
Tunçalp DEMİR,
Bilun GEMİCİOĞLU,
Dilşad MUNGAN,
Sevgi SARYAL,
Abdullah SAYINER,
Nurhayat YILDIRIM,
Tüberküloz ve Toraks
23 1
Yıl: 2015 Cilt: 63 Sayı: 4 Sayfa Aralığı: 265 - 277 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Astım-KOAH overlap sendromu

Öz:
Astım-KOAH overlap sendromuAstım ve kronik obstrüktif akciğer hastalığı (KOAH), kronik hava yolu inflamasyonu ve hava yolu obstrüksiyonu ile karakterize olan ve toplumda sık görülen akciğer hastalıklarıdır. KOAH ve astımlı olgular arasında her iki hastalık için hava yolu inflamasyonunun ve dolayısıyla klinik, fonksiyonel özelliklerin örtüştüğü "Astım-KOAH Overlap Sendromu" (AKOS) olarak tanımlanan hastalar bulunmaktadır. AKOS; persistan hava akımı kısıtlaması (postbronkodilatör FEV/FVC < %70) ve reverzibilite ile karakterize, hem astım hem KOAH'ın bazı özelliklerini taşıyan bir sendromdur. Kırk yaş üzeri, sigara içmiş ve çocukluğunda astım öyküsü veya doktor tanılı astımı olan ve persistan hava akımı kısıtlaması ile birlikte reverzibl hava yolu obstüksiyonu (400 mcg salbutamol veya 1000 mcg terbutalin inhalasyonu sonrasında FEV'de bazal değere göre > %12 ve > 200 mL artış) olan hastada AKOS düşünülmelidir. AKOS prevalansı farklı hasta serilerinde %11-55 oranlarında bildirilmektedir. Yaşla birlikte AKOS oranı artmakta ve her yaş diliminde kadınlarda daha sık görülmektedir. AKOS'lu hastaların; KOAH'a göre genç ama astıma göre daha ileri yaşta hastalar olduğu ve daha semptomatik oldukları gösterilmiştir. Sık ve ağır atak geçirme, bu nedenle hastaneye yatış veya acile başvuru AKOS'ta sıktır ve bu durum hastaların yaşam kalitelerini olumsuz yönde etkilemektedir. Rehberlerde AKOS'un farmakolojik tedavisi astım ve KOAH için var olan en uygun tedavi seçeneklerinin kombinasyonundan oluşmaktadır. Gelecekte ortaya çıkacak tedaviler endotipe dayalı olmalıdır. Klinik fenotip ve altta yatan endotipe yönelik yapılacak klinik çalışmalar gelecekte yazılacak AKOS rehberlerinin temelini oluşturacaktır.
Anahtar Kelime:

Konular: Solunum Sistemi Alerji

Asthma-COPD overlap syndrome

Öz:
Asthma-COPD overlap syndromeAsthma and chronic obstructive pulmonary disease (COPD) are common lung diseases characterized by chronic airway inflammation and airway obstruction. Among patient with COPD and asthma; there is a group of patients with an overlap between clinical, functional characteristics and airway inflammation patterns, named "Asthma-COPD Overlap Syndrome" (ACOS). ACOS is a syndrome characterized by reversible but persistant airflow limitation (postbronchodilator FEV/FVC < 70%) which has some features of both asthma and COPD. ACOS should be suspected in a patient > 40 years, with smoking history, previous asthma diagnosis or history of childhood asthma who has persistant airflow limitation and reversible ariway obstruction (defined by an increase of > %12 of FEV pred or increase of FEV > 200 mL after inhalation of 400 mcg salbutamol or 1000 mcg terbutaline). The prevalence for ACOS has been reported 11-55% in different case series to date and increases by age and is more frequent in females in different age groups. Patients with ACOS are younger than COPD patients and older than asthma patients. Frequent and severe exacerbations and related hospitalization and emergency room visits are common in ACOS and this causes an impaired quality of life. Current recommendations of guidelines for pharmacologic treatment of ACOS have been composed of a combination with optimal COPD and asthma treatment. Future therapeutic approaches should be based on endotypes. Clinical phenotype and underlying endotype driven clinical studies may be the base of ACOS guidelines.
