Ashtma-Chronic obstructive pulmonary disease overlap syndrome (ACOS): current evidence and future research directions (Free Full text from 2017 COPD Research and Practice)

Chronic obstructive pulmonary disease and asthma are the most frequent chronic respiratory diseases that affect the general population. For a long period of time these two conditions were considered to be separate diseases. However, it became evident that some patients share symptoms and clinical findings from both diseases. 

These patients are considered to represent a distinct phenotype, called asthma-COPD overlap syndrome (ACOS). However, since approximately the one third of the asthmatics smoke the ACOS may primarily define those patients. This is a relatively newly defined clinical syndrome whose underlying mechanisms and most appropriate management remain to be confirmed. In this review, we summarize current knowledge on this syndrome, aiming to update clinicians and help their daily practice.

Free full text:

https://copdrp.biomedcentral.com/articles/10.1186/s40749-017-0025-x

Pneumonology Quiz – Case 3 (article from Archives of Hellenic Medicine)

A 67-year-old male patient, lifelong smoker, with a background of asthma since childhood and recurrent ethmoid polyps attended for a routine clinical review. He was only prescribed a salbutamol inhaler, to be used when required. He reported intermittent episodes of shortness of breath with wheezing at night and a progressive deterioration of his symptoms over the previous two years. He was also complaining of cough productive of yellow phlegm, almost every morning. On examination, he was tachypneic at rest, with an oxygen saturation of 92% on room air. He was severely hyperinflated and a bit wheezy on auscultation.

Read full text:

https://www.researchgate.net/publication/304996769_Pneumonology_Quiz_-_Case_3

Do we really need asthma–chronic obstructive pulmonary disease overlap syndrome?

Dear Respiratory friends we are happy to present you exciting article from The Journal of Allergy and Clinical Immunology by our Italian friends Mario Cazzola and Paola Rogliani on Hot Topic: Do we really need asthma–chronic obstructive pulmonary disease overlap syndrome? 

The association of asthma and chronic obstructive pulmonary disease (COPD) in the same patient, which is designated as mixed asthma-COPD phenotype or overlap syndrome (ACOS), remains a controversial issue. This is primarily because many conflicting aspects in the definition of ACOS remain, and it is extremely difficult to summarize the distinctive features of this syndrome. Furthermore, we are realizing that asthma, COPD, and ACOS are not single diseases but rather syndromes consisting of several endotypes and phenotypes and, consequently, comprising a spectrum of diseases. The umbrella term ACOS blurs the lines between asthma and COPD and allows an approach that simplifies therapy. However, this approach contradicts the modern concept according to which we must move toward more targeted and personalized therapies to treat patients with these diseases.  

Therefore we argue that the term ACOS must be abandoned and ultimately replaced when new phenotypes and underlying endotypes are identified and a new taxonomy of airway diseases is generated.

Full text:

http://www.jacionline.org/article/S0091-6749(16)30368-2/fulltext

GOLD 2016 update on Asthma-COPD Overlap Syndrome (Link for free download)

Asthma and chronic obstructive pulmonary disease (COPD) are highly prevalent chronic diseases in the general population. Both are characterized by similar mechanisms: airway inflammation, airway obstruction and airway hyperresponsiveness. However, the distinction between the two obstructive disease is not always clear. Multiple epidemiological studies demonstrate that in elderly people with obstructive airway disease, as many as half or more may have overlapping diagnoses of asthma and COPD. 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 FEV1 ≥15% and ≥400 ml),  eosinophilia in sputum and personal history of asthma. 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 furture clinical studies and multicenter clinical trials should lead to the investigation of disease mechanisms and simultaneous development of the novel treatment.

Defining the Asthma-COPD Overlap Syndrome in a COPD Cohort (Chest article)

Asthma-COPD overlap syndrome is very contradictory topic in Respiratory medicine!
Background  Asthma-COPD overlap syndrome (ACOS) has been recently described by international guidelines. A stepwise approach to diagnosis using usual features of both diseases is recommended although its clinical application is difficult.

