Abandon ACOS as a specific phenotype

Thursday, 7 May 2015

Asthma-COPD overlap syndrome should be abandoned as a specific phenotype, say Peter Gibson and Vanessa McDonald.

Writing in a review published in Thorax the  authors note that there are several phenotypes that might fall under the asthma-COPD overlap (ACOS) banner but appear to have very different features.

These included severe asthma with incomplete airflow reversibility, childhood asthma and adult smoking, and eosinophilic COPD.

“These phenotypes appear to have such different mechanisms and treatment approaches, and it does not seem useful to assign them the same diagnosis label of asthma-COPD overlap,” they wrote.

Because of this Gibson and McDonald recommend that ACOS be abandoned as a specific phenotype in favour of  a “multidimensional assessment and management of complex obstructive airway diseases”.

Such an approach would start with recognition of obstructive airways disease (similar to GINA-GOLD recommendations) and assess clinical problems in the four domains of airway, comorbidity, risk factors and behavioural management.

This assessment would then be used to design an individualised management plan, the review authors suggested.


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