title: Consensus document on the overlap phenotype COPD-asthma in COPD.
abstract: BACKGROUND
  Although asthma and COPD are different pathologies, many patients share characteristics from both entities. These cases can have different evolutions and responses to treatment. Nevertheless, the evidence available is limited, and it is necessary to evaluate whether they represent a differential phenotype and provide recommendations about diagnosis and treatment, in addition to identifying possible gaps in our understanding of asthma and COPD.
  
  
  METHODS
  A nation-wide consensus of experts in COPD in two stages: 1) during an initial meeting, the topics to be dealt with were established and a first draft of statements was elaborated with a structured "brainstorming" method; 2) consensus was reached with two rounds of e-mails, using a Likert-type scale.
  
  
  RESULTS
  Consensus was reached about the existence of a differential clinical phenotype known as"Overlap Phenotype COPD-Asthma", whose diagnosis is made when 2 major criteria and 2 minor criteria are met. The major criteria include very positive bronchodilator test (increase in FEV(1) ≥ 15% and ≥ 400ml), eosinophilia in sputum and personal history of asthma. Minor criteria include high total IgE, personal history of atopy and positive bronchodilator test (increase in FEV(1) ≥ 12% and ≥ 200ml) on two or more occasions. The early use of individually-adjusted inhaled corticosteroids is recommended, and caution must be taken with their abrupt withdrawal. Meanwhile, in severe cases the use of triple therapy should be evaluated. Finally, there is an obvious lack of specific studies about the natural history and the treatment of these patients.
  
  
  CONCLUSIONS
  It is necessary to expand our knowledge about this phenotype in order to establish adequate guidelines and recommendations for its diagnosis and treatment.
authors.affiliation: Hospital General de Requena, Requena, Valencia, España. jjsoler@telefonica.net
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Soler-Cataluña
authors.forename: Borja
authors.initials: B
authors.lastname: Cosío
authors.forename: José Luis
authors.initials: JL
authors.lastname: Izquierdo
authors.forename: José Luis
authors.initials: JL
authors.lastname: López-Campos
authors.forename: José M
authors.initials: JM
authors.lastname: Marín
authors.forename: Ramón
authors.initials: R
authors.lastname: Agüero
authors.forename: Adolfo
authors.initials: A
authors.lastname: Baloira
authors.forename: Santiago
authors.initials: S
authors.lastname: Carrizo
authors.forename: Cristóbal
authors.initials: C
authors.lastname: Esteban
authors.forename: Juan B
authors.initials: JB
authors.lastname: Galdiz
authors.forename: M Cruz
authors.initials: MC
authors.lastname: González
authors.forename: Marc
authors.initials: M
authors.lastname: Miravitlles
authors.forename: Eduard
authors.initials: E
authors.lastname: Monsó
authors.forename: Teodoro
authors.initials: T
authors.lastname: Montemayor
authors.forename: Josep
authors.initials: J
authors.lastname: Morera
authors.forename: Francisco
authors.initials: F
authors.lastname: Ortega
authors.forename: Germán
authors.initials: G
authors.lastname: Peces-Barba
authors.forename: Luis
authors.initials: L
authors.lastname: Puente
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Rodríguez
authors.forename: Ernest
authors.initials: E
authors.lastname: Sala
authors.forename: Jaume
authors.initials: J
authors.lastname: Sauleda
authors.forename: Joan B
authors.initials: JB
authors.lastname: Soriano
authors.forename: José Luis
authors.initials: JL
authors.lastname: Viejo
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001249:Asthma / Q000145:classification / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use; D003245:Consensus Statements as Topic; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D034742:Electronic Mail; D004802:Eosinophilia / Q000209:etiology; D005541:Forced Expiratory Volume / Q000187:drug effects; D005544:Forecasting; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000150:complications; D007073:Immunoglobulin E / Q000032:analysis; D018727:Muscarinic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D010641:Phenotype; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000145:classification / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D012907:Smoking / Q000009:adverse effects; D013183:Sputum / Q000166:cytology; D009626:Terminology as Topic
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D001993:Bronchodilator Agents; D018727:Muscarinic Antagonists; D007073:Immunoglobulin E