Asthma and COPD Overlap Syndrome (ACOS): A Systematic Review and Meta Analysis

Alshabanat, Abdulmajeed; Zafarí, Zafar; Albanyan, Omar; Dairi, Mohammad S; FitzGerald, J. Mark

doi:10.1371/journal.pone.0136065

Cited by 239 publications

(193 citation statements)

References 42 publications

(109 reference statements)

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“…168,169 Although both a recent systematic review and a meta-analysis report higher health care utilization and worse outcomes for ACO patients when compared to asthma or COPD alone, both articles highlight that without a consensus definition or diagnostic criteria, there are significant limitations to the reliability of the data. 170,171 Secondly, there are no consistent recommendations regarding the evaluation of patients with suspected ACO. There remains no consistent agreement among experts as to which historical factors are required (e.g.…”

Section: Box 2 Preventing Acute Exacerbation In Stable Copdmentioning

confidence: 99%

CTS position statement: Pharmacotherapy in patients with COPD—An update

Bourbeau

Bhutani

Hernández

et al. 2017

Canadian Journal of Respiratory, Critical Care, and Sleep Medic

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RATIONALE: Since the last published Canadian Thoracic Society (CTS) COPD guideline in 2007 and the 2008 update -highlights for primary care, many new clinical trials have challenged COPD treatment practices. The current Canadian position statement provides the reader with an update on pharmacotherapy of patients with COPD as reviewed by the CTS. OBJECTIVES: The objectives of this position statement are: 1) to summarize the literature on topics relevant to the pharmacological therapy of patients with stable COPD; and 2) to provide clinical guidance with evidence-based recommendations and expert-informed key messages for the pharmacological therapy for patients with stable COPD. METHODS: The authors systematically reviewed the relevant literature focusing on randomized controlled trials and when available, systematic reviews of randomized controlled trials. The proposed key messages, based on scientific evidence and expert-informed opinion, were agreed upon by a majority consensus. MAIN RESULTS: There is typically a significant delay in seeking medical care by patients with dyspnea, often waiting until symptoms affect the performance of activities of daily living. The diagnosis of COPD requires spirometry to confirm the presence of airflow obstruction in any patient presenting with symptoms and/or risk factors of COPD. An effective management plan for individuals with COPD should include: smoking cessation, vaccination and education. A number of non-pharmacological treatments are available for COPD patients with symptoms to improve outcomes such as self-management with coaching from a health care professional; pulmonary rehabilitation; supplemental oxygen in selected patients; and surgery.Current pharmacotherapy for COPD has been shown to alleviate symptoms and prevent exacerbations and related complications such as hospital admissions. In symptomatic patients with stable COPD not having or having infrequent exacerbation, treatment should be started with inhaled LAMA or LABA monotherapy, and if experiencing persistent or increased dyspnea, exercise intolerance, and/or reduced health status despite use of monotherapy, patients should be considered for treatment "step up" with an inhaled LAMA plus LABA dual therapy. In this situation, the use of a single inhaler would be preferred to simplify the treatment regimen and minimize the cost. In patients with stable COPD experiencing exacerbations despite the use of LAMA or LABA monotherapy, treatment "step up" with inhaled LAMA plus LABA dual therapy should be considered unless a patient has concomitant asthma (Asthma/COPD overlap (ACO)). There has been recent interest in using biomarkers to identify patients who are more likely to respond to ICS. Most of the studies have demonstrated that high blood eosinophils could be valuable to predict an increase response in terms of reduction of exacerbation rate when treated with combination ICS/LABA; there is still uncertainty about the exact cut-off level of blood eosinophils having potential therapeutic value. If a pa...

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Section: Box 2 Preventing Acute Exacerbation In Stable Copdmentioning

confidence: 99%

CTS position statement: Pharmacotherapy in patients with COPD—An update

Bourbeau

Bhutani

Hernández

et al. 2017

Canadian Journal of Respiratory, Critical Care, and Sleep Medic

View full text Add to dashboard Cite

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“…A kiindulási légzésfunkciós értékek esetében megoszlanak az eredmények a különböző tanulmányokban, jelentős különbséget nem sikerült kimutatni az ACOSbetegek esetében a COPD-csoporthoz képest [42]. A hörgőtágító alkalmazását követő légúti reverzibilitás tekintetében azonban az ACOS-betegek esetében jelentősebb javulás figyelhető meg a COPD-betegekhez ké-pest [43,44].…”

