Consensus on the Asthma–COPD Overlap (ACO) Between the Spanish COPD Guidelines (GesEPOC) and the Spanish Guidelines on the Management of Asthma (GEMA)

Plaza, Vicente; Álvarez, Francisco; Calle, Myriam; Casanova, Ciro; Cosío, Borja G.; López-Viña, Antolín; Llano, Luís Pérez de; Quirce, Santiago; Román-Rodríguez, Miguel; Soler-Cataluña, Juan José; Miravitlles, Marc

doi:10.1016/j.arbr.2017.06.001

Cited by 49 publications

(63 citation statements)

References 40 publications

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“…In a real world study to assess the effectiveness of a triple drug combination in Severe COPD, the results with Tiotropium/Formoterol/Ciclesonide dry powder inhaler resulted in prebronchodilator FEV1 improvement of 200 ml (p<0.0001) for Smoker COPD patients with infrequent exacerbations (Deb, 2016) The study reported the results for twelve weeks Glycopyrronium add on therapy to ICS/LABA before rationalizing the review of ICS use in frequent exacerbators or Asthma COPD overlap cases. Asthma COPD overlap or COPD cases with BDR (>15%,400ml) and related exacerbations have often remained a clinical challenge with GesEPOC-GEMA (Plaza, 2017) recommendations on a likely diagnosis of overlap syndrome. The complexity of the diagnoses was further commented by GINA for likely BDR (>12%, 200 ml) along with other risk factors to be considered as Asthma-COPDoverlap.…”

Section: Discussion:-mentioning

confidence: 99%

“…This definition requires the concomitant presence of 3 basic elements ie. persistent airflow limitation over time, essential to confirm the presence of permanent obstruction that does not change spontaneously or after treatment; accumulated history of smoking (current or past) as a principal risk factor; typical characteristics of asthma, including clinical, biological and functional manifestations (Plaza, 2017).…”

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confidence: 99%

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A Post-Approval, Observational Study to Assess Clinical Impact of Glycopyrronium in High Risk Copd With Frequent Exacerbations: Post Hoc Analyses

Agrawal¹,

A.A.²,

K.³

2020

IJAR

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Background: Exacerbations remain a distinct clinical challenge in Chronic obstructive pulmonary disease (COPD) with consequent use of ICS in real-world practice of India. LAMA add-on therapy has been well highlighted by UPLIFT, TRIBUTE & KRONOS studies. Glycopyrronium add on therapy offers quick control of morning symptoms for likely improved patient adherence rates in COPD Objectives: To assess the clinical impact and use of Glycopyrronium add-on therapy in outpatient settings, real world observational study was planned Methods and Material: National, post-approval, observational, drug utilization, concurrent analyses was carried out at 128 centers during Sept '17 with institutional Ethics & CTRI registration. Post-hoc analyses was carried out by Quick Calcs GraphPad Prism ver. 7 software with p<0.05 considered as statistically significant Results: The per protocol analyses for 1117 consecutive Glycpyrronium & ICS/LABA combination cases was conducted for patients with baseline demographics included Male/Female (76%/24%); mean Age 59.5y; FEV1 (1.46 L/min, 48.9±16%), FEV1/FVC (58.7±13.3%); Reversibility (13.7±16.2%), Exacerbation (≥1/y; 1117, 100%; ≥2/y, 389,35%), CAT (22±10). At 12 weeks, the overall group (1117) and frequent exacerbators (389) showed prebronchodilator FEV1& CAT score change of 21% && 5.1 respectively (p<0.0001) at 12 wks. Posthoc analyses for frequent exacerbators' (≥2/y, BDR ≤10%, n=152) showed clinically significant change in prebronchodilator FEV1& CAT score of 22.8% & 5.4 respectively (p<0.0001) respectively showing positive test of interaction. Similarly the prebronchodilator FEV1 improvement for Frequent exacerbators' with Reversibility (≥2/y, BDR ≥12%, n=156) was documented as 35% (p<0.0001). TEAEs included dry mouth (42, 3.8%), constipation (4,0.4%), exacerbation (2,0.2%) that were managed with symptomatic therapy

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Section: Discussion:-mentioning

confidence: 99%

mentioning

confidence: 99%

A Post-Approval, Observational Study to Assess Clinical Impact of Glycopyrronium in High Risk Copd With Frequent Exacerbations: Post Hoc Analyses

Agrawal¹,

A.A.²,

K.³

2020

IJAR

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“…Diagnosis criteria are: patient's age ≥ 35years, ex-smoker or smoker for 10 years, airflow hinderance (post-bronchodilator FEV 1 /FVC < 0.7) that remains consistent after treatment with inhaled corticosteroids (ICS) and bronchodilators and current diagnosis of GEMA's defined asthma. In some cases asthma is not diagnosed then positive diagnosis is done on the basis of raised blood eosinophil count (≥300 eosinophils/µL) or bronchodilator test (FEV1 ≥15% and ≥400 ml) [30].…”

Section: Definition Of Acosmentioning

confidence: 99%

An Overview of Asthma Copd Overlapping Syndrome (Acos)

Sabar¹,

Khan²

2019

SJLS

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Asthma-COPD overlap Syndrome (ACOS) is a syndrome in which a patient suffers from both chronic obstructive pulmonary disease (COPD) and asthma. Standard definition and diagnostic criteria of this overlap syndrome is not established yet. It is important to formulate a definition of ACOS for accurate diagnosis and studies. Few biomarkers have been found which can be useful for diagnosis but much research is needed. The prevalence of ACOS depends upon the definition, diagnosis criteria and population analyzed. Different single nucleotide polymorphism (SNPs) has been identified in limited population.

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“…However, therapeutic decisions become more controversial for a patient with a single disease with a peculiar clinical presentation, as new clinical trials would be needed for this specific indication. The most recent Spanish proposal, although controversial, encompasses both concepts associated with ACO …”

Section: Step Up From Double Bronchodilation To Triple Therapymentioning

confidence: 99%

Current controversies in the stepping up and stepping down of inhaled therapies for COPD at the patient level

et al. 2018

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The implementation of potential new step-up or step-down treatment recommendations in response to current guidelines is one of the main challenges currently faced in actual daily practice settings. In the present narrative review, we aim to discuss the relevance of these step-up and step-down proposals at the patient level in daily clinical practice. In particular, we aim to review the challenges associated with inhaled maintenance therapy for chronic obstructive pulmonary disease (COPD) in four clinical scenarios. First, we discuss the step up from single to double bronchodilation, including current controversies regarding the addition of a second bronchodilator versus initial treatment with two bronchodilators. Second, we discuss the step up from double bronchodilation to triple therapy while challenging current indications for inhaled steroid therapy and discussing triple therapy designs. Third, we discuss the step down from triple therapy to double bronchodilation while evaluating the effect of this downshift in risk categories on the patient according to the new classifications. Finally, we discuss the step down from double to single bronchodilation, with a special focus on safety. We believe this review will help to highlight the most relevant discussion points regarding the treatment of COPD in a manner that will stimulate and guide related clinical research.

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Consensus on the Asthma–COPD Overlap (ACO) Between the Spanish COPD Guidelines (GesEPOC) and the Spanish Guidelines on the Management of Asthma (GEMA)

Cited by 49 publications

References 40 publications

A Post-Approval, Observational Study to Assess Clinical Impact of Glycopyrronium in High Risk Copd With Frequent Exacerbations: Post Hoc Analyses

A Post-Approval, Observational Study to Assess Clinical Impact of Glycopyrronium in High Risk Copd With Frequent Exacerbations: Post Hoc Analyses

An Overview of Asthma Copd Overlapping Syndrome (Acos)

Current controversies in the stepping up and stepping down of inhaled therapies for COPD at the patient level

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