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What pulmonologists think about the asthma-COPD overlap syndrome.

Miravitlles M, Alcázar B, Alvarez FJ, Bazús T, Calle M, Casanova C, Cisneros C, de-Torres JP, Entrenas LM, Esteban C, García-Sidro P, Cosio BG, Huerta A, Iriberri M, Izquierdo JL, López-Viña A, López-Campos JL, Martínez-Moragón E, Pérez de Llano L, Perpiñá M, Ros JA, Serrano J, Soler-Cataluña JJ, Torrego A, Urrutia I, Plaza V - Int J Chron Obstruct Pulmon Dis (2015)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Pneumology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain ; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.

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 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.

No MeSH data available.


Related in: MedlinePlus

Criteria preferred by the participants for the diagnosis of asthma–COPD overlap syndrome.Abbreviations: FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; FENO, fraction of nitric oxide in exhaled air.
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f1-copd-10-1321: Criteria preferred by the participants for the diagnosis of asthma–COPD overlap syndrome.Abbreviations: FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; FENO, fraction of nitric oxide in exhaled air.

Mentions: The criteria considered to be the most adequate for the diagnosis of ACOS were a previous history of asthma (88.5%), a history of smoking (73.1%), and postbronchodilator FEV1/forced vital capacity (FVC) <0.7 (69.2%) (Figure 1). Elevated Fraction of nitric oxide in exhaled air (FeNO) and a history of atopy were not considered to be adequate criteria by 53.8% (both). Of the participants, 69.2% considered smoking to be important in that ACOS is basically composed of smoking asthmatic patients, and 80.8% agreed that the Spanish ACOS criteria had contributed to disseminating the recognition of ACOS.


What pulmonologists think about the asthma-COPD overlap syndrome.

Miravitlles M, Alcázar B, Alvarez FJ, Bazús T, Calle M, Casanova C, Cisneros C, de-Torres JP, Entrenas LM, Esteban C, García-Sidro P, Cosio BG, Huerta A, Iriberri M, Izquierdo JL, López-Viña A, López-Campos JL, Martínez-Moragón E, Pérez de Llano L, Perpiñá M, Ros JA, Serrano J, Soler-Cataluña JJ, Torrego A, Urrutia I, Plaza V - Int J Chron Obstruct Pulmon Dis (2015)

Criteria preferred by the participants for the diagnosis of asthma–COPD overlap syndrome.Abbreviations: FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; FENO, fraction of nitric oxide in exhaled air.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4507793&req=5

f1-copd-10-1321: Criteria preferred by the participants for the diagnosis of asthma–COPD overlap syndrome.Abbreviations: FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; FENO, fraction of nitric oxide in exhaled air.
Mentions: The criteria considered to be the most adequate for the diagnosis of ACOS were a previous history of asthma (88.5%), a history of smoking (73.1%), and postbronchodilator FEV1/forced vital capacity (FVC) <0.7 (69.2%) (Figure 1). Elevated Fraction of nitric oxide in exhaled air (FeNO) and a history of atopy were not considered to be adequate criteria by 53.8% (both). Of the participants, 69.2% considered smoking to be important in that ACOS is basically composed of smoking asthmatic patients, and 80.8% agreed that the Spanish ACOS criteria had contributed to disseminating the recognition of ACOS.

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Pneumology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain ; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.

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 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.

No MeSH data available.


Related in: MedlinePlus