Defining the Asthma-COPD Overlap Syndrome in a COPD Cohort.
BACKGROUND
Asthma-COPD overlap syndrome (ACOS) has been recently described by international guidelines. A stepwise approach to diagnosis using usual features of both diseases is recommended although its clinical application is difficult.


METHODS
To identify patients with ACOS, a cohort of well-characterized patients with COPD and up to 1 year of follow-up was analyzed. We evaluated the presence of specific characteristics associated with asthma in this COPD cohort, divided into major criteria (bronchodilator test > 400 mL and 15% and past medical history of asthma) and minor criteria (blood eosinophils > 5%, IgE > 100 IU/mL, or two separate bronchodilator tests > 200 mL and 12%). We defined ACOS by the presence of one major criterion or two minor criteria. Baseline characteristics, health status (COPD Assessment Test [CAT]), BMI, airflow obstruction, dyspnea, and exercise capacity (BODE) index, rate of exacerbations, and mortality up to 1 year of follow-up were compared between patients with and without criteria for ACOS.


RESULTS
Of 831 patients with COPD included,125 (15%) fulfilled the criteria for ACOS, and 98.4% of them sustained these criteria after 1 year. Patients with ACOS were predominantly male (81.6%), with symptomatic mild to moderate disease (67%), who were receiving inhaled corticosteroids (63.2%). There were no significant differences in baseline characteristics, and only survival was worse in patients with non-ACOS COPD after 1 year of follow-up (P < .05).


CONCLUSIONS
The proposed ACOS criteria are present in 15% of a cohort of patients with COPD and these patients show better 1-year prognosis than clinically similar patients with COPD with no ACOS criteria.


BACKGROUND
ClinicalTrials.gov; No.: NCT01122758; URL: www.clinicaltrials.gov.
Department of Respiratory Medicine, Hospital Son Espases-IdISPa, Palma de Mallorca, Mallorca, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. Electronic address: borja.cosio@ssib.es.
Borja G
BG
Cosio
Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid (UAM), Cátedra UAM-Linde, Madrid, Spain.
Joan B
JB
Soriano
CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Respiratory Medicine, Hospital Universitario Virgen del Rocío-IBiS, Sevilla, Spain.
Jose Luis
JL
López-Campos
Department of Respiratory Medicine, Hospital Clinico San Carlos, Madrid, Spain.
Myriam
M
Calle-Rubio
CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Respiratory Medicine, Hospital Arnau de Vilanova, Valencia, Spain.
Juan José
JJ
Soler-Cataluna
Department of Respiratory Medicine, Clínica Universidad de Navarra, Pamplona, Spain.
Juan P
JP
de-Torres
CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Respiratory Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain.
Jose M
JM
Marín
Department of Respiratory Medicine, Hospital Central de Asturias, Oviedo, Spain.
Cristina
C
Martínez-Gonzalez
Department of Respiratory Medicine, Hospital Gregorio Marañon, Madrid, Spain.
Pilar
P
de Lucas
Department of Respiratory Medicine, Hospital Son Llátzer, Palma de Mallorca, Spain.
Isabel
I
Mir
CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Respiratory Medicine, Fundación Jimenez Diaz, Madrid, Spain.
Germán
G
Peces-Barba
Department of Respiratory Medicine, Hospital Universitario Reina Sofía, Cordoba-IMIBIC.UCO, Spain.
Nuria
N
Feu-Collado
Department of Respiratory Medicine, Hospital San Pablo y la Santa Cruz, Barcelona, Spain.
Ingrid
I
Solanes
Department of Respiratory Medicine, Hospital Universitario deValme, Sevilla, Spain.
Inmaculada
I
Alfageme
Department of Respiratory Medicine, Hospital Ntra. Sra. de Candelaria, Tenerife, Spain.
Ciro
C
Casanova
D000368:Aged; D001249:Asthma / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D001993:Bronchodilator Agents / Q000627:therapeutic use; D015331:Cohort Studies; D004804:Eosinophils; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D013577:Syndrome
D001993:Bronchodilator Agents
COPD; asthma; eosinophils