Recent research presented at the CHEST Annual Meeting in Boston, Massachusetts, highlighted the importance of recognizing asthma-COPD overlap syndrome (ACOS), a condition with the clinical features of asthma and chronic obstructive pulmonary disease (COPD). The authors emphasized that treatment approaches should differ among the three conditions and that misdiagnosis can be dangerous.
“Distinguishing between these three entities can be problematic, particularly in… older adults with a smoking history. Early recognition is important, as the recommended treatment regimen is different than that of COPD,” wrote the authors, led by Gordon White.
Patients with COPD may be treated with a long-acting beta agonist (LABA) inhaler as monotherapy. However, the Salmeterol Multicenter Asthma Research Trial found that patients with asthma who received LABA monotherapy had a higher risk of respiratory death. Therefore, the Global Initiative for Chronic Obstructive Lung Disease strongly opposes LABA monotherapy in patients with asthma in favor of inhaled corticosteroids with the potential addition of a LABA or long-acting muscarinic antagonist.
The authors conducted a retrospective observational study of 284 patients diagnosed with COPD who were seen in a pulmonology clinic at a Veterans Affairs Medical Center in 2020 or 2021. The researchers gathered data on forced expiratory volume within 1 second (FEV1) and eosinophil counts.
The analysis revealed that 17 patients (5.99%) had features of both asthma and COPD and met the criteria for ACOS, even though they had been diagnosed with COPD. The criteria consisted of a change in FEV1 greater than 12% and a volume increase of more than 400 mL but maintenance of an FEV1/forced vital capacity less than 70%. In addition, seven of those patients had eosinophil counts greater than 300 cells/uL.
“This study is a reminder that patients’ spirometry results should be thoroughly evaluated to ensure the appropriate diagnosis,” the authors concluded.
Reference
White G, Rehan M, Duchow M,et al. Undiagnosed asthma-COPD overlap syndrome among veteran patients diagnosed with COPD. Abstract #A4922. Presented at the CHEST Annual Meeting; October 6-9, 2024; Boston, Massachusetts.
