CHEST Guidelines-Asthma-COPD-Overlap

Asthma-COPD-Overlap_chest
Pdf Summary
Asthma-COPD overlap (ACO) encompasses patients exhibiting features of both asthma and chronic obstructive pulmonary disease (COPD), conditions typically distinguishable by onset age, symptom progression, and response to inhaled therapies. Unlike asthma, which often appears early with intermittent symptoms and good treatment response, COPD manifests later with progressively worsening symptoms and poor treatment outcomes. Despite distinct characteristics, some patients may exhibit a combination of asthma and COPD traits, categorized as asthma-COPD overlap, previously termed asthma-COPD overlap syndrome (ACOS).<br /><br />ACO is a recognized condition acknowledged in several guidelines, as it influences clinical management and therapy responsiveness. The prevalence of ACO varies, often higher in specialist-referred populations. Studies indicate that 10% to 20% of COPD patients may present asthma features, and a significant portion of asthma patients, especially smokers or those with severe asthma, may show COPD characteristics.<br /><br />Despite differences in inflammatory patterns between asthma and COPD, where asthma involves eosinophilic inflammation and COPD is predominantly neutrophilic, there are overlaps. Inflammatory cell infiltration and response to treatment in these patients may vary based on the predominant features they exhibit.<br /><br />Effective management of ACO involves detailed clinical assessment and may require unique therapeutic approaches. Evaluation of blood eosinophil counts can serve as an indicator for corticosteroid responsiveness and aid in tailoring treatments. Current large-scale trials often exclude ACO patients, leaving gaps in tailored treatment insights. New treatments, including monoclonal antibodies and kinase inhibitors, are undergoing development for future management of ACO. Recognizing and diagnosing ACO is critical for determining appropriate treatment strategies and improving patient outcomes, although further research is necessary to refine phenotyping, identify ACO in clinical settings, and establish optimal management protocols.
Keywords
Asthma-COPD overlap
ACO
asthma
COPD
clinical management
inflammatory patterns
treatment strategies
blood eosinophil counts
monoclonal antibodies
kinase inhibitors