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      What pulmonologists think about the asthma–COPD overlap syndrome

      1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 2 , 4 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 11 , 24

      International Journal of Chronic Obstructive Pulmonary Disease

      Dove Medical Press

      asthma, COPD, ACOS, survey, guidelines

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          Abstract

          Background

          Some patients with COPD may share characteristics of asthma; this is the so-called asthma–COPD overlap syndrome (ACOS). There are no universally accepted criteria for ACOS, and most treatments for asthma and COPD have not been adequately tested in this population.

          Materials and methods

          We performed a survey among pulmonology specialists in asthma and COPD aimed at collecting their opinions about ACOS and their attitudes in regard to some case scenarios of ACOS patients. The participants answered a structured questionnaire and attended a face-to-face meeting with the Metaplan methodology to discuss different aspects of ACOS.

          Results

          A total of 26 pulmonologists with a mean age of 49.7 years participated in the survey (13 specialists in asthma and 13 in COPD). Among these, 84.6% recognized the existence of ACOS and stated that a mean of 12.6% of their patients might have this syndrome. In addition, 80.8% agreed that the diagnostic criteria for ACOS are not yet well defined. The most frequently mentioned characteristics of ACOS were a history of asthma (88.5%), significant smoking exposure (73.1%), and postbronchodilator forced expiratory volume in 1 second/forced vital capacity <0.7 (69.2%). The most accepted diagnostic criteria were eosinophilia in sputum (80.8%), a very positive bronchodilator test (69.2%), and a history of asthma before 40 years of age (65.4%). Up to 96.2% agreed that first-line treatment for ACOS was the combination of a long-acting β 2-agonist and inhaled steroid, with a long-acting antimuscarinic agent (triple therapy) for severe ACOS.

          Conclusion

          Most Spanish specialists in asthma and COPD agree that ACOS exists, but the diagnostic criteria are not yet well defined. A previous history of asthma, smoking, and not fully reversible airflow limitation are considered the main characteristics of ACOS, with the most accepted first-line treatment being long-acting β 2-agonist/inhaled corticosteroids.

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          Most cited references 28

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          Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary.

           ,  Suzanne Hurd,  P Calverley (2001)
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            Chronic obstructive pulmonary disease

            Summary Chronic obstructive pulmonary disease (COPD) is characterised by progressive airflow obstruction that is only partly reversible, inflammation in the airways, and systemic effects or comorbities. The main cause is smoking tobacco, but other factors have been identified. Several pathobiological processes interact on a complex background of genetic determinants, lung growth, and environmental stimuli. The disease is further aggravated by exacerbations, particularly in patients with severe disease, up to 78% of which are due to bacterial infections, viral infections, or both. Comorbidities include ischaemic heart disease, diabetes, and lung cancer. Bronchodilators constitute the mainstay of treatment: β2 agonists and long-acting anticholinergic agents are frequently used (the former often with inhaled corticosteroids). Besides improving symptoms, these treatments are also thought to lead to some degree of disease modification. Future research should be directed towards the development of agents that notably affect the course of disease.
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                Author and article information

                Journal
                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                1176-9106
                1178-2005
                2015
                15 July 2015
                : 10
                : 1321-1330
                Affiliations
                [1 ]Pneumology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain
                [2 ]CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
                [3 ]Respiratory Department, Hospital de Alta Resolucion de Loja, Granada, Spain
                [4 ]Medical-Surgical Unit of Respiratory Diseases, Virgen del Rocio University Hospital, Biomedicine Institute of Seville (IBiS), Seville, Spain
                [5 ]Department of Pneumology, Hospital Universitario Central de Asturias, Oviedo, Spain
                [6 ]Department of Pneumology, Hospital Clínico San Carlos, Madrid, Spain
                [7 ]Department of Pneumology, Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
                [8 ]Department of Pneumology, Hospital Universitario de La Princesa/Instituto de Investigación Sanitaria (IIS-IP), Madrid, Spain
                [9 ]Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
                [10 ]Department of Pneumology, Hospital Universitario Reina Sofia, Córdoba, Spain
                [11 ]Department of Pneumology, Hospital Galdakao-Usansolo, Galdakao, Spain
                [12 ]Department of Pneumology, Hospital Universitario de La Plana, Vila-real, Spain
                [13 ]Department of Pneumology, Hospital Universitario Son Espases IdISPa, Palma de Mallorca, Spain
                [14 ]Sección Urgencias Medicina – Neumología, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain
                [15 ]Department of Pneumology, Hospital Universitario de Cruces, Bilbao, Spain
                [16 ]Department of Pneumology, Hospital Universitario de Guadalajara, Guadalajara, Spain
                [17 ]Department of Pneumology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
                [18 ]Department of Pneumology, Hospital Universitario Dr Peset, Valencia, Spain
                [19 ]Department of Pneumology, Hospital Universitario Lucus Augusti, Lugo, Spain
                [20 ]Department of Pneumology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
                [21 ]Department of Pneumology, Hospital Clínico Universitario Virgen de la Arrinxaca, Murcia, Spain
                [22 ]Department of Pneumology, Hospital Comarcal de Inca, Inca, Spain
                [23 ]Pneumology Department, Hospital Arnau de Vilanova-Lliria, Valencia, Spain
                [24 ]Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomédica Sant Pau (IIB Sant Pau), Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
                Author notes
                Correspondence: Marc Miravitlles, Pneumology Department, Hospital Universitari Vall d’Hebron, Passeig de la Vall d’Hebron 119-129, Barcelona 08035, Spain, Tel/fax +34 93 274 6083, Email mmiravitlles@ 123456vhebron.net
                Article
                copd-10-1321
                10.2147/COPD.S88667
                4507793
                26270415
                © 2015 Miravitlles et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Original Research

                Respiratory medicine

                copd, acos, survey, guidelines, asthma

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