Defining the Asthma-COPD Overlap Syndrome in a COPD Cohort

• Published in: Chest Vol. 149; no. 1; pp. 45 - 52
• Main Authors: Cosio, Borja G., MD, Soriano, Joan B., MD, López-Campos, Jose Luis, MD, Calle-Rubio, Myriam, MD, Soler-Cataluna, Juan José, MD, de-Torres, Juan P., MD, Marín, Jose M., MD, Martínez-Gonzalez, Cristina, MD, de Lucas, Pilar, MD, Mir, Isabel, MD, Peces-Barba, Germán, MD, Feu-Collado, Nuria, MD, Solanes, Ingrid, MD, Alfageme, Inmaculada, MD, Casanova, Ciro, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2016
• Subjects: Aged; asthma; Asthma - complications; Asthma - diagnosis; Asthma - drug therapy; Bronchodilator Agents - therapeutic use; Cohort Studies; COPD; Eosinophils; Female; Forced Expiratory Volume; Humans; Leukocyte Count; Male; Middle Aged; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - drug therapy; Pulmonary/Respiratory; Syndrome; 6-min walking distance; GOLD; mMRC; diffusion capacity for carbon monoxide; Global Initiative for Chronic Obstructive Lung Disease; eosinophils; asthma; LAMA; BMI, airflow obstruction, dyspnea, and exercise; COPD History Assessment in Spain; CHAIN; BODE; D lco; GINA; Global Initiative for Asthma; long-acting antimuscarinic agent; CAT; ACOS; COPD Assessment Test; asthma-COPD overlap syndrome; modified Medical Research Council; 6MWD; COPD; Dlco
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.15-1055

Background 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. Methods To identify patients with ACOS, a cohort of well-characterized patients with COPD and up to 1 year of follow-up was analyzed. We evaluated the presence of specific characteristics associated with asthma in this COPD cohort, divided into major criteria (bronchodilator test > 400 mL and 15% and past medical history of asthma) and minor criteria (blood eosinophils > 5%, IgE > 100 IU/mL, or two separate bronchodilator tests > 200 mL and 12%). We defined ACOS by the presence of one major criterion or two minor criteria. Baseline characteristics, health status (COPD Assessment Test [CAT]), BMI, airflow obstruction, dyspnea, and exercise capacity (BODE) index, rate of exacerbations, and mortality up to 1 year of follow-up were compared between patients with and without criteria for ACOS. Results Of 831 patients with COPD included,125 (15%) fulfilled the criteria for ACOS, and 98.4% of them sustained these criteria after 1 year. Patients with ACOS were predominantly male (81.6%), with symptomatic mild to moderate disease (67%), who were receiving inhaled corticosteroids (63.2%). There were no significant differences in baseline characteristics, and only survival was worse in patients with non-ACOS COPD after 1 year of follow-up ( P  < .05). Conclusions The proposed ACOS criteria are present in 15% of a cohort of patients with COPD and these patients show better 1-year prognosis than clinically similar patients with COPD with no ACOS criteria. Trial Registry ClinicalTrials.gov; No.: NCT01122758 ; URL: www.clinicaltrials.gov