Anahtar Kelime:

Konular: Solunum Sistemi Alerji
Belge Türü: Makale Makale Türü: Derleme Erişim Türü: Erişime Açık
  • Diagnosis of Diseases of Chronic Airflow Limitation: Asthma, COPD and asthma-COPD overlap syndrome (ACOS) GINA, GOLD. Available from: http://www.goldcopd.org
  • Nakawah MO, Hawkins C, Barbandi F. Asthma, chronic obstructive pulmonary disease (COPD), and the overlap syndrome. Am Board Fam Med 2013;26:470-7.
  • Steveling EH, Clarenbach CF, Miedinger D, Enz C, Dürr S, Maier S, et al. Predictors of the overlap syndrome and its association with comorbidities in patients with chronic obstructive pulmonary disease. Respiration 2014;88:451-7.
  • Hardin M, Cho M, McDonald ML, Beaty T, Ramsdell J, Bhatt S, et al. The clinical and genetic features of COPD- asthma overlap syndrome. Eur Respir J 2014;44:341-50.
  • Jakovljevic M, Ostojic L. Comorbidity and multimorbidity in medicine today: challenges and opportunities for bringing separated branches of medicine closer to each other. Psychiatr Danub 2013;25(Suppl 1):S18-S28.
  • Divo M, Cote C, de Torres JP, Casanova C, Marin JM, Pinto- Plata V, et al. Comorbidities and risk of mortality in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2012;186:155-61.
  • Wenzel SE. Asthma phenotypes: the evolution from clinical to molecular approaches. Nat Med 2012;18:716-25.
  • Vestbo J. COPD: definition and phenotypes. Clin Chest Med 2014;35:1-6.
  • Agustí A. Phenotypes and disease characterization in chronic obstructive pulmonary disease. Toward the extinction of phenotypes? Ann Am Thorac Soc 2013;(Suppl 10):S125-S30.
  • Anderson GP. Endotyping asthma: new insights into key pathogenic mechanisms in a complex, heterogeneous disease. Lancet 2008;372:1107-19.
  • Lötvall J, Akdis CA, Bacharier LB, Bjermer L, Casale TB, Custovic A, et al. Asthma endotypes: a new approach to classification of disease entities within the asthma syndrome. J Allergy Clin Immunol 2011;127:355-60.
  • Bujarski S, Parulekar AD, Sharafkhaneh A, Hanania NA. The Asthma COPD overlap syndrome (ACOS) Curr Allergy Asthma Rep 2015;15:6-10
  • The Asthma Foundation. Available from: www.asthmafoundation.org.nz/wp-content/uploads/2012/03/ COPD. Available date: 26.03.2015.
  • O'Donnell DE, Aaron S, Bourbeau J, Hernandez P, Marciniuk DD, Balter M, et al. Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease-2007 update. Can Respir J 2007;14(Suppl B):5B-32B.
  • Committee for the Third Edition of the COPD Guidelines of the Japanese Respiratory Society. Guidelines for the Diagnosis and Treatment of COPD 3rd ed. Available date: 26.03.2015. Medical Review Co, Tokyo, 2009.
  • Miravitlles M, Soler-Cataluna JJ, Calle M, Molina J, Almagro P, Quintano JA, et al. Spanish Guideline for COPD (GesEPOC). Update 2014. Arch Bronconeumol 2014;50(Suppl 1):S1-S16.
  • Soriano JB, Davis KJ, Coleman B, Visick G, Mannino D, Pride NB. The proportional Venn diagram of obstructive lung disease: two approximations from the United States and the United Kingdom. Chest 2003;124:474-81.
  • de Marco R, Pesce G, Marcon A, Accordini S, Antonicelli L, Bugiani M, et al. The coexistence of asthma and chronic obstructive pulmonary disease (copd): prevalence and risk factors in young, middle-aged and elderly people from the general population. PLoS One 2013;10;8:e62985.
