Asthma-chronic obstructive pulmonary disease overlap syndrome

Mart, Matthew F.; Peebles, R. Stokes

doi:10.1016/j.coi.2020.10.006

Cited by 8 publications

(9 citation statements)

References 40 publications

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“…These findings may include eosinophilia in the blood or sputum, in conjunction with clinical features consistent with COPD. 1,9 In 2016, an expert panel developed a defi nition that is based on clinical criteria. ACO is diagnosed for patients meeting all three major and at least one minor diagnostic criteria.…”

Section: ■ Defi Nition and Diagnostic Criteria For Acomentioning

confidence: 99%

“…Minor criteria include documented history of atopy or allergic rhinitis; bronchodilator response of FEV 1 at least 200 mL and 12% from baseline values on two or more visits; and peripheral blood eosinophilia count of at least 300 cells/mcL. [1][2][3]8,10 ACO was suggested as an interim clinical label by a joint American Thoracic Society/ National Heart, Lung, and Blood Institute workshop report in 2017, but the group decided against developing a single, universal defi nition. 1,11 ■ Spirometry interpretation Spirometry interpretation is paramount in the diagnosis of asthma, COPD, and ACO (see Normal spirometry results).…”

Section: ■ Defi Nition and Diagnostic Criteria For Acomentioning

confidence: 99%

“…[1][2][3]8,10 ACO was suggested as an interim clinical label by a joint American Thoracic Society/ National Heart, Lung, and Blood Institute workshop report in 2017, but the group decided against developing a single, universal defi nition. 1,11 ■ Spirometry interpretation Spirometry interpretation is paramount in the diagnosis of asthma, COPD, and ACO (see Normal spirometry results). Principal metrics for a diagnosis of asthma include reduced FEV 1 /forced vital capacity (FVC) ratio (less than 0.75-0.80 in adults) and postbronchodilator increase in FEV 1 of more than 12% and more than 200 mL.…”

Section: ■ Defi Nition and Diagnostic Criteria For Acomentioning

confidence: 99%

“…This is a term that encompasses many clinical phenotypes with disparate underlying pathophysiology. Patients with ACO have various clinical symptoms and pathways, which embody a heterogenous, composite inflammatory process that is poorly understood 1. A 2021 systematic review and meta-analysis concluded that patients with ACO have a higher number of exacerbations per year than patients with COPD alone 2.…”

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confidence: 99%

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Asthma-COPD overlap

Jarrell¹

2022

The Nurse Practitioner

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The Nurse Practitioner • February 2022 25 sthma-COPD overlap (ACO) presents in persons (primarily adults) with persistent airfl ow limitation along with clinical symptoms refl ective of both asthma and chronic obstructive pulmonary disease (COPD). This is a term that encompasses many clinical phenotypes with disparate underlying pathophysiology. Patients with ACO have various clinical symptoms and pathways, which embody a heterogenous, composite infl ammatory process that is poorly understood. 1 A 2021 systematic review and meta-analysis concluded that patients with ACO have a higher number of exacerbations per year than

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Section: ■ Defi Nition and Diagnostic Criteria For Acomentioning

confidence: 99%

Section: ■ Defi Nition and Diagnostic Criteria For Acomentioning

confidence: 99%

Section: ■ Defi Nition and Diagnostic Criteria For Acomentioning

confidence: 99%

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confidence: 99%

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Asthma-COPD overlap

Jarrell¹

2022

The Nurse Practitioner

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“…In addition, recent Japanese studies have suggested that 4.2%–66.0% of patients with COPD are diagnosed with ACO 5–9. The proportion of patients with COPD who respond to additional inhaled corticosteroid (ICS) treatment remains unclear,10–12 and it has been reported that Japanese physicians use ICS for 20%–30% of patients with COPD, including those with ACO 13 14…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of once-daily single-inhaler triple therapy for mild-to-moderate chronic obstructive pulmonary disease: a study protocol for a randomised and interventional study

