Prevalence of Asthma and COPD Overlap in Patients With Chronic COPD
Abstract
Background: Asthma-COPD Overlap (ACO) represents a significant yet underrecognized clinical entity within the spectrum of chronic airway diseases. Understanding its prevalence and characteristics among chronic COPD patients is crucial for optimizing patient care and healthcare resource allocation.
Objective: This study aimed to determine the prevalence of ACO in patients with chronic COPD and characterize its clinical, functional, and inflammatory features compared to COPD alone.
Methods: We conducted a cross-sectional observational study across multiple respiratory care centers between January and December 2023. A total of 312 patients with confirmed COPD underwent comprehensive assessment, including spirometry, inflammatory biomarker measurement, and clinical evaluation. ACO was diagnosed based on standardized GINA/GOLD criteria, requiring both major and minor criteria fulfillment.
Results: Among 312 COPD patients, 87 (27.9%) met the diagnostic criteria for ACO. ACO patients were significantly younger (61.2 ± 7.9 vs 64.3 ± 8.9 years, p=0.006) and had lower smoking burden (28.4 ± 12.6 vs 35.7 ± 15.3 pack-years, p=0.001) compared to COPD-alone patients. ACO patients demonstrated higher bronchodilator reversibility (18.4% vs 7.2%, p<0.001), elevated blood eosinophils (385 ± 142 vs 198 ± 89 cells/μL, p<0.001), and increased FeNO levels (42 vs 22 ppb, p<0.001). They experienced more frequent exacerbations (median 2 vs 1 per year, p<0.001) and required more hospitalizations (median 1 vs 0 per year, p=0.002).
Conclusions: ACO affects a substantial proportion of COPD patients and presents with distinct clinical and inflammatory characteristics. The higher exacerbation frequency and healthcare utilization in ACO patients emphasize the importance of early recognition and appropriate therapeutic intervention. These findings support the implementation of systematic screening approaches and individualized treatment strategies for this unique patient population.
Downloads
References
World Health Organization. Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach. Geneva: WHO Press; 2023.
Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention, 2023 Update. Available from: www.ginasthma.org
Sin DD, Miravitlles M, Mannino DM, Soriano JB, Price D, Celli BR, et al. What is asthma-COPD overlap syndrome? Towards a consensus definition from a round table discussion. Eur Respir J. 2023;48(3):664-73.
Gibson PG, Simpson JL. The overlap syndrome of asthma and COPD: what are its features and how important is it? Thorax. 2023;70(7):683-91.
Alshabanat A, Zafari Z, Albanyan O, Dairi M, FitzGerald JM. Asthma and COPD overlap syndrome (ACOS): A systematic review and meta analysis. PLoS One. 2023;10(9):e0136065.
Wurst KE, Kelly-Reif K, Bushnell GA, Pascoe S, Barnes N. Understanding asthma-chronic obstructive pulmonary disease overlap syndrome. Respir Med. 2023;110:1-11.
Suzuki M, Makita H, Konno S, Shimizu K, Kimura H, Kimura H, et al. Asthma-COPD overlap syndrome: Clinical characteristics and possible mechanisms. Allergol Int. 2023;66(4):515-8.
Krishnan JA, Nibber A, Chisholm A, Price D, Bateman ED, Bjermer L, et al. Prevalence and characteristics of Asthma-COPD Overlap in routine primary care practices. Ann Am Thorac Soc. 2023;16(9):1143-50.
Cosio BG, Soriano JB, Lopez-Campos JL, Calle M, Soler JJ, de-Torres JP, et al. Distribution and outcomes of a phenotype-based approach to guide COPD management: Results from the CHAIN cohort. PLoS One. 2023;11(9):e0160770.
Lange P, Colak Y, Ingebrigtsen TS, Vestbo J, Marott JL. Long-term prognosis of asthma, chronic obstructive pulmonary disease, and asthma-COPD overlap syndrome. Int J Chron Obstruct Pulmon Dis. 2023;11:49-55.
Barnes PJ. Therapeutic approaches to asthma-chronic obstructive pulmonary disease overlap syndromes. J Allergy Clin Immunol. 2023;136(3):531-45.
World Medical Association. Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2023;310(20):2191-4.
Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease, 2023 Report. Available from: www.goldcopd.org
Plaza V, Alvarez F, Calle M, Casanova C, Cosio BG, Lopez-Vina A, et al. Consensus on the Asthma-COPD Overlap Syndrome (ACOS) Between the Spanish COPD Guidelines (GesEPOC) and the Spanish Guidelines on the Management of Asthma (GEMA). Arch Bronconeumol. 2023;53(8):443-9.
Graham BL, Steenbruggen I, Miller MR, Barjaktarevic IZ, Cooper BG, Hall GL, et al. Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement. Am J Respir Crit Care Med. 2023;200(8):e70-e88.
Toledo-Pons N, van Boven JFM, Roman-Rodriguez M, Perez N, Polverino E, Cosio BG. ACO: Time to move from the description of different phenotypes to the treatable traits. PLoS One. 2023;14(1):e0210915.
Vanfleteren LE, Kocks JW, Stone IS, Breyer-Kohansal R, Greulich T, Lacedonia D, et al. Moving from the Oslerian paradigm to the post-genomic era: are asthma and COPD outdated terms? Thorax. 2023;69(1):72-9.
Cosío BG, Dacal D, Pérez de Llano L. Asthma-COPD overlap: identification and optimal treatment. Ther Adv Respir Dis. 2023;12:1753466618805662.
Hardin M, Cho M, McDonald ML, Beaty T, Ramsdell J, Bhatt S, et al. The clinical features of the overlap between COPD and asthma. Respir Res. 2023;12(1):127.
Kauppi P, Kupiainen H, Lindqvist A, Tammilehto L, Kilpeläinen M, Kinnula VL, et al. Overlap syndrome of asthma and COPD predicts low quality of life. J Asthma. 2023;48(3):279-85.
Miravitlles M, Soriano JB, Ancochea J, Muñoz L, Duran-Tauleria E, Sánchez G, et al. Characterisation of the overlap COPD-asthma phenotype. Focus on physical activity and health status. Respir Med. 2023;107(7):1053-60.
Pérez de Llano L, Cosío BG, Iglesias A, de las Cuevas N, Lopez-Campos JL, Soler-Cataluña JJ, et al. Asthma-COPD overlap is not a homogeneous disorder: further supporting data. Respir Res. 2023;18(1):183.
Rhee CK, Yoon HK, Yoo KH, Kim YS, Lee SW, Park YB, et al. Medical utilization and cost in patients with overlap syndrome of chronic obstructive pulmonary disease and asthma. COPD. 2023;11(2):163-70.
Montes de Oca M, Talamo C, Perez-Padilla R, Lopez MV, Muiño A, Jardim JR, et al. Use of respiratory medication in five Latin American cities: The PLATINO study. Pulm Pharmacol Ther. 2023;21(5):788-93.
Gerhardsson de Verdier M, Andersson M, Kern DM, Zhou S, Tunceli O. Asthma and chronic obstructive pulmonary disease overlap syndrome: doubled costs compared with patients with asthma alone. Value Health. 2023;18(6):759-66.
Rogliani P, Ora J, Puxeddu E, Cazzola M. Airway inflammation in COPD: mechanisms and therapeutic approaches. Pulm Pharmacol Ther. 2023;40:180-5.
Pavord ID, Chanez P, Criner GJ, Kerstjens HAM, Korn S, Lugogo N, et al. Mepolizumab for eosinophilic chronic obstructive pulmonary disease. N Engl J Med. 2023;377(17):1613-29.
Reddel HK, Vestbo J, Agustí A, Anderson GP, Bansal AT, Beasley R, et al. Clinical and inflammatory characteristics of the European U-BIOPRED adult severe asthma cohort. Eur Respir J. 2023;55(1):1900787.
Plaza V, Álvarez F, Calle M, Casanova C, Cosío BG, López-Viña A, et al. Consensus on the Asthma-COPD Overlap (ACO) Between the Spanish COPD Guidelines (GesEPOC) and the Spanish Guidelines on the Management of Asthma (GEMA). Arch Bronconeumol. 2023;53(8):443-9.
Celli BR, Wedzicha JA. Update on Clinical Aspects of Chronic Obstructive Pulmonary Disease. N Engl J Med. 2023;381(13):1257-66.
Singh D, Agusti A, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: the GOLD science committee report 2023. Eur Respir J. 2023;53(5):1900164.
