Abstract
The asthma–chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) remains poorly characterised. Our aim was to describe an algorithm for identifying possible ACOS in adults with newly diagnosed COPD in primary care. General practitioners (n=241) consecutively recruited subjects ⩾35 years, with tobacco exposure, at least one respiratory symptom and no previous diagnosis of obstructive lung disease. Possible ACOS was defined as chronic airflow obstruction, i.e., post-bronchodilator (BD) forced expiratory volume 1/forced vital capacity (FEV1/FVC) ratio<0.70, combined with wheeze (ACOS wheeze) and/or significant BD reversibility (ACOS BD reversibility). Of 3,875 (50% females, mean age 57 years) subjects screened, 700 (18.1%) were diagnosed with COPD, i.e., symptom(s), tobacco exposure and chronic airflow obstruction. Indications for ACOS were found in 264 (38%) of the COPD patients. The prevalence of ACOS wheeze and ACOS BD reversibility was 27% (n=190) and 16% (n=113), respectively (P<0.001), and only 6% (n=39) of the COPD patients fulfilled both criteria for ACOS. Patients with any ACOS were younger (P=0.04), had more dyspnoea (P<0.001), lower FEV1%pred (67% vs. 74%; P<0.001) and lower FEV1/FVC ratio (P=0.001) compared with COPD-only patients. Comparing subjects fulfilling both criteria for ACOS with those fulfilling criteria for ACOS wheeze only (n=151) and those fulfilling criteria for ACOS BD reversibility only (n=74) revealed no significant differences. Irrespective of the applied ACOS definition, no significant difference in life-time tobacco exposure was found between ACOS- and COPD-only patients. In subjects with a new diagnosis of COPD, the prevalence of ACOS is high. When screening for COPD in general practice among patients with no previous diagnosis of obstructive lung disease, patients with possible ACOS may be identified by self-reported wheeze and/or BD reversibility.
Highlights
As patients with asthma–chronic obstructive pulmonary disease (COPD) overlap seem to be at risk for a poor outcome, including a high risk of exacerbations, it is important to identify this subgroup of patients with COPD to ensure adequate treatment of the asthma component of their disease, including anti-inflammatory therapy, for patients diagnosed in primary care
Patients diagnosed with COPD were older, had more age 57 years) fulfilled the inclusion criteria, dyspnoea (Medical Research Council (MRC) score) and higher lifeand were included in the present analysis
Any asthma–COPD overlap syndrome (ACOS) defined as chronic airflow obstruction and wheeze and/or a positive BD test compared with COPD only
Summary
A significant proportion of patients presenting with symptoms of obstructive lung disease has features of both asthma and chronic obstructive pulmonary disease (COPD),[1,2] often referred to as the asthma–COPD overlap syndrome (ACOS).[3,4,5] In recent years, the ACOS has gained much attention and been extensively reviewed.[3,5,6,7,8,9] so far there is no generally agreed term or defining features for this category of patients with chronic airway obstruction,[10] diagnostic criteria have been proposed based on consensus for overlap in patients already diagnosed with COPD.[4,11,12]The proportion of patients with ACOS among individuals with existing COPD is unclear, as it depends very much on the applied defining criteria, but has been reported to be between 15 and 60%.13–15 concurrent doctor-diagnosed COPD and asthma have been reported in up to 20% of patients with obstructive lung disease.[16,17] Given these uncertainties, it appears important to establish useful and reliable criteria for identifying patients with possible ACOS, i.e., an asthma component of their disease, not least when these patients are diagnosed in primary care. Concurrent doctor-diagnosed COPD and asthma have been reported in up to 20% of patients with obstructive lung disease.[16,17] Given these uncertainties, it appears important to establish useful and reliable criteria for identifying patients with possible ACOS, i.e., an asthma component of their disease, not least when these patients are diagnosed in primary care. As patients with asthma–COPD overlap seem to be at risk for a poor outcome, including a high risk of exacerbations, it is important to identify this subgroup of patients with COPD to ensure adequate treatment of the asthma component of their disease, including anti-inflammatory therapy, for patients diagnosed in primary care
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