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Concern of underdiagnosing asthma–COPD overlap syndrome if age limit of 40 years for asthma is used

Don D. Sin, Janice M. Leung, Michael E. Wechsler
European Respiratory Journal 2017 50: 1701120; DOI: 10.1183/13993003.01120-2017
Don D. Sin
1Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
2Dept of Medicine (Respiratory Division), University of British Columbia, Vancouver, BC, Canada
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  • For correspondence: Don.Sin@hli.ubc.ca
Janice M. Leung
1Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
2Dept of Medicine (Respiratory Division), University of British Columbia, Vancouver, BC, Canada
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Michael E. Wechsler
3Dept of Medicine, National Jewish Health, Denver, CO, USA
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Abstract

While the ACOS criteria have not been validated, they are clinically workable and may identify asthma precisely http://ow.ly/qLSL30cOh4Z

From the authors:

M. Tommola and colleagues raise an important and hotly debated diagnostic criterion of asthma–chronic obstructive pulmonary disease overlap syndrome (ACOS): an age threshold of 40 years for the asthma component of ACOS. We agree with their comment that asthma can develop later in life and these patients may respond well to inhaled corticosteroids and novel biologics, similar to those with childhood-onset asthma [1]. Thus, in the roundtable consensus report [2], we suggested that the asthma component of ACOS could be fulfilled by a clinical diagnosis of asthma before age 40 years or in those without a clinical diagnosis of asthma before 40 years by demonstrating an improvement in forced expiratory volume in 1 s (FEV1) of ≥400 mL following short-acting β2-agonist therapy. While a significant bronchodilatory response (BDR) is a common feature in both asthma and chronic obstructive pulmonary disease (COPD) [3], it is very unusual for COPD patients to demonstrate a BDR of ≥400 mL in FEV1 without a concomitant diagnosis of asthma [4]. To further improve the specificity of the asthma component of ACOS, we also suggested that in addition to all three major criteria, patients fulfil at least one of the three minor criteria: 1) a history of atopy or allergic rhinitis; 2) a BDR of ≥200 mL in FEV1 on two separate visits; or 3) peripheral eosinophil count of ≥300 cells per μL. While none of these criteria has been validated in ACOS, we believe that these criteria are clinically workable and may be useful in identifying patients with asthma with reasonable precision. Future work will be needed to refine these criteria based on high-grade data.

Disclosures

Supplementary Material

D.D. Sin ERJ-01120-2017_Sin

M.E. Wechsler ERJ-01120-2017_Wechsler

Footnotes

  • Conflict of interest: Disclosures can be found alongside this article at erj.ersjournals.com

  • Received June 3, 2017.
  • Accepted June 13, 2017.
  • Copyright ©ERS 2017

References

  1. ↵
    1. Bleecker ER,
    2. FitzGerald JM,
    3. Chanez P, et al.
    Efficacy and safety of benralizumab for patients with severe asthma uncontrolled with high-dosage inhaled corticosteroids and long-acting β2-agonists (SIROCCO): a randomised, multicentre, placebo-controlled phase 3 trial. Lancet 2016; 388: 2115–2127.
    OpenUrl
  2. ↵
    1. Sin DD,
    2. Miravitlles M,
    3. Mannino DM, et al.
    What is asthma–COPD overlap syndrome? Towards a consensus definition from a round table discussion. Eur Respir J 2016; 48: 664–673.
    OpenUrlAbstract/FREE Full Text
  3. ↵
    1. Tan WC,
    2. Vollmer WM,
    3. Lamprecht B, et al.
    Worldwide patterns of bronchodilator responsiveness: results from the Burden of Obstructive Lung Disease study. Thorax 2012; 67: 718–726.
    OpenUrlAbstract/FREE Full Text
  4. ↵
    1. Tan WC,
    2. Bourbeau J,
    3. Hernandez P, et al.
    Bronchodilator responsiveness and reported respiratory symptoms in an adult population. PLoS One 2013; 8: e58932.
    OpenUrlCrossRefPubMed
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Concern of underdiagnosing asthma–COPD overlap syndrome if age limit of 40 years for asthma is used
Don D. Sin, Janice M. Leung, Michael E. Wechsler
European Respiratory Journal Aug 2017, 50 (2) 1701120; DOI: 10.1183/13993003.01120-2017

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Concern of underdiagnosing asthma–COPD overlap syndrome if age limit of 40 years for asthma is used
Don D. Sin, Janice M. Leung, Michael E. Wechsler
European Respiratory Journal Aug 2017, 50 (2) 1701120; DOI: 10.1183/13993003.01120-2017
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