  • Hardin M, Silverman EK, Barr RG, Hansel NH, Schroeder JD, Make BJ, et al. The clinical features of the overlap between COPD and asthma. Respir Research 2011;12:127.
  • Miravitlles M, Soriano JB, Ancochea J, Munoz L, Duran- Tauleria E, Sánchez G, et al. Characterisation of the overlap COPD asthma phenotype. Focus on physical activity and health status. Respir Med 2013;107:1053-60.
  • Zeki AA, Schivo M, Chan A, Albertson TE, Louie S. The asthma-COPD overlap syndrome: a common clinical problem in the elderly. J Allergy (Cairo) 2011; 2011:861926.
  • Shi W, Bellusci S, PhD, Warburton D. Lung development and adult lung diseases. Chest 2007;132:651-6.
  • Postma DS, Kerkhof M, Boezen HM, Koppelman G. Asthma and chronic obstructive pulmonary disease common genes, common environments? Am J Respir Crit Care 2011;183:1588-94.
  • Stocks J, Sonnappa S. Early life influences on the development of chronic obstructive pulmonary disease. Ther Adv Respir Dis 2013;7:161-73.
  • Postma DS, Boezen HM. Rationale for the Dutch Hypothesis allergy and airway hyperresponsiveness as genetic factors and their interaction with environment in the development of asthma and COPD. Chest 2004;126:96S-104S.
  • Smolonska J, Koppelman GH, Wijmenga C, Vonk JM, Zanen P, Bruinenberg M, et al. Common genes underlying asthma and COPD? Genome-wide analysis on the Dutch Hypothesis. Eur Respir J 2014;44:860-8.
  • Brutsche MH, Downs SH, Schindler C, Gerbase MW, Schwartz J, Frey M, et al. Bronchial hyperresponsiveness and the development of asthma and COPD in asymptomatic individuals: SAPALDIA Cohort Study. Thorax 2006;61:671-7.
  • Tai A, Tran H, Roberts M, Clarke N, Wilson J, Robertson CF. The association between childhood asthma and adult chronic obstructive pulmonary disease. Thorax 2014; 69:805-10.
  • Silva GE, Sherrill DL, Guerra S, Barbee RA. Asthma as a risk factor for COPD in a longitudinal study. Chest 2004;126:59- 65.
  • Matsunaga K, Ichikawa T, Oka A, Morishita Y, Kanai K, Hiramatsu M, et al. Changes in forced expiratory volume in 1 second over time in patients with controlledasthma at baseline. Respir Med 2014;108:976-82.
  • Bai TR, Vonk JM, Postma DS, Boezen HM. Severe exacerbations predict excess lung function decline in asthma. Eur Respir J 2007;30:452-6.
  • Amelink M, de Nijs SB, Berger M, Weersink EJ, ten Brinke A, Sterk PJ, et al. Non-atopic males with adult onset asthma are at risk of persistent airflow limitation. Clin Exp Allergy 2012;42:769-7.
  • Contoli M, Baraldo S, Marku B, Casolari P, Marwick JA, Turato G, et al. Fixed airflow obstruction due to asthma or chronic obstructive pulmonary disease: 5-year follow-up. J Allergy Clin Immunol 2010;125:830-7.
  • Bumbacea D, Campbell D, Nguyen L, Carr D, Barnes PJ, Robinson D, et al. Parameters associated with persistent airflow obstruction in chronic severe asthma. Eur Respir J 2004;24:122-8.
  • Gibson PG, Simpson JL. The overlap syndrome of asthma and COPD: what are its features and how important is it? Thorax 2009;64:728-35.
  • Menezes AM, Montes de Oca M, Pérez-Padilla R, Nadeau G, Wehrmeister FC, Lopez-Varela MV, et al; PLATINO Team. Increased risk of exacerbation and hospitalization in subjects with an overlap phenotype COPD-Asthma. Chest 2014;145:297-304.
