Tuberc Respir Dis.  2017 Jan;80(1):11-20. 10.4046/trd.2017.80.1.11.

Asthma-COPD Overlap Syndrome: What We Know and What We Don't

• Sin DD

• KMID: 2396336
• DOI: http://doi.org/10.4046/trd.2017.80.1.11

Abstract

Approximately one in four patients with chronic obstructive pulmonary disease (COPD) have asthmatic features consisting of wheezing, airway hyper-responsiveness or atopy. The Global initiative for Asthma/Globalinitiative for chronic Obstructive Lung Disease committee recently labelled these patients as having asthma-COPD overlap syndrome or ACOS. ACOS also encompasses patients with asthma, ≥40 years of age, who have been cigarette smokers (more than 5-10 pack years) or have had significant biomass exposure, and demonstrate persistent airflow limitation defined as a post-bronchodilator forced expiratory volume in 1 second (FEV₁)/forced vital capacity of <70%. Data over the past 30 years indicate that patients with ACOS have greater burden of symptoms including dyspnea and cough and show higher risk of COPD exacerbations and hospitalizations than those with pure COPD or pure asthma. Patients with ACOS also have increased risk of rapid FEV₁ decline and COPD mortality. Paradoxically, experimental evidence to support therapeutic decisions in ACOS patients is lacking because traditionally, patients with ACOS have been systematically excluded from therapeutic COPD and asthma trials to maintain homogeneity of the study population. In this study, we summarize the current understanding of ACOS, focusing on definitions, epidemiology and patient prognosis.

Keyword

Asthma; Pulmonary Disease, Chronic Obstructive; Review

MeSH Terms

Asthma
Biomass
Cough
Dyspnea
Epidemiology
Forced Expiratory Volume
Hospitalization
Humans
Mortality
Prognosis
Pulmonary Disease, Chronic Obstructive
Respiratory Hypersensitivity
Respiratory Sounds
Tobacco Products
Vital Capacity

Figure

• 

  Figure 1 Some helpful tips for the busy clinicians. ACOS: asthma-COPD overlap syndrome; COPD: chronic obstructive pulmonary disease; BDR: bronchodilator response; SEPAR: Spanish Society of Pneumology and Thoracic Surgery.

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