The asthma–chronic obstructive pulmonary disease overlap syndrome: pharmacotherapeutic considerations

Abstract

Asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) is a commonly encountered yet loosely defined clinical entity. ACOS accounts for approximately 15-25% of the obstructive airway diseases and patients experience worse outcomes compared with asthma or COPD alone. Patients with ACOS have the combined risk factors of smoking and atopy, are generally younger than patients with COPD and experience acute exacerbations with higher frequency and greater severity than lone COPD. Pharmacotherapeutic considerations require an integrated approach, first to identify the relevant clinical phenotype(s), then to determine the best available therapy. The authors discuss the array of existing and emerging classes of drugs that could benefit those with ACOS and share their therapeutic approach. A consensus international definition of ACOS is needed to design prospective, randomized clinical trials to evaluate specific drug interventions on important outcomes such as lung function, acute exacerbations, quality of life and mortality.

Mortality in Asthma-Chronic Obstructive Pulmonary Disease Overlap in the United States

“…[408][409][410][411][412] Several diagnostic terms, most including the word 'overlap', have been applied to such patients, and the topic has been extensively reviewed. 407,409,413,414 However, there is no generally agreed term or defining features for this category of chronic airflow limitation, although a definition based upon consensus has been published for overlap in patients with existing COPD. 415 In spite of these uncertainties, there is broad agreement that patients with features of both asthma and COPD experience frequent exacerbations, 409 have poor quality of life, a more rapid decline in lung function and high mortality, 409,416 and consume a disproportionate amount of healthcare resources 417 than asthma or COPD alone.…”

“…Concurrent doctor-diagnosed asthma and COPD has been reported in between 15 and 20% of patients. 410,413,419,420 This document has been developed by the Science Committees of both GINA and GOLD, based on a detailed review of available literature and consensus. It provides an approach to identifying patients with asthma or COPD, and for distinguishing these from those with overlapping features of asthma and COPD, for which the term Asthma COPD Overlap Syndrome (ACOS) is proposed.…”

Roles of roflumilast, a selective phosphodiesterase 4 inhibitor, in airway diseases

“…Asthma-COPD overlap syndrome (ACOS) is generally observed in 15-20% of patients in airway disease clinics, and they experience more frequent exacerbation and account for greater health care cost utilization than those with pure COPD (73,74). Treatment of ACOS currently consists of ICS/LABA with and without LAMA.…”

Asthma‐COPD overlap syndrome—Coexistence of chronic obstructive pulmonary disease and asthma in elderly patients and parameters for their differentiation

“…showed prevalence of ACOS patients by gender increased depending on aging. Guidelines2, 4 showed the prevalence rates of ACOS have ranged between 15% and 55%,6, 7, 8 and concurrent doctor‐diagnosed asthma and COPD have been reported in between 15% and 20% of patients 9, 10, 11, 12. In Japan, Nagai et al 13.…”