The asthma–chronic obstructive pulmonary disease overlap syndrome (ACOS): opportunities and challenges

Purpose of review Some individuals share characteristics of asthma and chronic obstructive pulmonary disease (COPD). The asthma–COPD overlap syndrome (ACOS) has been defined as symptoms of increased variability of airflow in association with an incompletely reversible airflow obstruction. In this review, we present the latest findings in the diagnosis, characterization and management of ACOS. Recent findings Around 15–20% of COPD patients may have an ACOS. Patients with ACOS are characterized by increased reversibility of airflow obstruction, eosinophilic bronchial and systemic inflammation, and increased response to inhaled corticosteroids, compared with the remaining patients with COPD. Patients with ACOS have more frequent exacerbations, more wheezing and dyspnoea, but similar cough and sputum production compared with COPD. Summary The relevance of the ACOS is to identify patients with COPD who may have underlying eosinophilic inflammation that responds to inhaled corticosteroids. So far, the previous diagnosis of asthma in a patient with COPD is the more reliable criterion for ACOS. Ongoing studies will clarify if concentrations of blood eosinophils may be useful to identify this subgroup of patients with COPD. If this is the case, the interest of ACOS may shift to that of eosinophilic COPD, which is easier to diagnose and has clear therapeutic implications.

[1]  M. Miravitlles,et al.  Generic utilities in chronic obstructive pulmonary disease patients stratified according to different staging systems , 2014, Health and Quality of Life Outcomes.

[2]  O. C. Añón,et al.  Distribución de fenotipos clínicos en pacientes con enfermedad pulmonar obstructiva crónica por humo de biomasa y por tabaco , 2014 .

[3]  J. Chang,et al.  Characteristics and self-rated health of overlap syndrome , 2014, International journal of chronic obstructive pulmonary disease.

[4]  H. Yoon,et al.  Clinical Characteristics of Asthma Combined with COPD Feature , 2014, Yonsei medical journal.

[5]  Edwin J R van Beek,et al.  The clinical and genetic features of COPD-asthma overlap syndrome , 2014, European Respiratory Journal.

[6]  S. Hung,et al.  Exhaled Nitric Oxide Predicts Eosinophilic Airway Inflammation in COPD , 2014, Lung.

[7]  Ioanna Kougioumtzi,et al.  Asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS): current literature review. , 2014, Journal of thoracic disease.

[8]  G. Valdivia,et al.  Increased risk of exacerbation and hospitalization in subjects with an overlap phenotype: COPD-asthma. , 2014, Chest.

[9]  D. Mannino,et al.  Chronic Obstructive Pulmonary Disease and Asthma–Patient Characteristics and Health Impairment , 2013, COPD.

[10]  J. Soriano,et al.  Spanish Guideline for COPD (GesEPOC). Update 2014 , 2014 .

[11]  J. Soriano,et al.  Spanish guideline for COPD (GesEPOC). Update 2014. , 2014, Archivos de bronconeumologia.

[12]  R. Golpe,et al.  Distribution of clinical phenotypes in patients with chronic obstructive pulmonary disease caused by biomass and tobacco smoke. , 2014, Archivos de bronconeumologia.

[13]  J. Soriano,et al.  Characterisation of the overlap COPD-asthma phenotype. Focus on physical activity and health status. , 2013, Respiratory medicine.

[14]  Mohammad Obadah Nakawah,et al.  Asthma, Chronic Obstructive Pulmonary Disease (COPD), and the Overlap Syndrome , 2013, The Journal of the American Board of Family Medicine.

[15]  Jing Gao,et al.  Differences in plasma and sputum biomarkers between COPD and COPD–asthma overlap , 2013, European Respiratory Journal.

[16]  J. Zak,et al.  Chronic Obstructive Pulmonary Disease: official diagnosis and treatment guidelines of the Czech Pneumological and Phthisiological Society; a novel phenotypic approach to COPD with patient-oriented care. , 2013, Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia.

[17]  R. de Marco,et al.  The Coexistence of Asthma and Chronic Obstructive Pulmonary Disease (COPD): Prevalence and Risk Factors in Young, Middle-aged and Elderly People from the General Population , 2013, PloS one.

[18]  E. Antón,et al.  Prevalence and characteristics of three clinical phenotypes of chronic obstructive pulmonary disease (COPD). , 2013, Respiratory medicine.

[19]  Hao Li,et al.  Which patients with chronic obstructive pulmonary disease benefit from the addition of an inhaled corticosteroid to their bronchodilator? A cluster analysis , 2013, BMJ Open.

