What pulmonologists think about the asthma–COPD overlap syndrome

Abstract

Marc Miravitlles,1,2 Bernardino Alcázar,3 Francisco Javier Alvarez,4 Teresa Bazús,5 Myriam Calle,6 Ciro Casanova,7 Carolina Cisneros,8 Juan P de-Torres,9 Luis M Entrenas,10 Cristóbal Esteban,11 Patricia García-Sidro,12 Borja G Cosio,13 Arturo Huerta,14 Milagros Iriberri,15 José Luis Izquierdo,16 Antolín López-Viña,17 José Luis López-Campos,2,4 Eva Martínez-Moragón,18 Luis Pérez de Llano,19 Miguel Perpiñá,20 José Antonio Ros,21 José Serrano,22 Juan José Soler-Cataluña,23 Alfons Torrego,24 Isabel Urrutia,11 Vicente Plaza24 1Pneumology Department, Hospital Universitari Vall d’Hebron, Barcelona, 2CIBER de Enfermedades Respiratorias (CIBERES), Madrid, 3Respiratory Department, Hospital de Alta Resolucion de Loja, Granada, 4Medical-Surgical Unit of Respiratory Diseases, Virgen del Rocio University Hospital, Biomedicine Institute of Seville (IBiS), Seville, 5Department of Pneumology, Hospital Universitario Central de Asturias, Oviedo, 6Department of Pneumology, Hospital Clínico San Carlos, Madrid, 7Department of Pneumology, Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, 8Department of Pneumology, Hospital Universitario de La Princesa/Instituto de Investigación Sanitaria (IIS-IP), Madrid, 9Pulmonary Department, Clínica Universidad de Navarra, Pamplona, 10Department of Pneumology, Hospital Universitario Reina Sofia, Córdoba, 11Department of Pneumology, Hospital Galdakao-Usansolo, Galdakao, 12Department of Pneumology, Hospital Universitario de La Plana, Vila-real, 13Department of Pneumology, Hospital Universitario Son Espases IdISPa, Palma de Mallorca, 14Sección Urgencias Medicina – Neumología, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, 15Department of Pneumology, Hospital Universitario de Cruces, Bilbao, 16Department of Pneumology, Hospital Universitario de Guadalajara, Guadalajara, 17Department of Pneumology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, 18Department of Pneumology, Hospital Universitario Dr Peset, Valencia, 19Department of Pneumology, Hospital Universitario Lucus Augusti, Lugo, 20Department of Pneumology, Hospital Universitario y Politécnico La Fe, Valencia, 21Department of Pneumology, Hospital Clínico Universitario Virgen de la Arrinxaca, Murcia, 22Department of Pneumology, Hospital Comarcal de Inca, Inca, 23Pneumology Department, Hospital Arnau de Vilanova-Lliria, Valencia, 24Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomédica Sant Pau (IIB Sant Pau), Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain Background: Some patients with COPD may share characteristics of asthma; this is the so-called asthma–COPD overlap syndrome (ACOS). There are no universally accepted criteria for ACOS, and most treatments for asthma and COPD have not been adequately tested in this population. Materials and methods: We performed a survey among pulmonology specialists in asthma and COPD aimed at collecting their opinions about ACOS and their attitudes in regard to some case scenarios of ACOS patients. The participants answered a structured questionnaire and attended a face-to-face meeting with the Metaplan methodology to discuss different aspects of ACOS. Results: A total of 26 pulmonologists with a mean age of 49.7 years participated in the survey (13 specialists in asthma and 13 in COPD). Among these, 84.6% recognized the existence of ACOS and stated that a mean of 12.6% of their patients might have this syndrome. In addition, 80.8% agreed that the diagnostic criteria for ACOS are not yet well defined. The most frequently mentioned characteristics of ACOS were a history of asthma (88.5%), significant smoking exposure (73.1%), and postbronchodilator forced expiratory volume in 1 second/forced vital capacity <0.7 (69.2%). The most accepted diagnostic criteria were eosinophilia in sputum (80.8%), a very positive bronchodilator test (69.2%), and a history of asthma before 40 years of age (65.4%). Up to 96.2% agreed that first-line treatment for ACOS was the combination of a long-acting β2-agonist and inhaled steroid, with a long-acting antimuscarinic agent (triple therapy) for severe ACOS. Conclusion: Most Spanish specialists in asthma and COPD agree that ACOS exists, but the diagnostic criteria are not yet well defined. A previous history of asthma, smoking, and not fully reversible airflow limitation are considered the main characteristics of ACOS, with the most accepted first-line treatment being long-acting β2-agonist/inhaled corticosteroids. Keywords: asthma, COPD, ACOS, survey, guidelines