A diagnostic approach and natural course of a patient with asthma– COPD overlap syndrome

Abstract

The diagnostic criteria of asthma–chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) advocated by the Global Initiative for Asthma (GINA)/Global Initiative for Chronic Obstructive Lung Disease (GOLD) are somewhat complicated, and limited data are available regarding how ACOS patients respond to current medications. We present a case of a 64‐year‐old man with ACOS. With features favoring asthma including childhood asthma history with intermittent episodes of dyspnea at night, elevated blood eosinophil count and total IgE, increased forced expiratory volume in 1 s (FEV 1) after bronchodilator (>200 mL and >12% from baseline), and positive skin prick tests, he also had features favoring COPD such as heavy smoker, persistent exertional dyspnea, and airflow limitation after inhaled therapy. Over 5‐year follow up, our patient experienced a single episode of moderate exacerbation. However, post‐bronchodilator FEV 1 decreased by 240 mL for 4 years (−60 mL/year) after 1.5 years of treatment, indicating rapid lung function decline. Longitudinal studies are necessary to assess optimal interventions and natural course of ACOS.

Different Biological Pathways Are Up-regulated in the Elderly With Asthma: Sputum Transcriptomic Analysis

“…We aimed to identify biological pathways explaining a whole feature of EA, and thus we did not consider asthma-COPD overlap (ACO) as a subtype of EA in this study. If we define ACO as 1) post-BD FEV1/FVC < 0.7 and 2) classic symptoms of chronic bronchitis or suggesting signs of emphysema with chest radiography or pulmonary function test,35 the proportion of ACO is higher in cluster 2 (28.6% vs 55.5%). Although the difference showed a borderline significance ( P = 0.083), the present study raised new insight in understanding ACO in the elderly.…”

Overlapping of Asthma and Chronic Obstructive Pulmonary Disease: A Literature Review

“…However, these diagnostic criteria are not definitive and physicians usually change diagnosis during follow-up (46). In addition, the diagnostic criteria of ACOS advocated by GINA/GOLD are somewhat complicated and there are limited data regarding how ACOS patients respond to current medications (52). Thus, this paper reviews the diagnostic criteria and biomarkers of ACOS used in previous studies and propose practical approaches for diagnosing ACOS.…”