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

Abstract

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.

Selected Aspects of Medical Care for Patients with Asthma and Chronic Obstructive Pulmonary Disease (COPD) in Poland

“…Cardiovascular system disorders, diabetes, metabolic syndrome and obesity impair the general condition of the patient and worsen the prognosis of obstructive lung diseases [4,5,9]. Overlapping features of asthma and COPD were identified in 5% of the Polish population; however, this prevalence was found to range from 2.1 to 51% across the world, depending on study criterion and country [14].…”

“…It is important to note that 22.6% of interviewed doctors in the present study prescribed the use of combined inhaled glucocorticoids and LABA, which is highly recommended by global opinion-forming organisations and confirmed by several studies [4,5,14,15]. However, the majority of asthma cases are mild, allowing the basic application of ICS alone, with the option of dose manipulation [4].…”

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

“…The inflammation process of COPD includes the increase of the number of CD8 associated with TC1 lymphocytes in smokers. Moreover, the inflammatory airways of COPD patients include macrophages, T lymphocytes, and dendritic cells (34). Furthermore, the lack of Alpha 1 antitrypsin, the only known genetic factor of COPD, can cause emphysema pan lobular and airway changes (35).…”

“…The inflammation in asthma induced by eosinophilic and the production of pro-inflammatory transmitters and basic proteins lead to the injury of epithelial cells and airway remodeling. In addition, other cells such as lymphocytes, mast cells, dendritic cells, and macrophages play roles in the inflammation process and help it to occur (34). Overall, the inflammation process of airways in asthma differs from that of COPD; in asthma, it is related to eosinophils activity and Th2 cells while neutrophils play an important role in COPD.…”

“…In other words, there is little data about ACOS patients' responses to most pharmacological treatments because they have been eliminated from clinical trials of both asthma and COPD recently (65). Overall, the treatment must include smoking cessation, pulmonary rehabilitation, oxygen supplementation, vaccination, and disease management (34). According to Japanese COPD guidelines, the first-line treatment for ACOS includes the combination of long-acting beta-2agonists (LABA) and inhaled corticosteroids (ICS) without consideration of the obstructive levels of the airway (66).…”