Special article
Asthma-chronic obstructive pulmonary disease overlap syndrome – Literature review and contributions towards a Portuguese consensus
D. Araújoa,b,1, E. Padrãoa,b,1,, , M. Morais-Almeidac, J. Cardosod,e, F. Pavãof, R.B. Leitef,g, A.C. Caldasf, A. Marquesb,h
a Institute of Health Sciences, Universidade Católica Portuguesa, Portugal
b Pulmonology Department, Centro Hospitalar de São João, Porto, Portugal
c Coordinator of Allergy Center of CUF Hospitals, Lisbon, Portugal
d Pulmonology Department, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
e Nova Medical School, Lisbon, Portugal
f Institute of Health Sciences, Universidade Católica Portuguesa, Portugal
g Faculty of Health, Medicine and Life Sciences, Maastricht University, Portugal
h Faculty of Medicine, University of Porto, Portugal
Received 25 October 2016, Accepted 05 November 2016
Abstract
Introduction

Phenotypic overlap between the two main chronic airway pulmonary diseases, asthma and chronic obstructive pulmonary disease (COPD), has been the subject of debate for decades, and recently the nomenclature of asthma-COPD overlap syndrome (ACOS) was adopted for this condition. The definition of this entity in the literature is, however, very heterogeneous, it is therefore important to define how it applies to Portugal.

Methods

A literature review of ACOS was made in a first phase resulting in the drawing up of a document that was later submitted for discussion among a panel of chronic lung diseases experts, resulting in reflexions about diagnosis, treatment and clinical guidance for ACOS patients.

Results

There was a consensus among the experts that the diagnosis of ACOS should be considered in the concomitant presence of: clinical manifestations characteristic of both asthma and COPD, persistent airway obstruction (post-bronchodilator FEV1/FVC<0.7), positive response to bronchodilator test (increase in FEV1 of ≥200mL and ≥12% from baseline) and current or past history of smoking or biomass exposure. In reaching diagnosis, the presence of peripheral eosinophilia (>300eosinophils/¿L or >5% of leukocytes) and previous history of atopy should also be considered. The recommended first line pharmacological treatment in these patients is the ICS/LABA association; if symptomatic control is not achieved or in case of clinical severity, triple therapy with ICS/LABA/LAMA may be used. An effective control of the exposure to risk factors, vaccination, respiratory rehabilitation and treatment of comorbidities is also important.

Conclusions

The creation of initial guidelines on ACOS, which can be applied in the Portuguese context, has an important role in the generation of a broad nationwide consensus. This will give, in the near future, a far better clinical, functional and epidemiological characterization of ACOS patients, with the ultimate goal of achieving better therapeutic guidance.

Keywords
Asthma, Chronic obstructive pulmonary disease, Overlap syndrome, Portuguese consensus
Abbreviations
ACOS, BD, CARAT, COPD, FENO, FEV1, FVC, GINA, GOLD, ICS, IgE, IL, LABA, LAMA, LLN, mMRC scale, PEF, RCT, 6MWT

Metrics

  • Impact Factor: 1.357(2015)
  • 5-years Impact Factor: 0,841
  • SCImago Journal Rank (SJR):0,29
  • Source Normalized Impact per Paper (SNIP):0,685