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Diagnosis of asthma-COPD overlap

A Belgian survey on the diagnosis of asthma-COPD overlap syndrome

Cataldo et al. - Int J of COPD 2017

Background
  • Patients with chronic airway disease may present features of both asthma and COPD, commonly referred to as asthma-COPD overlap (ACO).
  • The reported frequency of ACO varies widely. When using the Spanish criteria between 5-21% of COPD patients were diagnosed as having ACO. The prevalence of ACO in asthma patients with a smoking history was estimated to be 27% in a cross-sectional study in Finland.
  • As COPD patients might mostly benefit from bronchodilator therapies, there is a challenge for the clinician to recognize an asthma component that will require ICS treatment.
  • Recommendations on the diagnosis of ACO are diffuse and inconsistent. This survey aimed to identify consensus on criteria for diagnosing ACO and additionally criteria for initiating ICS therapy in COPD patients.
Methods
  • A Belgian expert panel developed an online survey on ACO diagnosis, which was completed by 87 (response rate 23.4%) pulmonologists. Answers chosen by ≥ 70% of respondents were considered as useful criteria for ACO diagnosis.
  • The 2 most frequently selected answers were considered major criteria, others as minor criteria. The expert panel proposed a minimal requirement of 2 major criteria and 1 minor criterion for the diagnosis of ACO.
Results

Important criteria for the diagnosis of ACO

  • 77% of the pulmonologists mentioned ‘reversibility in lung function and/or airway obstruction’ as most important criterion for ACO diagnosis. Other commonly reported criteria were ‘history or diagnosis of asthma’, ‘allergy or atopy’ and ‘smoking’.

Criteria to qualify a patient as ACO patient

  • It was agreed upon by the expert panel that the presence of 2 major criteria and at least one minor criterion would be required for the diagnosis of ACO.


Criteria to prescribe ICS to a COPD patient

  • The most important criterion to prescribe ICS in COPD is ‘exacerbations’, mentioned by 89% of survey participants. Other commonly reported criteria were ‘eosinophilia/increased FeNO’ and ‘reversibility in lung function and/or airway obstruction’.
Conclusions
  • The strengths and novelty of the Belgian expert recommendations are that they provide, for the first time, specific criteria for previously diagnosed asthma or COPD patients in whom the suspicion of ACO is raised during follow-up.
  • Criteria used to classify COPD patients as ACO were largely similar to those used to prescribe ICS in COPD patients.

Reference:
Cataldo et al., Int J of COPD. 2017: 12; 601-613

NS ID BE-1313-RD08/2017-WEB