What pulmonologists think about the asthma-COPD overlap syndrome.
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.


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.


CONCLUSIONS
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.
Pneumology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain ; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
Marc
M
Miravitlles
Respiratory Department, Hospital de Alta Resolucion de Loja, Granada, Spain.
Bernardino
B
Alcázar
Medical-Surgical Unit of Respiratory Diseases, Virgen del Rocio University Hospital, Biomedicine Institute of Seville (IBiS), Seville, Spain.
Francisco Javier
FJ
Alvarez
Department of Pneumology, Hospital Universitario Central de Asturias, Oviedo, Spain.
Teresa
T
Bazús
Department of Pneumology, Hospital Clínico San Carlos, Madrid, Spain.
Myriam
M
Calle
Department of Pneumology, Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain.
Ciro
C
Casanova
Department of Pneumology, Hospital Universitario de La Princesa/Instituto de Investigación Sanitaria (IIS-IP), Madrid, Spain.
Carolina
C
Cisneros
Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain.
Juan P
JP
de-Torres
Department of Pneumology, Hospital Universitario Reina Sofia, Córdoba, Spain.
Luis M
LM
Entrenas
Department of Pneumology, Hospital Galdakao-Usansolo, Galdakao, Spain.
Cristóbal
C
Esteban
Department of Pneumology, Hospital Universitario de La Plana, Vila-real, Spain.
Patricia
P
García-Sidro
Department of Pneumology, Hospital Universitario Son Espases IdISPa, Palma de Mallorca, Spain.
Borja G
BG
Cosio
Sección Urgencias Medicina - Neumología, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain.
Arturo
A
Huerta
Department of Pneumology, Hospital Universitario de Cruces, Bilbao, Spain.
Milagros
M
Iriberri
Department of Pneumology, Hospital Universitario de Guadalajara, Guadalajara, Spain.
José Luis
JL
Izquierdo
Department of Pneumology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
Antolín
A
López-Viña
CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain ; Medical-Surgical Unit of Respiratory Diseases, Virgen del Rocio University Hospital, Biomedicine Institute of Seville (IBiS), Seville, Spain.
José Luis
JL
López-Campos
Department of Pneumology, Hospital Universitario Dr Peset, Valencia, Spain.
Eva
E
Martínez-Moragón
Department of Pneumology, Hospital Universitario Lucus Augusti, Lugo, Spain.
Luis
L
Pérez de Llano
Department of Pneumology, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
Miguel
M
Perpiñá
Department of Pneumology, Hospital Clínico Universitario Virgen de la Arrinxaca, Murcia, Spain.
José Antonio
JA
Ros
Department of Pneumology, Hospital Comarcal de Inca, Inca, Spain.
José
J
Serrano
Pneumology Department, Hospital Arnau de Vilanova-Lliria, Valencia, Spain.
Juan José
JJ
Soler-Cataluña
Department 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.
Alfons
A
Torrego
Department of Pneumology, Hospital Galdakao-Usansolo, Galdakao, Spain.
Isabel
I
Urrutia
Department 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.
Vicente
V
Plaza
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D058666:Adrenergic beta-2 Receptor Agonists / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D001291:Attitude of Health Personnel; D001993:Bronchodilator Agents / Q000627:therapeutic use; D032921:Consensus; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D015272:Pulmonary Medicine; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013030:Spain / Q000453:epidemiology; D013038:Specialization; D011795:Surveys and Questionnaires
D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D018927:Anti-Asthmatic Agents; D001993:Bronchodilator Agents
ACOS; COPD; asthma; guidelines; survey