Asthma-COPD Overlap—A Discordance Between Patient Populations Defined by Different Diagnostic Criteria

Barczyk, Adam; Maskey-Warzęchowska, Marta; Górska, Katarzyna; Barczyk, Marek; Krzemieniecki, Krzysztof; Śliwiński, Paweł; Batura‐Gabryel, Halina; Mróz, Robert; Kania, Aleksander; Obojski, Andrzej; Tażbirek, Maciej; Celejewska‐Wójcik, Natalia; Guziejko, Katarzyna; Brajer-Luftmann, Beata; Korzybski, Damian; Damps-Kostańska, Iwona; Krenke, Rafał

doi:10.1016/j.jaip.2019.04.022

Cited by 25 publications

(18 citation statements)

References 24 publications

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“…Based on the available studies, whose main purpose was to evaluate the concordance of the different diagnostic ACO criteria, the level of agreement between different ACO definitions is poor. 2 , 31 Similarly, due to the small size of the studied groups, patients with COPD and asthma were not analyzed in terms of their different phenotypes. Demonstrating differences between patients who constitute a set of different subgroups is a great challenge.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Airway Remodeling Using Endobronchial Ultrasound in Asthma-COPD Overlap

Górka¹,

Gross‐Sondej²,

Górka³

et al. 2021

JAA

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Purpose The aim of this study was to evaluate the structural changes of the airways using the endobronchial ultrasound (EBUS) in ACO patients compared to severe asthma and COPD patients. Patients and Methods The study included 17 patients with ACO, 17 patients with COPD and 33 patients with severe asthma. Detailed clinical data were obtained from all participants. Basic laboratory tests were performed, including measurement of eosinophil counts in blood and serum immunoglobulin E (IgE) concentrations. All patients underwent spirometry and bronchoscopy with EBUS (a 20‑MHz ultrasound probe) to measure the total thicknesses of the bronchial walls and their particular layers in segmental bronchi of the right lower lobe. EBUS allows to distinguish five layers of the bronchial wall. Layer 1 (L 1 ) and layer 2 (L 2 ) were analyzed separately, while the outer layers (layers 3–5 [L 3–5 ]) that correspond to cartilage were assessed together. Results In patients with ACO the thicknesses of the L 1 and L 2 layers, which are mainly responsible for remodeling, were significantly greater than in patients with COPD and significantly smaller than in patients with severe asthma (median L 1 = 0.17 mm vs 0.16 mm vs 0.18 mm, p <0.001; median L 2 = 0.18 mm vs 0.17 mm vs 0.20 mm, p <0.001, respectively). The thicknesses of the total bronchial walls (L 1 +L 2 +L 3–5 ) and L 3–5 were significantly smaller in ACO and COPD patients compared to asthma patients (median L 1 +L 2 +L 3–5 = 1.2 mm vs 1.14 mm vs 1.31 mm, p <0.001; median L 3–5 = 0.85 mm vs, 0.81 mm vs 0.92 mm, p =0.001, respectively). Conclusion The process of structural changes in the airways assessed by EBUS is more advanced in individuals with ACO compared to patients with COPD, and less pronounced compared to patients with severe asthma. It seems that EBUS may provide useful information about differences in airway remodeling between ACO, COPD and severe asthma.

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Section: Discussionmentioning

confidence: 99%

Assessment of Airway Remodeling Using Endobronchial Ultrasound in Asthma-COPD Overlap

Górka¹,

Gross‐Sondej²,

Górka³

et al. 2021

JAA

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“…The resulting plethora of reported definitions is summarised in the helpful review of Cazzola and Rogliani [ 33 ]. It is no surprise in this setting that the type of patients included in what are mainly observational studies appear to be rather different in their nature, illustrated by Barczyk et al [ 34 ].…”

Section: Defining Acomentioning

confidence: 99%

“…This approach works well if the initial FEV 1 is relatively normal, but as the pre-test FEV 1 falls the same dose of agonist can produce a more dramatic fall in FEV 1 due to the altered airway geometry rather than a greater degree of airway smooth muscle contraction. In this context, absence of AHR is more informative than its presence, as has been seen when trying to interpret the diagnosis of asthma in obese subjects [ 34 ]. Relatively few groups have looked at AHR in more severe COPD.…”

Section: The Physiology Of Acomentioning

confidence: 99%

ACO (Asthma–COPD Overlap) Is Independent from COPD: The Case Against

Calverley

Walker

2021

Diagnostics

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Over the last decade interest has been shown in people with symptomatic lung disease who have features both of COPD and asthma. In this review we examine how COPD and asthma are defined and examine clinical characteristics of people defined by researchers as having asthma-COPD overlap (ACO). We look at pathological and physiological features along with symptoms and consider the impact of each diagnosis upon therapeutic management. We highlight challenges in the diagnosis and management of airway disease and the various phenotypes that could be part of ACO, in so doing suggesting ways for the clinician to manage patients with features of both asthma and COPD.

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“…[15][16][17][18][19][20][21] However, interpreting these studies is complicated by a lack of consistency in terms of patient selection (diagnostic criteria), definitions of pulmonary function impairment, and concomitant medication received by patients. 22 In short, the complexities surrounding the definition and diagnosis of ACO may be the driving force behind the recent change in the GOLD 2021 strategy report. The consequence of all this for primary care physicians is potential confusion and a lack of clarity on how to treat patients with COPD who show features of asthma.…”

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confidence: 99%

GOLD 2021 Strategy Report: Implications for Asthma–COPD Overlap

Román-Rodríguez¹,

Kaplan²

2021

COPD

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In its 2021 strategy report, the Global Initiative for Chronic Obstructive Lung Disease states: “we no longer refer to asthma-COPD overlap (ACO), instead we emphasize that asthma and COPD are different disorders, although they may […] coexist in an individual patient. If a concurrent diagnosis of asthma is suspected, pharmacotherapy should primarily follow asthma guidelines, but pharmacological and non-pharmacological approaches may also be needed for their COPD.” What does this mean for the treating physician? In this review, we explore the implications of this new guidance on treating patients with chronic obstructive pulmonary disease, arguing for a personalized approach to treatment.

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Asthma-COPD Overlap—A Discordance Between Patient Populations Defined by Different Diagnostic Criteria

Cited by 25 publications

References 24 publications

Assessment of Airway Remodeling Using Endobronchial Ultrasound in Asthma-COPD Overlap

Assessment of Airway Remodeling Using Endobronchial Ultrasound in Asthma-COPD Overlap

ACO (Asthma–COPD Overlap) Is Independent from COPD: The Case Against

GOLD 2021 Strategy Report: Implications for Asthma–COPD Overlap

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