Identifying possible asthma-COPD overlap syndrome in patients with a new diagnosis of COPD in primary care

Abstract

The asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) remains poorly characterised. Our aim was to describe an algorithm for identifying possible ACOS in adults with newly diagnosed COPD in primary care. General practitioners (n=241) consecutively recruited subjects ⩾35 years, with tobacco exposure, at least one respiratory symptom and no previous diagnosis of obstructive lung disease. Possible ACOS was defined as chronic airflow obstruction, i.e., post-bronchodilator (BD) forced expiratory volume 1/forced vital capacity (FEV₁/FVC) ratio<0.70, combined with wheeze (ACOS wheeze) and/or significant BD reversibility (ACOS BD reversibility). Of 3,875 (50% females, mean age 57 years) subjects screened, 700 (18.1%) were diagnosed with COPD, i.e., symptom(s), tobacco exposure and chronic airflow obstruction. Indications for ACOS were found in 264 (38%) of the COPD patients. The prevalence of ACOS wheeze and ACOS BD reversibility was 27% (n=190) and 16% (n=113), respectively (P<0.001), and only 6% (n=39) of the COPD patients fulfilled both criteria for ACOS. Patients with any ACOS were younger (P=0.04), had more dyspnoea (P<0.001), lower FEV₁%pred (67% vs. 74%; P<0.001) and lower FEV₁/FVC ratio (P=0.001) compared with COPD-only patients. Comparing subjects fulfilling both criteria for ACOS with those fulfilling criteria for ACOS wheeze only (n=151) and those fulfilling criteria for ACOS BD reversibility only (n=74) revealed no significant differences. Irrespective of the applied ACOS definition, no significant difference in life-time tobacco exposure was found between ACOS- and COPD-only patients. In subjects with a new diagnosis of COPD, the prevalence of ACOS is high. When screening for COPD in general practice among patients with no previous diagnosis of obstructive lung disease, patients with possible ACOS may be identified by self-reported wheeze and/or BD reversibility.

Figure 1

Prevalence of respiratory symptoms among the enrolled subjects (n=3.875). LRTI, recurrent lower respiratory tract infections.

Figure 2

Flow chart of the 3,875 individuals at high risk of COPD, but no previous diagnosis of obstructive lung disease, included in the present analysis divided according to the presence or absence of COPD, possible asthma–COPD overlap syndrome (ACOS) or COPD only, respectively.

Figure 3

Prevalence of respiratory symptoms among participants with no COPD (n=3.175), COPD only (n=436) and possible ACOS, identified by either self-reported wheeze (ACIS wheeze; n=151), bronchodilator reversibility (ACOS-BDR; n=74) of both (ACOS wheeze+BDR; n=39).