  • Lee HY, Kang JY, Yoon HK, Lee SY, Kwon SS, Kim YK, et al. Clinical characteristics of asthma combined with COPD feature. Yonsei Med J 2014;55:980-6.
  • Kauppi P, Kupiainen H, Lindqvist A, Tammilehto L, Kilpeläinen M, Kinnula VL, et al; Overlap syndrome of asthma and COPD predicts low quality of life. J Asthma 2011;48:279-85.
  • Chung JW, Ae Kong K, Lee JH, Lee SJ, Ryu YJ, Chang HJ. Characteristics and self-rated health of overlap syndrome. Int J COPD 2014;9:795-804.
  • Shaya FT, Dongyi D, Akazawa MO, Blanchette CM, Wang J, Mapel DW, et al. Burden of concomitant asthma and COPD in a Medicaid population. Chest 2008;134:14-9.
  • Rhee CK, Yoon HK, Yoo KH, Kim YS, Lee SW, Park YB, et al. Medical utilization and cost in patients with overlap syndrome of chronic obstructive pulmonary disease and asthma. COPD 2014;11:163-170.
  • Diaz-Guzman E, Khosravi M, Mannino DM. Asthma, chronic obstructive pulmonary disease, and mortality in the U.S. population. COPD 2011;8:400-7.
  • Fu JJ, Gibson PG, Simpson JL, McDonald VM. Longitudinal changes in clinical outcomes in older patients with asthma, COPD and asthma-COPD overlap syndrome. Respiration 2014;87:63-74.
  • Louie S, Zeki AA, Schivo M, Chan AW, Yoneda KY, Avdalovic M, et al. The astma- COPD overlap syndrome: pharmacotherapeutic considerations. Expert Rev Clin Pharmacol 2013;6:197-219.
  • Soler-Cataluna JJ, Cosio B, Izguierdo JL, Lopez-Campos JL, Marin JM, Aguero R, et al. Consensus document on the Overlap Phenotype COPD-Asthma in COPD. Arch Bronconeumol 2012;48:331-7.
  • Papaiwannou A, Zarogoulidis P, Porpodis K, Spyratos D, Kioumis I, Pitsiou G, et al. Asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS): current literature review. J Thorac Dis 2014;6:S146-S51.
  • Global Initiative for Asthma. Accesed date: 2015. Available from: www.ginasthma.org.
  • Yoshida M, Nakano T, Fukuyama S, Matsumoto T, Eguchi M, Moriwaki A, et al. Effects of tiotropium on lung function in severe asthmatics with or without emphysematous changes. Pulm Pharmacol Ther 2013;26:159-16.
  • Kim SR, Rhee YK. Overlap between asthma and COPD: Where the two diseases converge. Allergy Asthma Immunol Res 2010;2:209-14.
  • Douwes J, Gibson P, Pekkanen J, Pearce N. Non- eosinophilic asthma: importance and possible mechanisms. Thorax 2002;57:643-8.
  • Chalmers GW, Macleod KJ, Little SA, Thomson LJ, McSharry CP, Thomson NC. Influence of cigarette smoking on inhaled corticosteroid treatment in mild asthma. Thorax 2002;57:226-30.
  • Chaudhuri R, Livingston E, McMahon AD, Thomson L, Borland W, Thomson NC. Cigarette smoking impairs the therapeutic response to oral corticosteroids in chronic asthma. Am J Respir Crit Care Med 2003;168:1308-11.
  • Chanez P, Vignola AM, O'Shaugnessy T, Enander I, Li D, Jeffery PK, et al. Corticosteroid reversibility in COPD is related to features of asthma. Am J Respir Crit Care Med 1997;155:1529-34.
  • Siva R, Green RH, Brightling CE, Shelley M, Hargadon B, McKenna S, et al. Eosinophilic airway inflammation and exacerbations of COPD: a randomised controlled trial. Eur Respir J 2007;29:906-13.
  • Christenson SA, Steiling K, van den Berge M, Hijazi K, Hiemstra PS, Postma DS, et al. Asthma-COPD overlap. clinical relevance of genomic signatures of type 2 inflammation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2015;191:758-66.
