Objective
To study the clinical application of the GOLD/GINA criteria and the Spanish guideline in the diagnosis of asthma-COPD overlap syndrome (ACOS).
Methods
Patients with stable COPD were consecutively enrolled in the study. Clinical data were collected, lung function with bronchodilator test and peak expiratory flow (PEF) were performed, and peripheral blood eosinophils, total IgE, and sputum inflammatory cells were measured. Those overlap with asthma were identified by the 2 different criteria, and the prevalence and features of ACOS were compared.
Results
Among 104 cases of stable COPD, 24 (23.1%) and 10 (9.6%) were identified as ACOS by the GOLD/GINA criteria and the Spanish guideline, respectively; the latter 10 cases were all included in the former 24. For the GOLD/GINA criteria, the most common features were symptoms triggered by exercise or emotions, variable airflow limitation, family history of asthma, and other allergic conditions. Mean diurnal PEF variation≥10% was evident in 11 cases (45.8%, 11/24), while bronchodilator test was positive in 16 cases (66.7%, 16/24). For the Spanish guideline, the most common features were diagnosis of asthma before 40, other allergic diseases, positive bronchodilator test on 2 occasions.
Conclusions
The GOLD/GINA criteria may be more sensitive for the diagnosis of ACOS, and do not need sophisticated lab tests, which may be more applicable for clinical use. The Spanish guideline is restrictive, and therefore may lead to under-diagnosis.
Citation：
LI Ruimin, XU Weihan, JIN Jianmin, ZHANG Yongxiang, SUN Yongchang. A preliminary study on the diagnosis of asthma-COPD overlap syndrome by different criteria. Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(6): 557-560. doi: 10.7507/1671-6205.201705034
Copy
Copyright © the editorial department of Chinese Journal of Respiratory and Critical Care Medicine of West China Medical Publisher. All rights reserved
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Cosio BG, Soriano JB, Lopez-Campos JL, et al. Defining the asthma-COPD overlap syndrome in a COPD cohort. Chest, 2016, 149(1): 45-52.
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Jin JM, Liu XF, Sun YC. The prevalence of increased serum IgE and Aspergillus sensitization in patients with COPD and their association with symptoms and lung function. Respir Res, 2014, 15: 130.
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Tamada T, Sugiura H, Takahashi T, et al. Biomarker-based detection of asthma-COPD overlap syndrome in COPD population. Int J COPD, 2015, 10: 2169-2176.
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- 1. Global strategy for asthma management and prevention. Revised 2014. Available at: http://www.ginasthma.org.
- 2. 孙永昌. 哮喘-慢阻肺重叠综合征指南解读. 中国呼吸与危重监护杂志, 2014, 13(4): 325-329.
- 3. Miravitlles M, Soler-Cataluña JJ, Calle M, et al. A new approach to grading and treating COPD based on clinical phenotypes: summary of the Spanish COPD Guidelines (GesEPOC). Prim Care Respir J, 2013, 22(1): 117-121.
- 4. 中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南(2013 年修订版). 中华结核和呼吸杂志, 2013, 36(4): 255-264.
- 5. Vignola AM, Rennar SI, Hargreave FE, et al. Standardised methodology of sputum induction and processing: future directions. Eur Respir J, 2002, 20(Suppl 37): 51s-55s.
- 6. Barrecheguren M, Esquinas C, Miravitlles M. The asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS): opportunities and challenges. Curr Opin Pulm Med, 2015, 21(1): 74-79.
- 7. Gibson PG, McDonald VM. Asthma-COPD overlap 2015: now we are six. Thorax, 2015, 70(7): 683-691.
- 8. Menezes AMB, Montes de Oca M, Pérez-Padilla R, et al. Increased risk of exacerbation and hospitalization in subjects with an overlap phenotype: COPD-asthma. Chest, 2014, 145(2): 297-304.
- 9. Rubio MC, Casamor R, Miravitlles M. Identification and distribution of COPD phenotypes in clinical practice according to Spanish COPD Guidelines: the FENEPOC study. Int J COPD, 2017, 12: 2373-2383.
- 10. Cosio BG, Soriano JB, Lopez-Campos JL, et al. Defining the asthma-COPD overlap syndrome in a COPD cohort. Chest, 2016, 149(1): 45-52.
- 11. Jin JM, Liu XF, Sun YC. The prevalence of increased serum IgE and Aspergillus sensitization in patients with COPD and their association with symptoms and lung function. Respir Res, 2014, 15: 130.
- 12. Tamada T, Sugiura H, Takahashi T, et al. Biomarker-based detection of asthma-COPD overlap syndrome in COPD population. Int J COPD, 2015, 10: 2169-2176.
