ACO: Time to move from the description of different phenotypes to the treatable traits.

Nuria Toledo-Pons,Noemí Pérez,Jose Luis Valera Felices,Borja G Cosío,Joan B Soriano,Job F M Van Boven,Miguel Román-Rodríguez,Konstantinos Kostikas

doi:10.1371/journal.pone.0210915

Abstract

BackgroundAsthma-COPD overlap (ACO) is a term that encompasses patients with characteristics of two conditions, smoking asthmatics or COPD patients with asthma-like features such as high bronchodilator response or blood eosinophil count ≥300 cells/μL. The aim of this study was to compare the different phenotypes inside the ACO definition in a real-life population cohort.MethodsWe analyzed patients from the MAJORICA cohort who had a diagnosis of asthma and/or COPD based on current guidelines, laboratory data in 2014 and follow-up until 2015. Prevalence of ACO according to the different criteria, demographic, clinical and functional characteristics, prescriptions and use of health resources data were compared between three groups.ResultsWe included 603 patients. Prevalence of smoking asthmatics was 14%, COPD patients with high bronchodilator response 1.5% and eosinophilic COPD patients 12%. Smoking asthmatics were younger and used more rescue inhalers, corticosteroids and health resources. Conversely, eosinophilic COPD patients were older than the other groups, often treated with corticosteroids and had lower use of health resources. Most of the COPD patients with high bronchodilator response were included in the eosinophilic COPD group.ConclusionsACO includes two conditions (smoking asthmatics and eosinophilic COPD patients) with different medication requirement and prognosis that should not be pooled together. Use of ≥300 blood eosinophils/μL as a treatable trait should be recommended.

Highlights

The GOLD-GINA consensus recommends combining three characteristics of asthma and three of chronic obstructive pulmonary disease (COPD) to make a diagnosis of overlap between asthma and COPD (ACO)
Eosinophilic COPD patients were older than the other groups, often treated with corticosteroids and had lower use of health resources
Most of the COPD patients with high bronchodilator response were included in the eosinophilic COPD group

Summary

Introduction

The GOLD-GINA consensus recommends combining three characteristics of asthma and three of chronic obstructive pulmonary disease (COPD) to make a diagnosis of overlap between asthma and COPD (ACO). Recent studies have shown that ACO is an heterogeneous condition with clinical and inflammatory differences between smoking asthmatics and eosinophilic COPD [1, 2]. A recent publication proposed an algorithm to help clinicians to identify ACO among patients with chronic obstructive airway disease [3]. It requires the diagnosis of COPD based on current guidelines [4]. Asthma-COPD overlap (ACO) is a term that encompasses patients with characteristics of two conditions, smoking asthmatics or COPD patients with asthma-like features such as high bronchodilator response or blood eosinophil count 300 cells/μL. The aim of this study was to compare the different phenotypes inside the ACO definition in a real-life population cohort

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Discussion

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