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2016 ; 11
(ä): 1297-306
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The asthma-COPD overlap syndrome: do we really need another syndrome in the
already complex matrix of airway disease?
#MMPMID27366057
Kostikas K
; Clemens A
; Patalano F
Int J Chron Obstruct Pulmon Dis
2016[]; 11
(ä): 1297-306
PMID27366057
show ga
The term asthma-COPD overlap syndrome (ACOS) is one of multiple terms used to
describe patients with characteristics of both COPD and asthma, representing ~20%
of patients with obstructive airway diseases. The recognition of both sets of
morbidities in patients is important to guide practical treatment decisions. It
is widely recognized that patients with COPD and coexisting asthma present with a
higher disease burden, despite the conceptual expectation that the "reversible"
or "treatable" component of asthma would allow for more effective management and
better outcomes. However, subcategorization into terms such as ACOS is
complicated by the vast spectrum of heterogeneity that is encapsulated by asthma
and COPD, resulting in different clinical clusters. In this review, we discuss
the possibility that these different clusters are suboptimally described by the
umbrella term "ACOS", as this additional categorization may lead to clinical
confusion and potential inappropriate use of resources. We suggest that a more
clinically relevant approach would be to recognize the extreme variability and
the numerous phenotypes encompassed within obstructive airway diseases, with
various degrees of overlapping in individual patients. In addition, we discuss
some of the evidence to be considered when making practical decisions on the
treatment of patients with overlapping characteristics between COPD and asthma,
as well as the potential options for phenotype and biomarker-driven management of
airway disease with the aim of providing more personalized treatment for
patients. Finally, we highlight the need for more evidence in patients with
overlapping disease characteristics and to facilitate better characterization of
potential treatment responders.