Introduction Asthma-COPD Overlap Syndrome (ACOS) is characterised by persistent airflow limitation with several features usually associated with asthma and several features usually associated with COPD, which can be difficult to define. In response to the document produced by GINA and GOLD (2014) there is a need for further studies to identify the proportion of ACOS patients within treatment centres. Patients with features of ACOS are reported between 15–55% and have outcomes that are far worse than COPD or asthma alone.1
Objectives To locally identify the proportion and current management of ACOS patients within a tertiary treatment centre.
Method The study was carried out retrospectively reviewing patient data over a 6 month period from electronically documented clinic letters, discharge summaries, pathology and lung function results. Patients included were identified from a severe difficult asthma clinic list at a large tertiary centre in London.
Results 101 patients were reviewed with a mean age of 49.1 years. Table 1 identifies patients with chronic airflow limitation with a cohort of 6.9% (n = 7) diagnosed as asthma and COPD; showing fixed airway obstruction (n = 6), mean age 54.6 years. There are no patients receiving LABA mono therapy, however 7.9% patients have no ICS in their treatment plan.
Conclusion This review of severe difficult asthma clinic patients highlights the challenge in identifying ACOS patients. Spirometry results documented are of limited value in diagnosis between asthma, COPD and ACOS; reversibility testing would be more indicative for future work. Interestingly we have a relatively young patient population on high BDP doses and some potentially at risk due to no ICS treatment. Further prospective studies in the form of patient questionnaires is required in order to identify detailed clinical history to aid earlier diagnosis and management.
Reference 1 Diagnosis of Diseases of Chronic Airflow Limitation: Asthma, COPD, and Asthma – COPD Overlap Syndrome (ACOS). GINA and GOLD, 2014