  • Fahy JV, Kim KW, Liu J, Boushey HA. Prominent neutrophilic inflammation in sputum from subjects with asthma exacerbation. J Allergy Clin Immunol 1995;95:843-52.
  • Zhu J, Qiu YS, Majumdar S, Gamble E, Matin D, Turato G, et al. Exacerbations of bronchitis: bronchial eosinophilia and gene expression for interleukin-4, interleukin-5, and eosinophil chemoattractants. Am J Respir Crit Care Med 2001;164:109-16.
  • Mauad T, Silva LF, Santos MA, Grinberg L, Bernardi FD, Martins MA, et al. Abnormal alveolar attachments with decreased elastic fiber content in distal lung in fatal asthma. Am J Respir Crit Care Med 2004;170:857-62.
  • Zheng T, Zhu Z, Wang Z, Homer RJ, Ma B, Riese RJ Jr, et al. Inducible targeting of IL-13 to the adult lung causes matrix metalloproteinase- and cathepsin-dependent emphysema. J Clin Invest 2000;106:1081-93.
  • Iwamoto H, Gao J, Koskela J, Kinnula V, Kobayashi H, Laitinen T, et al. Differences in plasma and sputum biomarkers between COPD and COPD-asthma overlap. Eur Respir J 2014;43:421-9.
  • Fu JJ, McDonald VM, Gibson PG, Simpson JL. Systemic inflammation in older adults with asthma-COPD overlap syndrome. Allergy Asthma Immunol Res 2014;6:316-24.
  • Ghebre MA, Bafadhel M, Desai D, Cohen SE, Newbold P, Rapley L, et al. Biological clustering supports both "Dutch" and "British" hypotheses of asthma and chronic obstructive pulmonary disease. J Allergy Clin Immunol 2015;135:63-72.
  • Kaneko Y, Yatagai Y, Yamada H, Iijima H, Masuko H, Sakamoto T, et al. The search for common pathways underlying asthma and COPD. Int J Chron Obstruct Pulmon Dis 2013;8:65-78.
APA SEN E, OĞUZÜLGEN İ, Bavbek S, Gunen H, KIYAN E, turktas h, YORGANCIOĞLU A, POLATLI M, Yildiz F, ÇELİK G, DEMİR T, Gemicioglu B, Mungan D, SARYAL S, Sayiner A, YILDIRIM N (2015). Astım-KOAH overlap sendromu. , 265 - 277.
Chicago SEN ELIF,OĞUZÜLGEN İPEK KIVILCIM,Bavbek Sevim,Gunen Hakan,KIYAN Esen,turktas haluk,YORGANCIOĞLU Arzu,POLATLI MEHMET,Yildiz Fusun,ÇELİK Gülfem,DEMİR Tunçalp,Gemicioglu Bilun,Mungan Dilşad,SARYAL SEVGI BEHIYE,Sayiner Abdullah,YILDIRIM Nurhayat Astım-KOAH overlap sendromu. (2015): 265 - 277.
MLA SEN ELIF,OĞUZÜLGEN İPEK KIVILCIM,Bavbek Sevim,Gunen Hakan,KIYAN Esen,turktas haluk,YORGANCIOĞLU Arzu,POLATLI MEHMET,Yildiz Fusun,ÇELİK Gülfem,DEMİR Tunçalp,Gemicioglu Bilun,Mungan Dilşad,SARYAL SEVGI BEHIYE,Sayiner Abdullah,YILDIRIM Nurhayat Astım-KOAH overlap sendromu. , 2015, ss.265 - 277.
AMA SEN E,OĞUZÜLGEN İ,Bavbek S,Gunen H,KIYAN E,turktas h,YORGANCIOĞLU A,POLATLI M,Yildiz F,ÇELİK G,DEMİR T,Gemicioglu B,Mungan D,SARYAL S,Sayiner A,YILDIRIM N Astım-KOAH overlap sendromu. . 2015; 265 - 277.