[20]  L. Wood,et al.  Multidimensional assessment and tailored interventions for COPD: respiratory utopia or common sense? , 2013, Thorax.

[21]  R. Wood‐Baker,et al.  The interplay between the effects of lifetime asthma, smoking, and atopy on fixed airflow obstruction in middle age. , 2013, American journal of respiratory and critical care medicine.

[22]  B. Morrissey,et al.  The asthma–chronic obstructive pulmonary disease overlap syndrome: pharmacotherapeutic considerations , 2013, Expert review of clinical pharmacology.

[23]  Joan B. Soriano,et al.  Treatment of COPD by clinical phenotypes: putting old evidence into clinical practice , 2012, European Respiratory Journal.

[24]  J. Soriano,et al.  Consensus document on the overlap phenotype COPD-asthma in COPD. , 2012, Archivos de bronconeumologia.

[25]  José Raúl Rodríguez Rodríguez,et al.  Documento de consenso sobre el fenotipo mixto EPOC-asma en la EPOC , 2012 .

[26]  M. Miravitlles,et al.  The overlap phenotype: the (missing) link between asthma and COPD , 2012, Multidisciplinary Respiratory Medicine.

[27]  K. Kubo,et al.  Sputum eosinophilia can predict responsiveness to inhaled corticosteroid treatment in patients with overlap syndrome of COPD and asthma , 2012, International journal of chronic obstructive pulmonary disease.

[28]  M. Miravitlles,et al.  Clinical Phenotypes of COPD: Identication, Denition and Implications for Guidelines , 2012 .

[29]  M. Miravitlles,et al.  Difficulties in differential diagnosis of COPD and asthma in primary care. , 2012, The British journal of general practice : the journal of the Royal College of General Practitioners.

[30]  박용범,et al.  Medical Utilization and Cost in Patients with Overlap Syndrome of Chronic Obstructive Pulmonary Disease and Asthma , 2012 .

[31]  Joyce D. Schroeder,et al.  The clinical features of the overlap between COPD and asthma , 2011, Respiratory research.

[32]  T. Haahtela,et al.  Overlap Syndrome of Asthma and COPD Predicts Low Quality of Life , 2011, The Journal of asthma : official journal of the Association for the Care of Asthma.

[33]  Edwin K Silverman,et al.  Chronic obstructive pulmonary disease phenotypes: the future of COPD. , 2010, American journal of respiratory and critical care medicine.

[34]  P. Gibson,et al.  The overlap syndrome of asthma and COPD: what are its features and how important is it? , 2009, Thorax.

[35]  A L Hansell,et al.  Proportional classifications of COPD phenotypes , 2008, Thorax.

[36]  Anand A. Dalal,et al.  Burden of concomitant asthma and COPD in a Medicaid population. , 2008, Chest.

[37]  H. Magnussen,et al.  Improvements with tiotropium in COPD patients with concomitant asthma. , 2008, Respiratory medicine.

[38]  I. Pavord,et al.  Eosinophilic airway inflammation and exacerbations of COPD: a randomised controlled trial , 2007, European Respiratory Journal.

[39]  Sean Keenan,et al.  Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease - 2007 update. , 2007, Canadian respiratory journal.

[40]  Joan B Soriano,et al.  The proportional Venn diagram of obstructive lung disease in the Italian general population. , 2004, Chest.

[41]  Joan B Soriano,et al.  The proportional Venn diagram of obstructive lung disease: two approximations from the United States and the United Kingdom. , 2003, Chest.

[42]  L. Corbetta,et al.  Differences in airway inflammation in patients with fixed airflow obstruction due to asthma or chronic obstructive pulmonary disease. , 2003, American journal of respiratory and critical care medicine.

[43]  F. Maltais,et al.  Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease--2003. , 2003, Canadian respiratory journal.

[44]  D. Postma,et al.  Chronic obstructive pulmonary disease. , 2002, Clinical evidence.

[45]  L. Fabbri,et al.  Partial reversibility of airflow limitation and increased exhaled NO and sputum eosinophilia in chronic obstructive pulmonary disease. , 2000, American journal of respiratory and critical care medicine.

[46]  I. Pavord,et al.  Sputum eosinophilia and short-term response to prednisolone in chronic obstructive pulmonary disease: a randomised controlled trial , 2000, The Lancet.

[47]  J. Bousquet,et al.  Corticosteroid reversibility in COPD is related to features of asthma. , 1997, American journal of respiratory and critical care medicine.