Push towards consensus definition on asthma?COPD overlap syndrome


By Amanda Sheppeard

7 Aug 2016

A push to have asthma–chronic obstructive pulmonary disease overlap syndrome  declared a disease in its own right is gathering momentum with the release of a draft operational definition.

An article in the European Journal of Respirology details key features of asthma–chronic obstructive pulmonary disease (ACOS), which the authors said should be considered in the operational definition. These include:

  1. Persistent airflow limitation spirometry despite adequate administration of a short-acting bronchodilator in subjects 40 years of age or older.
  2. A “significant” history of cigarette smoking or an equivalent lifetime exposure to biomass.
  3. A physician diagnosis of asthma before 40 years of age.

Speaking to the limbic, co-author Conjoint Professor Peter Wark, a senior staff specialist in Respiratory and Sleep Medicine at John Hunter Hospital, Newcastle and a conjoint Professor with the University of Newcastle, said this issue was important, especially in the wake of an “explosion” of new medications.

“We know there is a group who have overlapping syndromes,” he said. “There is an urgent clinical need to better define what’s going on.”

He said he was concerned that patients could be over-treated or even under treated.

“There’s a bit of a desperate need to know who to treat and with what,” he said.

The lack of a clear label for the syndrome has also proved to be a disadvantage, the authors revealed.

“Patients with asthma–chronic obstructive pulmonary disease overlap syndrome (ACOS) have been largely excluded from pivotal therapeutic trials and, as a result, its treatment remains poorly defined and lacking firm evidence,” they wrote.

“To date, there is no universally accepted definition of ACOS, which has made it difficult to understand its epidemiology or pathophysiology.”

This operational definition is the result of a global expert panel discussion, comprising specialists and generalists, held in 2015, to discuss ACOS and to develop a framework to scientifically and clinically advance the field.

“It should be noted that, while the group reached an agreement on the most salient features of ACOS through discussion, iteration and electronic communications, there was not uniformity or singularity of opinion, the authors wrote. “For ACOS to move forward as a unique entity, a universally accepted operational definition is urgently required, even if it is not perfect.”

Professor Work said it that while the guidelines were still in the infancy state and the final stage may be different.

“I think it’s probably helpful for people to read and think about,” he said. “It’s not going to be the final definition, but at the moment I think is as good as any definition.”

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