Abstract
BackgroundThe combination of asthma and chronic obstructive pulmonary disease (COPD), or ACOS is a recently defined syndrome. The epidemiology of the condition is poorly described and previous research has suggested ACOS is associated with worse outcomes than either condition alone. We therefore decided to complete a systematic review of the published literature.MethodsThis review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta- Analyses guidelines. A structured search was performed in the PubMed, Embase, and Medline databases up to Feb 2015 to identify studies reporting incidence, prevalence, health care utilization, morbidity, or mortality in COPD and asthma.ResultsA total of 19 studies were included in the present study. The pooled prevalence of overlap among COPD was 27% (95% CI: 0.16–0.38, p<0.0001) and 28% (95% CI: 0.09–0.47, p = 0.0032) in the population and hospital-based studies, respectively. We found no significant difference between ACOS and COPD in terms of gender, smoking status, lung function and 6mWD. However, in comparison to subject with only COPD, ACOS subjects were significantly younger, had higher BMI, healthcare utilization, and lower HRQoL.ConclusionACOS is a common condition that exists in a substantial proportion of subjects with COPD. ACOS represents a distinct clinical phenotype with more frequent exacerbations, hospitalization, worse health-related quality of life, and higher healthcare costs than either disease alone. There is a critical need to better define the management and treatment of this syndrome.
Highlights
Asthma and Chronic Obstructive Pulmonary Disease (COPD) are major public health problems
We found no significant difference between ACOS and chronic obstructive pulmonary disease (COPD) in terms of gender, smoking status, lung function and 6mWD
In comparison to subject with only COPD, ACOS subjects were significantly younger, had higher Body Mass Index (BMI), healthcare utilization, and lower Health-Related Quality of Life (HRQoL)
Summary
Asthma and Chronic Obstructive Pulmonary Disease (COPD) are major public health problems. Asthma is an allergic disease that often develops during childhood, it can be diagnosed in adult life It is characterized by airway hyper-responsiveness (AHR) that leads to intermittent and usually reversible airway obstruction, whereas COPD is a chronic respiratory disease that is typically linked to smoking tobacco, usually presents in subjects older than forty years of age, and is characterized by progressive and irreversible airway obstruction[1,2]. In a recent document developed by the science committees of both the Global Initiative for Asthma (GINA) and the Global Initiative for Chronic Obstructive Lung Disease (GOLD), ACOS was defined as a syndrome characterized by persistent airflow limitation with several features usually associated with asthma and several features usually associated with COPD [5] This overlap makes the differentiation between COPD and asthma with persistent airflow limitation difficult, especially in smokers and elderly people[3,6,7]. We decided to complete a systematic review of the published literature
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