What pulmonologists think about the asthma–COPD overlap syndrome

Abstract

BackgroundSome patients with COPD may share characteristics of asthma; this is the so-called asthma–COPD overlap syndrome (ACOS). There are no universally accepted criteria for ACOS, and most treatments for asthma and COPD have not been adequately tested in this population.Materials and methodsWe performed a survey among pulmonology specialists in asthma and COPD aimed at collecting their opinions about ACOS and their attitudes in regard to some case scenarios of ACOS patients. The participants answered a structured questionnaire and attended a face-to-face meeting with the Metaplan methodology to discuss different aspects of ACOS.ResultsA total of 26 pulmonologists with a mean age of 49.7 years participated in the survey (13 specialists in asthma and 13 in COPD). Among these, 84.6% recognized the existence of ACOS and stated that a mean of 12.6% of their patients might have this syndrome. In addition, 80.8% agreed that the diagnostic criteria for ACOS are not yet well defined. The most frequently mentioned characteristics of ACOS were a history of asthma (88.5%), significant smoking exposure (73.1%), and postbronchodilator forced expiratory volume in 1 second/forced vital capacity <0.7 (69.2%). The most accepted diagnostic criteria were eosinophilia in sputum (80.8%), a very positive bronchodilator test (69.2%), and a history of asthma before 40 years of age (65.4%). Up to 96.2% agreed that first-line treatment for ACOS was the combination of a long-acting β2-agonist and inhaled steroid, with a long-acting antimuscarinic agent (triple therapy) for severe ACOS.ConclusionMost Spanish specialists in asthma and COPD agree that ACOS exists, but the diagnostic criteria are not yet well defined. A previous history of asthma, smoking, and not fully reversible airflow limitation are considered the main characteristics of ACOS, with the most accepted first-line treatment being long-acting β2-agonist/inhaled corticosteroids.

Ashtma-Chronic obstructive pulmonary disease overlap syndrome (ACOS): current evidence and future research directions

“…However, globally consensus is still lacking on the existence of ACOS as a separate syndrome, and on its diagnostic criteria [55].…”

“…There is consensus that first-line treatment for ACOS is the combination of a long-acting β2-agonist and inhaled steroid, and this combination can be used with a longacting antimuscarinic agent (triple therapy) for severe ACOS [55].…”

Asthma-COPD overlap szindróma

“…COPD-betegek esetében az ACOS megjelenése 10-55%-ra tehető, attól függően, hogy milyen diagnosztikus kritériumok alapján készült a vizsgálat. Megfigyelhető, hogy az életkor előre-haladtával az ACOS prevalenciája emelkedik [8][9][10], míg a populáción belüli átlagos megjelenése 2%-ra tehető [11,12]. A magas prevalencia ellenére a betegek jelentős része eddig kizárásra került a kontrollált, kettős vak, illetve prospektív klinikai vizsgálatokból és az inhalatív gyógyszerek hatásossági vizsgálataiból.…”

“…Szá-mos tanulmány igazolta, hogy a COPD-betegek légúti reverzibilitása időről időre változhat és függ a beteg egyéni jellemzőitől [8,41].…”

“…Munkacsoportunk eredményei alapján az ACOS-betegek asthmakontrollteszt (ACT) pontszáma jelentősen alacsonyabb volt az asthmás betegekhez képest, azonban a COPD Assessment Test (CAT) eredményeiben nem volt szignifikáns különbség a COPD-csoporthoz képest [61]. Több tanulmány alapján megfigyelhető, hogy az ACOS-betegek testsúlya és testtömegindexe (BMI) általában magasabb, mint a COPD-betegeké [8,43,60].…”