Asthma COPD overlap Syndrome Flashcards
What is asthma COPD overlap syndrome (ACOS)?
Persistent airflow limitation with several features associated with asthma and several with COPD
What is classic epid of ACOS?
Usually age over 40 but may have had symptoms in childhood or early adulthood
What are RF for ACOS?
- Hx of asthma
2. Allergies and Fhx of asthma and/or noxious exposures
How common does ACOS happen in COPD and Asthma?
¼ with COPD
1/3 patient previously had asthma
How does ACOS compare to asthma and COPD?
- ACOS worse resp symptoms
- Poorer quality of life
- Increased risk of exacerbation and hospital admission than asthma or COPD alone
What are symptoms and signs of ACOS?
- Exertional dyspnoea persistent
2. Variable symptoms
What is lung function like in ACOS?
airflow limitation not fully reversible and persistent between symptoms
What would CXR be like in ACOS?
similar to COPD: hyperinflations
What is airway inflammation like in ACOS?
eosinophils and/or neutrophils in sputum
What is spirometry?
- Post-BD FEV1/FVC<0.7 usually present
- FEV1>80% diagnosis of mild ACOS
- FEV1<80%predicted: indicator of severity of airflow limitation and risk of future events
What does management of ACOS target?
eosinophilic, neutrophilic or paucigranulocytic airway inflammation
What does treatment of ACOS involve?
- Low or moderate dose inhaled corticosteroids + LABA and/or LAMA
- If features of asthma avoid LABA monotherapy
What complications of ACOS?
- Co-morbidities
2. Exacerbation more common that in COPD but reduced by treatment
What is the first thing needed for diagnosis of ACOS?
Identify history of chronic airway disease e.g. chronic or recurrent cough, sputum production, wheezing, or repeated acute lower respiratory tract infection
What is second thing needed for diagnosis of ACOS?
features of asthma and those of COPD best describe patient (age of onset, pattern of symptoms, results of PFTs and finding on chest radiographs)
