Table 4

Summary of consensus documents for asthma–COPD overlap

Diagnosis of Diseases of Chronic Airflow Limitation: Asthma, COPD and Asthma-COPD Overlap Syndrome (ACOS)4
In 2014, representatives of the scientific committees of GOLD and GINA joined to produce the ‘Diagnosis of Diseases of Chronic Airflow Limitation: Asthma, COPD and Asthma-COPD Overlap Syndrome (ACOS)’ consensus document. A stepwise approach was recommended whereby the chronic airways disease is recognised through clinical history, physical examination, radiology and potentially screening questionnaires. Next a syndromic approach is recommended where the features of airways disease are assembled and the features that favour asthma and COPD are compared. Three or more features of one disease gives a high likelihood of the correct diagnosis; if there are a similar number of asthma and COPD features, then the overlap of asthma–COPD overlap is more likely. Spirometry is then recommended for confirmation of the diagnosis. If asthma–COPD overlap is confirmed, the initiation of asthma therapy is advised; that is, combination ICS/LABA. Recommendation for specialised referral is the final step
Australian Asthma Management Handbook 201478The Australian Asthma Management Handbook recommends pooling of features corresponding to asthma and COPD in order to make a diagnosis, followed by a trial of ICS and then the addition of LABA for symptom control
Guidelines for the Diagnosis and Treatment of COPD75The Japanese Respiratory Society's COPD guidelines suggest the following indices for diagnosis of an asthma component: paroxysmal dyspnoea, cough and wheeze that is worse at night and in the early morning, atopy and the presence of peripheral blood and or sputum eosinophilia. These guidelines also recommend the initiation of ICS irrespective of the severity of COPD, together with a LABA or LAMA
Consensus document on the overlap phenotype COPD–asthma in COPD74The Spanish COPD consensus document74 for asthma–COPD overlap agreed upon six major and minor criteria required for a diagnosis of asthma–COPD overlap. They suggest that two major criteria (increase in FEV1 ≥15% and ≥400 mL, eosinophilia in sputum and a history of asthma) or one major and two minor (elevated total IgE, history of atopy and positive bronchodilator response of ≥12% and ≥200 mL) on two or more occasions) are strongly suggestive of the overlap phenotype. Treatment recommendations include ICS with adjustment according to symptoms, lung function and sputum eosinophilia in conjunction with a LABA, and as disease severity increases triple therapy with a LAMA is recommended
Consensus guidelines for the Czech Pneumological and Physiological Society79The Czech guideline defined major and minor criteria for the diagnosis of asthma–COPD overlap: Major criteria included (a) strong bronchodilator test (BDT) positivity (FEV1 >15% and >400 mL), (b) bronchoconstrictor test (BCT) positivity,(c) FeNO ≥45–50 ppb and/or ↑eosinophils (sputum) ≥3%, (d) history of asthma. Minor criteria included (a) mild BDT positivity (FEV1 > 12% and > 200 mL), (b) ↑ total IgE, (c) history of atopy and definite COPD diagnosis. The COPD+asthma phenotype can be confirmed by the presence of two major criteria or one major plus two minor criteria
  • FeNO, fractional exhaled nitric oxide; GINA, Global Initiative for Asthma; GOLD, Global Initiative for Chronic Obstructive Lung Disease; ICS, inhaled corticosteroid; LABA, long-acting β2 agonist; LAMA, long-acting muscarinic antagonist.