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Diagnostic criteria identifies patients with asthma-COPD overlap syndrome

Researchers demonstrated the effective use of clinical asthma features for the diagnosis of asthma-COPD overlap syndrome in a cohort of patients with COPD.

“Using simple and easy to apply clinical criteria [for] the diagnosis of this clinical phenotype is feasible,” Borja G. Cosío, MD, director of the research unit in the department of respiratory medicine at Hospital Universitario son Espases in Spain, told Healio.com/Allergy.

Borja G. Cosío

Cosío and colleagues assessed patients with COPD who participated in the COPD History Assessment in Spain multicenter study to determine if the use of usual clinical features for the diagnosis of asthma and COPD could identify asthma-COPD overlap syndrome (ACOS).

The analysis included 831 patients with COPD. The researchers assessed if patients fit either major criteria — bronchodilator test greater than 400 mL and 15% as well as past medical history of asthma — or minor criteria — blood eosinophils greater than 5%, immunoglobulin-E greater than 100 Ul/mL or two separate bronchodilator tests greater than 200 mL and 12% — to diagnoses ACOS.

Patients had ACOS if they fit either one major or two minor criterion.

Fifteen percent of patients met the criteria for ACOS, and 98.4% of them maintained the criteria for at least 1 year.

Patients with ACOS primarily had mild to moderate disease severity (67%) and received inhaled corticosteroids (63.2%).

At the end of the first year of follow-up, researchers identified an additional 48 new patients with ACOS not initially diagnosed at baseline.

Death during the year of follow-up happened significantly more often in patients without ACOS (n = 60) as compared with patients who had ACOS (n = 7).

Cosío told Healio.com/Allergy why he thought less deaths occurred in patients with ACOS.

“The use of inhaled steroids is probably responsible for a better prognosis of these patients,” he said.

“Clinicians should think of ACOS when assessing a COPD patient, since [there] appeared to be around 15% of them [in this study],” he told Healio.com/Allergy. – by Ryan McDonald

Disclosure: Cosío reports receiving lecture fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline and Menarini. Please see the full study for a list of all other researchers’ relevant financial disclosures.