Section: Bronchodilatator-reverzibilitás éS Bhrunclassified

Asthma-COPD overlap szindróma

Odler

Müller

2016

Orvosi Hetilap

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Az obstruktív tüdőbetegségek világszerte jelentős népegészségügyi problémát jelentenek, magas prevalenciájuk és a társadalmat érintő nagy szocioökonómiai költségeik miatt. Az asthma bronchiale és a krónikus obstruktív tüdőbeteg-ség krónikus légúti gyulladással járó betegségek, amelyeket légúti obstrukció jellemez, azonban külön nozológiai entitások, figyelembe véve kialakulásukat, diagnosztikájukat, a terápiás megfontolásokat és prognosztikai jellemzői-ket. A két betegség együttesen is előfordulhat, vagy az egyik állapot képes a másik jellemzőit felvéve, abba átalakulni. Ezt a kevert asthma-COPD fenotípust nevezzük asthma-COPD overlap szindrómának, amelyet úgy jellemeznek, hogy olyan perzisztáló légúti áramláskorlátozottsággal járó betegség, amely rendelkezik mind az asthma, mind a krónikus obstruktív tüdőbetegség egyes jellemzőivel. A szindróma az elmúlt években jelentős figyelmet kapott, azonban a betegek nagy része mostanáig kizárásra került a klinikai és légúti gyógyszer-hatásossági vizsgálatokból, így a jól meghatározott klinikai jellemzők és a megfelelő terápia továbbra sem ismertek. Az összefoglaló közlemény elsődleges célja az elmúlt években leírt patofiziológiai és klinikai jellemzők, terápiás megfontolások és irodalmi újdonságok bemutatása. Orv. Hetil., 2016, 157(33), 1304-1313. Kulcsszavak: ACOS overlap szindróma, COPD, asthma bronchiale, obstruktív, terápia Asthma-COPD overlap syndromeObstructive lung diseases represent a major health problem worldwide due to their high prevalence associated with elevated socioeconomic costs. Bronchial asthma and chronic obstructive pulmonary disease are chronic obstructive ventilatory disorders with airway inflammation, however they are separate nosological entities based on thedifferent development, diagnostic and therapeutic approaches, and prognostic features. However, these diseases may coexist and can be defined as the coexistence of increased variability of airflow in a patient with incompletely reversible airway obstruction. This phenotype is called asthma -chronic obstructive pulmonary disease overlap syndrome. The syndrome is a clinical and scientific challenge as the majority of these patients have been excluded from the clinical and pharmacological trials, thus well-defined clinical characteristics and therapeutic approaches are lacking. The aim of this review is to summarize the currently available literature focusing on pathophysiological and clinical features, and discuss possible therapeutic approaches of patients with asthma -chronic obstructive pulmonary disease overlap syndrome. -nél kisebb erek átmérőjének százalékos ará-nya; AA = afroamerikai; ACOS = asthma-COPD overlap szindróma; ACT = asthmakontrollteszt; BHR = fokozott válaszadó készség; BMI = testtömegindex; BODE-index = body mass index (testtömegindex), airflow obstruction (légúti obstrukció), dyspnea and exercise capacity (légszomj és terhelési kapacitás); BOLD = Burden of Obstructive Lung Diseases; CAT = COPD Assessment Test; COPD = krónikus obstruktív tüdőbe-tegség; CRP = C reaktív protei...

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“…However, a significant proportion of patients often present with overlapping conditions, which has now become a major health concern worldwide, accounting for approximately 15-25% of the obstructive airway diseases with patients experiencing worse outcomes compared with either of the conditions alone (2)(3)(4). Majorly, patients of a chronic airway disease present with a syndrome comprising symptoms of both asthma and COPD, the exact definition of which remains ambiguous (2).…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, lack of specific biomarkers for ACOS makes the diagnosis more difficult (5). Recurrent exacerbations, rapid disease progression, diminished health-related quality of life, rapidly deteriorating lung function, high co-morbidities, increased reversibility of airflow obstruction, eosinophilic bronchial and systemic inflammation, frequent hospitalization, and high mortality rates are frequently observed in such patients and they tend to receive an inconsistent healthcare management compared with either of the conditions alone (3)(4)(5)9,10). A stepwise approach for diagnosis and treatment of asthma, COPD, and ACOS is advised in the recent 2015 Global Initiative for Asthma (GINA) report along with differentiating features that identify and characterize ACOS (4).…”

Section: Introductionmentioning

confidence: 99%