This article is more than 5 years old. Information may no longer be current.

Asthma-COPD overlap syndrome should not yet be identified as a disease entity

It is premature to recommend the designation of asthma-COPD overlap syndrome as a disease in primary care, according to a review article published in The New England Journal of Medicine.

Further research is necessary to properly characterize patients and obtain a standard definition of asthma-COPD overlap syndrome, according to the researchers.

“The danger of seeing [asthma-COPD overlap syndrome (ACOS)] as a disease entity is that we may blur the lines between asthma and COPD, because studies addressing the patient population with ACOS are specifically lacking, which could lead to overtreatment, particularly with inhaled glucocorticoids,” Dirkje S. Postma, MD, PhD, a professor in pulmonology at University of Groningen in the Netherlands, and a colleague wrote.

Postma and Klaus F. Rabe, MD, PhD, director of the department of pneumology at Pulmonary Clinic Grosshansdorf in Germany, attempted to address two questions with their review:

• how does someone determine whether a diagnostic label of asthma, COPD or ACOS is appropriate in a patient, and
• what treatment patients with ACOS should receive.

Without studies addressing ACOS as a disease entity and studies determining relevant treatment approaches, answers to the questions could not be evidence-based, according to the researchers.

Postma and Rabe recommended health professionals keep records with measures — such as lung function and response to treatments — on every patient.

The researchers acknowledged there are more concerns with ACOS as a disease entity and suggested how to better understand treating patients with possible ACOS.

“Another problem is that different ACOS definitions are being applied in various studies, thus precluding firm conclusions regarding clinical severity, management and prognosis for ACOS,” the researchers wrote. “Inconsistent definitions used in treatment studies make it almost impossible to determine the most effective therapy for an individual patient. Therefore, we suggest extensive phenotypic characterization of individual patients before inclusion in clinical trials.”

Disclosure: Postma reports consulting fees paid to her institution by AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Takeda and Teva. Please see the full study for a list of all other researchers’ relevant financial disclosures.