Vancouver SEN E,OĞUZÜLGEN İ,Bavbek S,Gunen H,KIYAN E,turktas h,YORGANCIOĞLU A,POLATLI M,Yildiz F,ÇELİK G,DEMİR T,Gemicioglu B,Mungan D,SARYAL S,Sayiner A,YILDIRIM N Astım-KOAH overlap sendromu. . 2015; 265 - 277.
IEEE SEN E,OĞUZÜLGEN İ,Bavbek S,Gunen H,KIYAN E,turktas h,YORGANCIOĞLU A,POLATLI M,Yildiz F,ÇELİK G,DEMİR T,Gemicioglu B,Mungan D,SARYAL S,Sayiner A,YILDIRIM N "Astım-KOAH overlap sendromu." , ss.265 - 277, 2015.
ISNAD SEN, ELIF vd. "Astım-KOAH overlap sendromu". (2015), 265-277.
APA SEN E, OĞUZÜLGEN İ, Bavbek S, Gunen H, KIYAN E, turktas h, YORGANCIOĞLU A, POLATLI M, Yildiz F, ÇELİK G, DEMİR T, Gemicioglu B, Mungan D, SARYAL S, Sayiner A, YILDIRIM N (2015). Astım-KOAH overlap sendromu. Tüberküloz ve Toraks, 63(4), 265 - 277.
Chicago SEN ELIF,OĞUZÜLGEN İPEK KIVILCIM,Bavbek Sevim,Gunen Hakan,KIYAN Esen,turktas haluk,YORGANCIOĞLU Arzu,POLATLI MEHMET,Yildiz Fusun,ÇELİK Gülfem,DEMİR Tunçalp,Gemicioglu Bilun,Mungan Dilşad,SARYAL SEVGI BEHIYE,Sayiner Abdullah,YILDIRIM Nurhayat Astım-KOAH overlap sendromu. Tüberküloz ve Toraks 63, no.4 (2015): 265 - 277.
MLA SEN ELIF,OĞUZÜLGEN İPEK KIVILCIM,Bavbek Sevim,Gunen Hakan,KIYAN Esen,turktas haluk,YORGANCIOĞLU Arzu,POLATLI MEHMET,Yildiz Fusun,ÇELİK Gülfem,DEMİR Tunçalp,Gemicioglu Bilun,Mungan Dilşad,SARYAL SEVGI BEHIYE,Sayiner Abdullah,YILDIRIM Nurhayat Astım-KOAH overlap sendromu. Tüberküloz ve Toraks, vol.63, no.4, 2015, ss.265 - 277.
AMA SEN E,OĞUZÜLGEN İ,Bavbek S,Gunen H,KIYAN E,turktas h,YORGANCIOĞLU A,POLATLI M,Yildiz F,ÇELİK G,DEMİR T,Gemicioglu B,Mungan D,SARYAL S,Sayiner A,YILDIRIM N Astım-KOAH overlap sendromu. Tüberküloz ve Toraks. 2015; 63(4): 265 - 277.
Vancouver SEN E,OĞUZÜLGEN İ,Bavbek S,Gunen H,KIYAN E,turktas h,YORGANCIOĞLU A,POLATLI M,Yildiz F,ÇELİK G,DEMİR T,Gemicioglu B,Mungan D,SARYAL S,Sayiner A,YILDIRIM N Astım-KOAH overlap sendromu. Tüberküloz ve Toraks. 2015; 63(4): 265 - 277.
IEEE SEN E,OĞUZÜLGEN İ,Bavbek S,Gunen H,KIYAN E,turktas h,YORGANCIOĞLU A,POLATLI M,Yildiz F,ÇELİK G,DEMİR T,Gemicioglu B,Mungan D,SARYAL S,Sayiner A,YILDIRIM N "Astım-KOAH overlap sendromu." Tüberküloz ve Toraks, 63, ss.265 - 277, 2015.
ISNAD SEN, ELIF vd. "Astım-KOAH overlap sendromu". Tüberküloz ve Toraks 63/4 (2015), 265-277.
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