Borja G Cosio1, Joan B Soriano2, Jose Luis López-Campos3, Myriam Calle-Rubio4, Juan José Soler-Cataluna5, Juan P de-Torres6, Jose M Marín7, Cristina Martínez-Gonzalez8, Pilar de Lucas9, Isabel Mir10, Germán Peces-Barba11, Nuria Feu-Collado12, Ingrid Solanes13, Inmaculada Alfageme14, Ciro Casanova15. 1. 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. 2. Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid (UAM), Cátedra UAM-Linde, Madrid, Spain. 3. CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Respiratory Medicine, Hospital Universitario Virgen del Rocío-IBiS, Sevilla, Spain. 4. Department of Respiratory Medicine, Hospital Clinico San Carlos, Madrid, Spain. 5. CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Respiratory Medicine, Hospital Arnau de Vilanova, Valencia, Spain. 6. Department of Respiratory Medicine, Clínica Universidad de Navarra, Pamplona, Spain. 7. CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Respiratory Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain. 8. Department of Respiratory Medicine, Hospital Central de Asturias, Oviedo, Spain. 9. Department of Respiratory Medicine, Hospital Gregorio Marañon, Madrid, Spain. 10. Department of Respiratory Medicine, Hospital Son Llátzer, Palma de Mallorca, Spain. 11. CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Respiratory Medicine, Fundación Jimenez Diaz, Madrid, Spain. 12. Department of Respiratory Medicine, Hospital Universitario Reina Sofía, Cordoba-IMIBIC.UCO, Spain. 13. Department of Respiratory Medicine, Hospital San Pablo y la Santa Cruz, Barcelona, Spain. 14. Department of Respiratory Medicine, Hospital Universitario deValme, Sevilla, Spain. 15. Department of Respiratory Medicine, Hospital Ntra. Sra. de Candelaria, Tenerife, Spain.
Abstract
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. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01122758; URL: www.clinicaltrials.gov.
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. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01122758; URL: www.clinicaltrials.gov.
Authors: Ankura Singh; Charles Liu; Barbara Putman; Rachel Zeig-Owens; Charles B Hall; Theresa Schwartz; Mayris P Webber; Hillel W Cohen; Kenneth I Berger; Anna Nolan; David J Prezant; Michael D Weiden Journal: Chest Date: 2018-07-17 Impact factor: 9.410