Management of asthma COPD overlap

Abstract

Asthma-COPD Overlap (ACO) is not a distinct disease entity but a term applied to patients with clinical features of both asthma and COPD. Asthma-COPD Overlap is associated with greater morbidity than asthma and COPD alone and with relative treatment refractoriness, but information is sparse about its course and optimal treatment. Current treatment recommendations are based on consensus because most clinical studies in asthma and COPD have excluded patients with ACO. Initial management approach should include addressing environmental triggers as well as identifying and treating underlying comorbidities. In selecting pharmacologic therapies, patients with ACO should be treated early with an ICS and 1 or more long-acting bronchodilator. In patients with severe disease, every effort should be made to address and target the patient's treatable traits. A better understanding of the molecular mechanisms and drivers of airway inflammation in patients with ACO as well as the identification of novel biomarkers may lead to a more precise treatment approach for important unmet needs.

Risk factors and associated outcomes of hospital readmission in COPD: A systematic review

“…Five studies of good quality in 448,680 patients found that comorbid asthma increased the risk of readmission from 5% [33] up to 66% [40]. There is the overlapping spectrum of some patients having a distinct phenotype of COPD and some features of asthma, and it has been reported that patients with this overlapping spectrum have higher exacerbation frequency and hospitalisations [29,83,84]. Asthma flare-ups in these patients could result in exacerbation of COPD and further rehospitalisation.…”

Update on Asthma–COPD Overlap (ACO): A Narrative Review

“…Currently, decisions regarding therapy in these patients should be guided based on phenotypical data and severity of symptoms, taking into account whether asthma or COPD is most pronounced in the individual ACO patient, even in mild stages of the disease. 75 Next, a stepwise approach similar to the algorithms for the treatment of asthma or COPD must be followed according to the severity of symptoms ( Figure 2 ). 8 , 21 For patients with milder forms of asthma inhaled therapy comprising of ICS is adequate, while symptomatic COPD patients are treated with long-acting bronchodilators.…”

An Overview of the Safety and Efficacy of Monoclonal Antibodies for the Chronic Obstructive Pulmonary Disease

“… 57 Apparently, there is also no major impact of these mAbs on lung function. 85 For other classes of mAbs, information is even more scarce. There is no doubt that in the future it will be necessary to study in detail the impact of mAbs on other key outcomes such as pulmonary function, as important differences may also be detected.…”