Janus Look in Pulmonology: COPD-Asthma overlap syndrome

In ancient Roman religion, Janus (his name in Greek is 'Ιανός - Ianós) is the god of beginnings and transitions, thence also of gates, doors, passages, endings and time. He is usually depicted as having two faces, since he looks to the future and to the past. The Romans named the month of January (Ianuarius) in his honor.

An overlap syndrome is a disease in which a patient presents with symptoms of two or more diseases. That is why Janus can be associated with overlap syndrome.

Multiple epidemiological studies demonstrate that in persons with obstructive airway disease, as many as half or more may have overlapping of asthma and COPD. The term Asthma COPD overlap syndrome (ACOS) was recognized and is appearing for the first time in GOLD 2014, but without clear definition and therapeutic options. A COPD-Asthma overlap syndrome is defined as an airflow obstruction that is not completely reversible, accompanied by symptoms and signs of increased obstruction reversibility. For the clinical identification of overlap syndrome COPD-Asthma Spanish guidelines proposed six diagnostic criteria. The major criteria include very positive bronchodilator test [increase in forced expiratory volume in one second (FEV1) ≥15% and ≥400 ml], eosinophilia in sputum, and personal history of asthma. The minor criteria include high total IgE, personal history of atopy and positive bronchodilator test (increase in FEV1 ≥12% and ≥200 ml) on two or more occasions. The overlap syndrome COPD-Asthma is associated with enhanced response to inhaled corticosteroids due to the predominance of eosinophilic bronchial inflammation.The future clinical studies and multicenter clinical trials should lead to the investigation of disease mechanisms and simultaneous development of the novel treatment.

New review article on this Hot Respiratory topic just published in Journal of Cardio-Thoracic Medicine and its free for download.