Take our 5-question quiz to find out what you know about the intersection of these frequently misunderstood disorders.
According to the Global Initiative for Obstructive Lung Disease (GOLD) many adult patients over age 40 years who manifest symptoms of chronic airway disease have features of both asthma and COPD. This overlapping of heterogeneous conditions, once referred to as “asthma-COPD overlap syndrome (ACOS)” is now designated simply as “asthma-COPD overlap (ACO)” in recognition that the intersection of the 2 conditions is not, in fact, a single disease.
The GOLD and Global Initiative for Asthma (GINA) are now collaborating to provide practical advice to clinicians, particularly those in primary care, for differentiating the individual diseases from each other and from ACO and for identifying and treating patients who have ACO.
Take this brief test to find out what you know about the intersection of these frequently misunderstood disorders.
Question 1. Which of the above describes how patients who have features of both asthma and COPD compare with those who have asthma or COPD alone?
Answer: B. More frequent exacerbations. Lung function also declines more rapidly in patients with asthma-COPD overlap; they have more comorbidities, poorer quality of life, and higher mortality than patients with asthma or COPD alone and they consume a disproportionate amount of healthcare resources.
Question 2. According to GOLD/GINA descriptions, by what is asthma-COPD overlap best identified in clinical practice?
Answer: D. The features it shares with both asthma and COPD. GOLD/GINA describe ACO as characterized by persistent airflow limitation with several features usually associated with asthma and several features usually associated with COPD.
Question 3. A recent study validated an algorithm for identifying ACO among patients with COPD that proposed considering which of the above criteria for the ACO diagnosis?
Answer: A and C but not B. The criteria included a high bronchodilator response (change of >400 mL and >15% in forced expiratory volume in 1 second) along with a previous diagnosis of asthma and a significant blood eosinophil count (≥300 cells/Î¼L).
Question 4. Which of the above are the GOLD/GINA initial treatment recommendations for patients with asthma-COPD overlap?
Answer: C. Treatment with ICS in a low or moderate dose, usually with add-on treatment with a LAMA or LABA. GOLD/GINA recommended avoiding LABA monotherapy if there are features of asthma.
Question 5. GOLD/GINA calls for referral for expert advice and further diagnostic evaluation in which of the above circumstances?
Answer: D. A, B, and C. Additional reasons for referral offered by GOLD/GINA include suspicion of chronic airways disease with few syndromic features of both asthma and COPD and the presence of comorbidities that may interfere with the assessment and management of a patient’s airways disease.