Publicaciones científicas
What pulmonologists think about the asthma-COPD overlap syndrome
Miravitlles M (1), Alcázar B (2), Alvarez FJ (3), Bazús T (4), Calle M (5), Casanova C (6), Cisneros C (7), de-Torres JP (8), Entrenas LM (9), Esteban C (10), García-Sidro P (11), Cosio BG (12), Huerta A (13), Iriberri M (14), Izquierdo JL (15), López-Viña A (16), López-Campos JL (17), Martínez-Moragón E (18), Pérez de Llano L (19), Perpiñá M (20), Ros JA (21), Serrano J (22), Soler-Cataluña JJ (23), Torrego A (24), Urrutia I (10), Plaza V (24).
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 β2-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 β2-agonist/inhaled corticosteroids.
CITA DEL ARTÍCULO Int J Chron Obstruct Pulmon Dis. 2015 Jul 15;10:1321-30. doi: 10.2147/COPD.S88667. eCollection 2015