10. ACOS: Asthma-COPD Overlap Syndrome

Abstract

Bronchial asthma and chronic obstructive pulmonary disease (COPD) are common respiratory disorders, and it seems possible that in specific clinical situations, they can coexist in one patient. Although both diseases have been known for years, the overlapping syndrome (asthma/COPD overlap syndrome, ACOS) has not been sufficiently well defined and studied yet. So far the international consensus on uniform definitions and diagnostic criteria for ACOS has not been agreed. It remains an open question whether the changes observed in pathophysiological and clinical pictures of asthma and COPD are due to the natural history of both obstructive diseases, or whether it should be recognized as a distinct phenotype called an overlap syndrome. Some risk factors for this syndrome are similar to those associated with asthma and/or COPD - including atopy (increased IgE, and allergic rhinitis), severe asthma in childhood, smoking more than 10-pack-years. Physiological changes in patients suffering from chronic asthma in the elderly are similar to the changes found in the airways of patients with COPD. The lung function measurements confirm incomplete reversibility of airflow obstruction. Patients with ACOS experience exacerbations more frequently than patients with COPD. ACOS significantly reduces quality of life and represents an important risk factor for mortality. The treatment comprises the application of a long-acting inhaled beta2-agonists (LABAs), long acting anticholinergics (LAMA) and inhaled glucocorticoids. Drug treatment should be individualized depending on the clinical picture. In addition to taking the necessary pharmacological action, the most important is to stop smoking.