Marc Miravitlles 1 , 2 , Bernardino Alcázar 3 , Francisco Javier Alvarez 4 , Teresa Bazús 5 , Myriam Calle 6 , Ciro Casanova 7 , Carolina Cisneros 8 , Juan P de-Torres 9 , Luis M Entrenas 10 , Cristóbal Esteban 11 , Patricia García-Sidro 12 , Borja G Cosio 13 , Arturo Huerta 14 , Milagros Iriberri 15 , José Luis Izquierdo 16 , Antolín López-Viña 17 , José Luis López-Campos 2 , 4 , Eva Martínez-Moragón 18 , Luis Pérez de Llano 19 , Miguel Perpiñá 20 , José Antonio Ros 21 , José Serrano 22 , Juan José Soler-Cataluña 23 , Alfons Torrego 24 , Isabel Urrutia 11 , Vicente Plaza 24
15 July 2015
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.
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.
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.
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.