et al. 2023

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IntroductionBronchodilators, including long-acting muscarinic antagonists (LAMA) and long-acting beta 2 agonists (LABA), are the main treatments for chronic obstructive pulmonary disease (COPD). The efficacy of triple therapy (inhaled corticosteroids/LAMA/LABA) has also been reported. However, the effect of triple therapy on patients with mild-to-moderate COPD has not yet been clarified. This study aims to investigate the safety and efficacy of triple therapy, compared with LAMA/LABA combination therapy, for lung function and health-related quality of life in patients with mild-to-moderate COPD and identify baseline characteristics and biomarkers to predict responders and non-responders to triple therapy.Methods and analysisThis is a multicentre, prospective, open-label, randomised, parallel-group study. Mild-to-moderate patients with COPD will be randomised to receive fluticasone furoate/umeclidinium/vilanterol or umeclidinium/vilanterol for 24 weeks. A total of 668 patients will be enrolled from March 2022 to September 2023 from 38 sites in Japan. The primary endpoint is the change in the trough forced expiration volume in 1 s after 12 weeks of treatment. Secondary endpoints are responder rates based on the COPD assessment test score and the St. George’s Respiratory Questionnaire total score after 24 weeks of treatment. The safety endpoint is the occurrence of any adverse events. We will also investigate safety in terms of changes in microbial colonisation in sputum and antimycobacterium avium complex antibodies.Ethics and disseminationThe study protocol and informed consent documents were approved by the Saga University Clinical Research Review Board (approval number: CRB7180010). Written informed consent will be obtained from all patients. Recruitment of the patients began in March 2022. The results will be disseminated through scientific peer-reviewed publications and domestic and international medical conferences.Trial registration numbersUMIN000046812 and jRCTs031190008.

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Prisco

Moll

Doyle

et al. 2022

Arthritis & Rheumatology

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The authors addressed this by using self-reported patient data, which could undermine the validity of the diagnosis and lead to information bias. We believe that inaccurate measurement of the prevalence of 2 key chronic respiratory diseases, bronchiectasis and chronic obstructive pulmonary disease (COPD), is especially relevant here.First, previous studies showed a bronchiectasis prevalence of ~30% among RA patients (2). However, the current study, which relied on self-reported bronchiectasis, revealed a prevalence of only 0.9%. This vast discrepancy implies that, in many patients with RA-associated bronchiectasis, the disease is clinically silent and unrecognized yet can be readily detected by pulmonary function tests.Second, COPD is notoriously prone to evading clinical detection; one study showed that it was undiagnosed in ~70% of COPD patients worldwide (3). In the current study, mean packyears of smoking and the percentages of participants who were current or past smokers were all higher among RA cases than among controls. These differences suggest that the rate of undiagnosed COPD might have been higher in the RA group and could have contributed in part to the increased odds of obstructive patterns among these patients. Moreover, quitting smoking requires strong personal motivation, and we wonder whether RA patients had a greater prevalence of more severe smoking-related airway symptoms and disease and, in turn, a higher rate of smoking cessation.We understand that image correlation is difficult in databank analysis. However, chest images (if available) from these participants would be very informative for assessing the scale of information bias, if present.Finally, the prevalence of rheumatoid factor (RF) positivity in the RA group (86%) was much higher than typically reported (4). In a small study, we found that 42% of COPD patients tested positive for RF (5). Therefore, we wonder whether the excess RF positivity reported by Prisco et al (1) could have been attributable to undiagnosed COPD among RA cases, since RF positivity was common in this group.We appreciate the robust work done by the authors and look forward to their reply.

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Asthma-chronic obstructive pulmonary disease overlap syndrome

Cited by 8 publications

References 40 publications

Asthma-COPD overlap

Asthma-COPD overlap

Efficacy and safety of once-daily single-inhaler triple therapy for mild-to-moderate chronic obstructive pulmonary disease: a study protocol for a randomised and interventional study

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