The overlap syndrome of asthma and COPD: what are its features and how important is it?
- 1Centre for Asthma and Respiratory Diseases, University of Newcastle, Newcastle, Australia
- 2Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
- Professor P Gibson, Department of Respiratory and Sleep Medicine, Level 3 HMRI, John Hunter Hospital, Locked Bag 1, Hunter Mail Centre, Newcastle, NSW Australia 2310;
- Received 14 November 2008
- Accepted 23 April 2009
There is a need to re-evaluate the concept of asthma and chronic obstructive pulmonary disease (COPD) as separate conditions, and to consider situations when they may coexist, or when one condition may evolve into the other. Epidemiological studies show that in older people with obstructive airway disease, as many as half or more may have overlapping diagnoses of asthma and COPD (overlap syndrome). These people are typically excluded from current therapy trials, which limit the generalisability of these trials, and this presents a problem for evidence-based guidelines for obstructive airway diseases. Studying overlap syndrome may shed light on the mechanisms of COPD development. Overlap syndrome is recognised by the coexistence of increased variability of airflow in a patient with incompletely reversible airway obstruction. Patients typically have inflammatory features that resemble COPD, with increased airway neutrophilia, as well as features of airway wall remodelling. Overlap syndrome can develop when there is accelerated decline in lung function, or incomplete lung growth, or both. The risk factors for these events are shared, such that increasing age, bronchial hyper-responsiveness, tobacco smoke exposure, asthma and lower respiratory infections/exacerbations are significant risk factors for both incomplete lung growth and accelerated loss of lung function. Studying these events may offer new insights into the mechanisms and treatment of obstructive airway diseases.
Competing interests: None.
Funding: PGG holds an NHMRC Practitioner Fellowship and JLS holds am NHMRC Centre of Respiratory Research Excellence Fellowship.