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Review
. 2013 Mar;6(2):197-219.
doi: 10.1586/ecp.13.2.

The asthma-chronic obstructive pulmonary disease overlap syndrome: pharmacotherapeutic considerations

Samuel Louie  1 , Amir A Zeki, Michael Schivo, Andrew L Chan, Ken Y Yoneda, Mark Avdalovic, Brian M Morrissey, Timothy E Albertson
Affiliations
Review

The asthma-chronic obstructive pulmonary disease overlap syndrome: pharmacotherapeutic considerations

Samuel Louie et al. Expert Rev Clin Pharmacol. 2013 Mar.

Abstract

Asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) is a commonly encountered yet loosely defined clinical entity. ACOS accounts for approximately 15-25% of the obstructive airway diseases and patients experience worse outcomes compared with asthma or COPD alone. Patients with ACOS have the combined risk factors of smoking and atopy, are generally younger than patients with COPD and experience acute exacerbations with higher frequency and greater severity than lone COPD. Pharmacotherapeutic considerations require an integrated approach, first to identify the relevant clinical phenotype(s), then to determine the best available therapy. The authors discuss the array of existing and emerging classes of drugs that could benefit those with ACOS and share their therapeutic approach. A consensus international definition of ACOS is needed to design prospective, randomized clinical trials to evaluate specific drug interventions on important outcomes such as lung function, acute exacerbations, quality of life and mortality.

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Figures

Figure 1.
Figure 1.
Prevalence of obstructive airway disease in the University of California Davis Medical Center general pulmonary clinics. *p = 0.0009; **p < 0.0001; ***p < 0.0001 by Fisher’s exact test. ‘Other’ represents a combination of bronchitis, bronchiectasis, bronchiolitis and/or cystic fibrosis cases. ACOS: Asthma–chronic obstructive pulmonary disease overlap syndrome; COPD: Chronic obstructive pulmonary disease; NS: Not significant. Adapted with permission from [2].
Figure 2.
Figure 2.
Prevalence of obstructive airway disease in the University of California Davis Medical Center severe asthma clinics. *p = 0.0009; **p < 0.0001; ***p < 0.0001 by Fisher’s exact test. ‘Other’ represents a combination of bronchitis, bronchiectasis, bronchiolitis and/or cystic fibrosis cases. ACOS: Asthma–chronic obstructive pulmonary disease overlap syndrome; COPD: Chronic obstructive pulmonary disease. Adapted with permission from [2].
Figure 3.
Figure 3.
Percentage of frequent and severe exacerbations in subjects with chronic obstructive pulmonary disease compared with subjects with chronic obstructive pulmonary disease with asthma. *p < 0.0001 for the difference between COPD and COPD with asthma. COPD: Chronic obstructive pulmonary disease. Adapted with permission from [4].
Figure 4.
Figure 4.
Pharmacotherapeutic targets in asthma–chronic obstructive pulmonary disease overlap syndrome. COPD: Chronic obstructive pulmonary disease.
Figure 5.
Figure 5.
Algorithm of potential pharmacotherapeutic considerations in asthma–chronic obstructive pulmonary disease overlap syndrome. 5-LO: 5-lipoxygenase; Ab: Antibody; FEV1: Forced expiratory volume in 1 s; FeNO: Fractional exhaled nitric oxide; LABA: Long-acting β2 agonist; LAMA: Long-acting muscarinic receptor antagonist; MABA: Muscarinic antagonist-β2 agonist; SABA: Short-acting β2 agonist; SAMA: Short-acting muscarinic receptor antagonist. Adapted with permission from [2].
Figure 6.
Figure 6.
Overview and considerations in the approach to asthma–chronic obstructive pulmonary disease overlap syndrome. Red arrows indicate that patients with asthma–COPD overlap syndrome can be found in asthma populations and COPD populations. 5-LO: 5-lipoxygenase; AHR: Abnormal hyper-responsiveness; COPD: Chronic obstructive pulmonary disease; ICS: Inhaled corticosteroids; LABA: Long-acting β2 agonist; LAMA: Long-acting muscarinic receptor antagonist; LTRA: Leukotriene receptor antagonist; LVRS: Lung volume reduction surgery. Adapted with permission from [2].
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