What is asthma−COPD overlap syndrome? Towards a consensus definition from a round table discussion

Sin, Don D.; Miravitlles, Marc; Mannino, David M.; Soriano, Joan B.; Price, David; Celli, Bartolomé R.; Leung, Janice M.; Nakano, Yasutaka; Park, Hye Yun; Wark, Peter; Wechsler, Michael E.

doi:10.1183/13993003.00436-2016

Cited by 316 publications

(333 citation statements)

References 79 publications

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“…The Spanish consensus paper 165 agreed upon a combination of six major and minor criteria, which included both clinical and physiologic components. These major and minor criteria differ slightly from the ones proposed by Sin et al 166 Both of those reports differ from the approach recommended in the 2015 Global Initiative for Asthma (GINA) and GOLD recommendations. Several other articles have been written on diagnostic criteria, [165][166][167] all with differing opinions.…”

Section: Box 2 Preventing Acute Exacerbation In Stable Copdcontrasting

confidence: 46%

“…These major and minor criteria differ slightly from the ones proposed by Sin et al 166 Both of those reports differ from the approach recommended in the 2015 Global Initiative for Asthma (GINA) and GOLD recommendations. Several other articles have been written on diagnostic criteria, [165][166][167] all with differing opinions. This lack of consensus affects our understanding of the impact, management and outcomes of ACO.…”

Section: Box 2 Preventing Acute Exacerbation In Stable Copdcontrasting

confidence: 46%

“…The majority of asthma RCTs exclude smokers and the majority of COPD trials exclude patients with a history of asthma or who demonstrate significant bronchial reversibility. Sin et al 166 reviewed the inclusion and exclusion criteria of recent large phase 3 COPD and asthma clinical trials and found that the likely ACO population was systematically excluded from all of the trials. Thus, the majority of the pharmacotherapy recommendations for patients with ACO are consensus based.…”

Section: Box 2 Preventing Acute Exacerbation In Stable Copdmentioning

confidence: 99%

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CTS position statement: Pharmacotherapy in patients with COPD—An update

Bourbeau

Bhutani

Hernández

et al. 2017

Canadian Journal of Respiratory, Critical Care, and Sleep Medic

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RATIONALE: Since the last published Canadian Thoracic Society (CTS) COPD guideline in 2007 and the 2008 update -highlights for primary care, many new clinical trials have challenged COPD treatment practices. The current Canadian position statement provides the reader with an update on pharmacotherapy of patients with COPD as reviewed by the CTS. OBJECTIVES: The objectives of this position statement are: 1) to summarize the literature on topics relevant to the pharmacological therapy of patients with stable COPD; and 2) to provide clinical guidance with evidence-based recommendations and expert-informed key messages for the pharmacological therapy for patients with stable COPD. METHODS: The authors systematically reviewed the relevant literature focusing on randomized controlled trials and when available, systematic reviews of randomized controlled trials. The proposed key messages, based on scientific evidence and expert-informed opinion, were agreed upon by a majority consensus. MAIN RESULTS: There is typically a significant delay in seeking medical care by patients with dyspnea, often waiting until symptoms affect the performance of activities of daily living. The diagnosis of COPD requires spirometry to confirm the presence of airflow obstruction in any patient presenting with symptoms and/or risk factors of COPD. An effective management plan for individuals with COPD should include: smoking cessation, vaccination and education. A number of non-pharmacological treatments are available for COPD patients with symptoms to improve outcomes such as self-management with coaching from a health care professional; pulmonary rehabilitation; supplemental oxygen in selected patients; and surgery.Current pharmacotherapy for COPD has been shown to alleviate symptoms and prevent exacerbations and related complications such as hospital admissions. In symptomatic patients with stable COPD not having or having infrequent exacerbation, treatment should be started with inhaled LAMA or LABA monotherapy, and if experiencing persistent or increased dyspnea, exercise intolerance, and/or reduced health status despite use of monotherapy, patients should be considered for treatment "step up" with an inhaled LAMA plus LABA dual therapy. In this situation, the use of a single inhaler would be preferred to simplify the treatment regimen and minimize the cost. In patients with stable COPD experiencing exacerbations despite the use of LAMA or LABA monotherapy, treatment "step up" with inhaled LAMA plus LABA dual therapy should be considered unless a patient has concomitant asthma (Asthma/COPD overlap (ACO)). There has been recent interest in using biomarkers to identify patients who are more likely to respond to ICS. Most of the studies have demonstrated that high blood eosinophils could be valuable to predict an increase response in terms of reduction of exacerbation rate when treated with combination ICS/LABA; there is still uncertainty about the exact cut-off level of blood eosinophils having potential therapeutic value. If a pa...

