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      ACO: Time to move from the description of different phenotypes to the treatable traits

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          Abstract

          Background

          Asthma-COPD overlap (ACO) is a term that encompasses patients with characteristics of two conditions, smoking asthmatics or COPD patients with asthma-like features such as high bronchodilator response or blood eosinophil count ≥300 cells/μL. The aim of this study was to compare the different phenotypes inside the ACO definition in a real-life population cohort.

          Methods

          We analyzed patients from the MAJORICA cohort who had a diagnosis of asthma and/or COPD based on current guidelines, laboratory data in 2014 and follow-up until 2015. Prevalence of ACO according to the different criteria, demographic, clinical and functional characteristics, prescriptions and use of health resources data were compared between three groups.

          Results

          We included 603 patients. Prevalence of smoking asthmatics was 14%, COPD patients with high bronchodilator response 1.5% and eosinophilic COPD patients 12%. Smoking asthmatics were younger and used more rescue inhalers, corticosteroids and health resources. Conversely, eosinophilic COPD patients were older than the other groups, often treated with corticosteroids and had lower use of health resources. Most of the COPD patients with high bronchodilator response were included in the eosinophilic COPD group.

          Conclusions

          ACO includes two conditions (smoking asthmatics and eosinophilic COPD patients) with different medication requirement and prognosis that should not be pooled together. Use of ≥300 blood eosinophils/μL as a treatable trait should be recommended.

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          Most cited references18

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          Blood Eosinophils and Exacerbations in Chronic Obstructive Pulmonary Disease. The Copenhagen General Population Study.

          Whether high blood eosinophils are associated with chronic obstructive pulmonary disease (COPD) exacerbations among individuals with COPD in the general population is largely unknown.
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            The clinical features of the overlap between COPD and asthma

            Background The coexistence of COPD and asthma is widely recognized but has not been well described. This study characterizes clinical features, spirometry, and chest CT scans of smoking subjects with both COPD and asthma. Methods We performed a cross-sectional study comparing subjects with COPD and asthma to subjects with COPD alone in the COPDGene Study. Results 119 (13%) of 915 subjects with COPD reported a history of physician-diagnosed asthma. These subjects were younger (61.3 vs 64.7 years old, p = 0.0001) with lower lifetime smoking intensity (43.7 vs 55.1 pack years, p = 0.0001). More African-Americans reported a history of asthma (33.6% vs 15.6%, p < 0.0001). Subjects with COPD and asthma demonstrated worse disease-related quality of life, were more likely to have had a severe COPD exacerbation in the past year, and were more likely to experience frequent exacerbations (OR 3.55 [2.19, 5.75], p < 0.0001). Subjects with COPD and asthma demonstrated greater gas-trapping on chest CT. There were no differences in spirometry or CT measurements of emphysema or airway wall thickness. Conclusion Subjects with COPD and asthma represent a relevant clinical population, with worse health-related quality of life. They experience more frequent and severe respiratory exacerbations despite younger age and reduced lifetime smoking history. Trial registration ClinicalTrials.gov: NCT00608764
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              Defining the Asthma-COPD Overlap Syndrome in a COPD Cohort.

              Asthma-COPD overlap syndrome (ACOS) has been recently described by international guidelines. A stepwise approach to diagnosis using usual features of both diseases is recommended although its clinical application is difficult.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: MethodologyRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: InvestigationRole: MethodologyRole: ResourcesRole: ValidationRole: VisualizationRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: MethodologyRole: ResourcesRole: SoftwareRole: ValidationRole: Writing – review & editing
                Role: Data curationRole: MethodologyRole: ResourcesRole: SoftwareRole: ValidationRole: VisualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: ResourcesRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                24 January 2019
                2019
                : 14
                : 1
                : e0210915
                Affiliations
                [1 ] CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
                [2 ] Department of Respiratory Medicine, Hospital Universitari Son Espases-IdISBa, Mallorca, Spain
                [3 ] Department of General Practice & Elderly Care Medicine, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
                [4 ] Primary Care respiratory research unit, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Mallorca, Spain
                [5 ] Gabinete Técnico Servicios Centrales, Servicio de Salud de las Islas Baleares, Mallorca, Spain
                [6 ] Hopital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
                [7 ] Consultor de Metodología e Investigación de SEPAR, Barcelona, Spain
                National and Kapodistrian University of Athens, SWITZERLAND
                Author notes

                Competing Interests: We have read the journal’s policy and the authors of this manuscript have the following competing interests: B. G. C. has received speaker fees from Sanofi, AstraZeneca, Boehringer Ingelheim, Chiesi, Teva, Mundipharma and Menarini, outside the submitted work. M. R.-R. has received personal fees from Astra Zeneca, Boehringer Ingelheim, Mundipharma, Novartis, and TEVA, and grants and personal fees from GSK, outside the submitted work. None declared (J. F. M. v. B., J.L.V., N. T.-P., N.P. and J. B. S.). This does not alter our adherence to PLOS ONE policies on sharing data and materials.

                Author information
                http://orcid.org/0000-0002-2599-4473
                Article
                PONE-D-18-32478
                10.1371/journal.pone.0210915
                6345463
                30677059
                1858842d-4fdb-4aec-b565-51a66378329f
                © 2019 Toledo-Pons et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 12 November 2018
                : 3 January 2019
                Page count
                Figures: 4, Tables: 3, Pages: 15
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100007509, Sociedad Española de Neumología y Cirugía Torácica;
                Award ID: (478/2017)
                Award Recipient :
                N. T.-P. was a recipient of a SEPAR travel fellowship (478/2017, https://www.separ.es/) aimed to set a collaboration with GRIAC for the purpose of this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Pulmonology
                Chronic Obstructive Pulmonary Disease
                Biology and Life Sciences
                Cell Biology
                Cellular Types
                Animal Cells
                Blood Cells
                White Blood Cells
                Eosinophils
                Biology and Life Sciences
                Cell Biology
                Cellular Types
                Animal Cells
                Immune Cells
                White Blood Cells
                Eosinophils
                Biology and Life Sciences
                Immunology
                Immune Cells
                White Blood Cells
                Eosinophils
                Medicine and Health Sciences
                Immunology
                Immune Cells
                White Blood Cells
                Eosinophils
                Medicine and Health Sciences
                Pulmonology
                Asthma
                Medicine and Health Sciences
                Pharmacology
                Drugs
                Bronchodilators
                Medicine and Health Sciences
                Critical Care and Emergency Medicine
                Medicine and Health Sciences
                Diagnostic Medicine
                Prognosis
                Medicine and Health Sciences
                Pulmonology
                Pulmonary Function
                Biology and Life Sciences
                Anatomy
                Body Fluids
                Blood
                Blood Counts
                Medicine and Health Sciences
                Anatomy
                Body Fluids
                Blood
                Blood Counts
                Biology and Life Sciences
                Physiology
                Body Fluids
                Blood
                Blood Counts
                Medicine and Health Sciences
                Physiology
                Body Fluids
                Blood
                Blood Counts
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                All relevant data are within the manuscript and its Supporting Information files.

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