Understanding COPD-overlap syndromes

Abstract

Chronic obstructive pulmonary disease accounts for a large burden of lung disease. It can 'overlap' with other respiratory diseases including bronchiectasis, fibrosis and obstructive sleep apnea (OSA). While COPD alone confers morbidity and mortality, common features with contrasting clinical outcomes can occur in COPD 'overlap syndromes'. Areas covered: Given the large degree of heterogeneity in COPD, individual variation to treatment is adopted based on its observed phenotype, which in turn overlaps with features of other respiratory disease states such as asthma. This is coined asthma-COPD overlap syndrome ('ACOS'). Other examples of such overlapping clinical states include bronchiectasis-COPD ('BCOS'), fibrosis-COPD ('FCOS') and OSA-COPD ('OCOS'). The objective of this review is to highlight similarities and differences between the COPD-overlap syndromes in terms of risk factors, pathophysiology, diagnosis and potential treatment differences. Expert commentary: As a consequence of COPD overlap syndromes, a transition from the traditional 'one size fits all' treatment approach is necessary. Greater treatment stratification according to clinical phenotype using a precision medicine approach is now required. In this light, it is important to recognize and differentiate COPD overlap syndromes as distinct disease states compared to individual diseases such as asthma, COPD, fibrosis or bronchiectasis.

The relationship of depression in asthma–chronic obstructive pulmonary disease overlap syndrome

“…Despite its negative impact, depression often remains unrecognized and untreated in ACOS patients. This study alert the physician to early detect the ACOS [ 29 ] among the patients with the COPD [ 14 , 21 ] or asthma [ 29 , 43 ].…”

RESPIRE: breathing new life into bronchiectasis

“…Nevertheless, no single therapeutic approach for all patients is ever likely to succeed as an approach for bronchiectasis. In fact, with the emergence of overlap syndromes, a broader, more comprehensive and complementary approach to treatment will more likely be required [15][16][17][18].…”

Are We Ill Because We Age?

“…In the case of communicable diseases, the aggressor is generally a pathogen (usually virus, bacteria, or fungus) which is propagating from person to person, while in non-communicable diseases it is determined by environmental hazards, life habits, and/or genetics which do not spread from person to person (Prüss-Ustün et al, 2019). Thus again, various diseases manifest themselves more or less specifically by objectively evidenced signs and symptoms (Poh et al, 2017). Considering these characteristics, it is clear that the causes and pathomechanisms can be different depending on the nature of the disease: caused by acute or chronic exposure to pathogens, by improperly executed physiological processes such as inflammation or autoimmunity, by genetic, biochemical, or environmental problems or failure in normal functioning/adaptability of an organ or organ system (dysregulation), ultimately becoming chronic after the initial aggression has been eliminated (Bury, 1982).…”