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Section: Box 2 Preventing Acute Exacerbation In Stable Copdcontrasting

confidence: 46%

Section: Box 2 Preventing Acute Exacerbation In Stable Copdcontrasting

confidence: 46%

Section: Box 2 Preventing Acute Exacerbation In Stable Copdmentioning

confidence: 99%

See 1 more Smart Citation

CTS position statement: Pharmacotherapy in patients with COPD—An update

Bourbeau

Bhutani

Hernández

et al. 2017

Canadian Journal of Respiratory, Critical Care, and Sleep Medic

Self Cite

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“…Smokers and ex‐smoker asthma patients were included in the study, so we cannot rule out the presence of ACOS 41 in some of them. Nevertheless, the impact of this circumstance in our results would be very small.…”

Section: Discussionmentioning

confidence: 99%

Asthma outcomes improve with continuous positive airway pressure for obstructive sleep apnea

Serrano-Pariente

Plaza

Soriano

et al. 2016

Allergy

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BackgroundContinuous positive airway pressure (CPAP) in asthma patients with concomitant obstructive sleep apnea syndrome (OSAS) seems to have a favorable impact on asthma, but data are inconsistent due to methodological limitations of previous studies.MethodsProspective, multicenter study. We examined asthma outcomes after 6 months of CPAP in 99 adult asthma patients (mean age 57 years) with OSAS (respiratory disturbance index ≥20). Asthma control and quality of life were assessed with the Asthma Control Questionnaire (ACQ) and the Mini Asthma Quality of Life Questionnaire (MiniAQLQ), respectively. Data were analyzed by intention‐to‐treat basis.ResultsThe mean ± SD score of the ACQ decreased from 1.39 ± 0.91 at baseline to 1.0 ± 0.78 at 6 months (P = 0.003), the percentage of patients with uncontrolled asthma from 41.4% to 17.2% (P = 0.006), and the percentage of patients with asthma attacks in the 6 months before and after treatment from 35.4% to 17.2% (P = 0.015). The score of the mAQLQ increased from 5.12 ± 1.38 to 5.63 ± 1.17 (P = 0.009). There were also significant improvements in symptoms of gastroesophageal reflux and rhinitis, bronchial reversibility, and exhaled nitric oxide values (all P < 0.05). No significant changes were observed in drug therapy for asthma or their comorbidities nor in the patients’ weight.ConclusionsAsthma control (both actual and future risk), quality of life, and lung function improved after starting continuous positive airway pressure in asthmatics with moderate to severe obstructive sleep apnea syndrome.

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“…The most recently published consensus of ACO included six criteria, three of which are major ( persistent airflow limitation, tobacco smoking and previous asthma or reversibility >400 mL FEV1) and three minor (history of atopy or rhinitis, at least two positive bronchodilator tests and ⩾300 blood eosinophils per μL) [23]. In an attempt to simplify this, the Spanish guidelines for COPD and for asthma agreed on a definition of ACO that included patients with a concomitant diagnosis of both diseases or patients with COPD and either ⩾300 blood eosinophils per μL or a reversibility >400 mL or both [24].…”

mentioning

confidence: 99%