Methods  To identify patients with ACOS, a cohort of well-characterized patients with COPD and up to 1 year of follow-up was analyzed. We evaluated the presence of specific characteristics associated with asthma in this COPD cohort, divided into major criteria (bronchodilator test > 400 mL and 15% and past medical history of asthma) and minor criteria (blood eosinophils > 5%, IgE > 100 IU/mL, or two separate bronchodilator tests > 200 mL and 12%). We defined ACOS by the presence of one major criterion or two minor criteria. Baseline characteristics, health status (COPD Assessment Test [CAT]), BMI, airflow obstruction, dyspnea, and exercise capacity (BODE) index, rate of exacerbations, and mortality up to 1 year of follow-up were compared between patients with and without criteria for ACOS.
Results  Of 831 patients with COPD included,125 (15%) fulfilled the criteria for ACOS, and 98.4% of them sustained these criteria after 1 year. Patients with ACOS were predominantly male (81.6%), with symptomatic mild to moderate disease (67%), who were receiving inhaled corticosteroids (63.2%). There were no significant differences in baseline characteristics, and only survival was worse in patients with non-ACOS COPD after 1 year of follow-up (P < .05).
Conclusions  The proposed ACOS criteria are present in 15% of a cohort of patients with COPD and these patients show better 1-year prognosis than clinically similar patients with COPD with no ACOS criteria.
Full text:
http://journal.publications.chestnet.org/article.aspx?articleid=2430458&resultClick=3

The Asthma–COPD Overlap Syndrome 2015 Update

This week in NEJM was published review on asthma–COPD overlap syndrome!

Approximately 1 in 12 people worldwide are affected by asthma or chronic obstructive pulmonary disease (COPD); once regarded as two distinct disease entities, these two conditions are now recognized as heterogeneous and often overlapping conditions. The term “asthma–COPD overlap syndrome” (ACOS) has been applied to the condition in which a person has clinical features of both asthma and COPD.

Full text for free download:

http://www.nejm.org/doi/full/10.1056/NEJMra1411863

COPD 2015 Guidelines: The 2015 update of the Global Initiative for Chronic Obstructive Lung Disease

In 2011, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) released a consensus report, Global Strategy for the Diagnosis, Management, and Prevention of COPD. It recommended a major revision in the management strategy for COPD that was presented in the original 2001 document. Updated reports released in January 2013, January 2014, and January 2015 are based on scientific literature published since the completion of the 2011 document but maintain the same treatment paradigm. Assessment of COPD is based on the patient’s level of symptoms, future risk of exacerbations, the severity of the spirometric abnormality, and the identification of comorbidities. The 2015 update adds an Appendix on Asthma COPD Overlap Syndrome, material prepared jointly by the GOLD and GINA Science Committees.

 

The GOLD 2015 report is presented as a “strategy document” for health care professionals to use as a tool to implement effective management programs based on available health care systems. The quadrant management strategy tool is designed to be used in any clinical setting; it draws together a measure of the impact of the patient’s symptoms and an assessment of the patient’s risk of having a serious adverse health event in the future. Many studies have assessed the utility/relevance of this new tool. Evidence will continue to be evaluated by the GOLD committees and management strategy recommendations modified as required.

GOLD has been fortunate to have a network of international distinguished health professionals from multiple disciplines. Many of these experts have initiated investigations of the causes and prevalence of COPD in their countries, and have developed innovative approaches for the dissemination and implementation of the GOLD management strategy. The GOLD initiative will continue to work with National Leaders and other interested health care professionals to bring COPD to the attention of governments, public health officials, health care workers, and the general public to raise awareness of the burden of COPD and to develop programs for early detection, prevention and approaches to management.

The GOLD 2015 report: direct link

www.goldcopd.org/uploads/users/files/GOLD_Report_2015_Apr2.pdf

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.