title: What is asthma-COPD overlap syndrome? Towards a consensus definition from a round table discussion.
abstract: Patients with asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) have been largely excluded from pivotal therapeutic trials and, as a result, its treatment remains poorly defined and lacking firm evidence. To date, there is no universally accepted definition of ACOS, which has made it difficult to understand its epidemiology or pathophysiology. Despite many uncertainties, there is emerging agreement that some of the key features of ACOS include persistent airflow limitation in symptomatic individuals 40 years of age and older, a well-documented history of asthma in childhood or early adulthood and a significant exposure history to cigarette or biomass smoke. In this perspective, we propose a case definition of ACOS that incorporates these key features in a parsimonious algorithm that may enable clinicians to better diagnose patients with ACOS and most importantly enable researchers to design therapeutic and clinical studies to elucidate its epidemiology and pathophysiology and to ascertain its optimal management strategies.
authors.affiliation: Centre for Heart Lung Innovation, St. Paul's Hospital, & Department of Medicine (Respiratory Division), University of British Columbia, Vancouver, BC, Canada don.sin@hli.ubc.ca.
authors.forename: Don D
authors.initials: DD
authors.lastname: Sin
authors.affiliation: Servicio de Neumología, Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Spain.
authors.forename: Marc
authors.initials: M
authors.lastname: Miravitlles
authors.affiliation: Dept of Preventive Medicine and Environmental Health, University of Kentucky, College of Public Health, Lexington, KY, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Mannino
authors.affiliation: Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Joan B
authors.initials: JB
authors.lastname: Soriano
authors.affiliation: Centre for Academic Primary Care, The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK Research in Real-Life, Cambridge, UK.
authors.forename: David
authors.initials: D
authors.lastname: Price
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Bartolome R
authors.initials: BR
authors.lastname: Celli
authors.affiliation: Centre for Heart Lung Innovation, St. Paul's Hospital, & Department of Medicine (Respiratory Division), University of British Columbia, Vancouver, BC, Canada.
authors.forename: Janice M
authors.initials: JM
authors.lastname: Leung
authors.affiliation: Dept of Medicine, Division of Respiratory Medicine, Shiga University of Medical Science, Shiga, Japan.
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Nakano
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Hye Yun
authors.initials: HY
authors.lastname: Park
authors.affiliation: Priority Centre for Healthy Lungs, HMRI University of Newcastle, Newcastle, Australia.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Wark
authors.affiliation: Dept of Medicine, National Jewish Health, Denver, CO, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Wechsler
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000465:Algorithms; D001249:Asthma / Q000150:complications* / Q000503:physiopathology*; D018533:Biomass; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D003697:Delphi Technique; D004804:Eosinophils / Q000166:cytology; D019317:Evidence-Based Medicine; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000503:physiopathology; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000503:physiopathology*; D015272:Pulmonary Medicine / Q000592:standards; D012307:Risk Factors; D012907:Smoking; D013147:Spirometry; D013577:Syndrome
chemical_list: D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents