Dtsch Med Wochenschr 2021; 146(21): 1405-1409
DOI: 10.1055/a-1404-1998
Dossier

Asthma-COPD-Overlap – diagnostisches und therapeutisches Management

Asthma-COPD-Overlap – diagnostic and therapeutic management
Dirk Skowasch
,
Carmen Pizarro

Asthma-COPD-Overlap (ACO) ist ein umstrittener Begriff, der Patienten charakterisieren soll, die Merkmale einer Asthma- und COPD-Erkrankung aufweisen. Es existieren weder ein spezieller Diagnosealgorithmus noch eindeutige Therapieempfehlungen. Die klinische Konsequenz dieses Dilemmas sollte sein, die führende obstruktive Atemwegserkrankung Asthma oder COPD möglichst zu differenzieren und den vorherrschenden Phänotyp zu therapieren.

Abstract

Asthma-COPD Overlap (ACO) is a fuzzy and controversial term intended to characterize patients who have characteristics of asthma and COPD. Since there is no uniform definition, the information on prevalence varies considerably. There is no special diagnostic algorithm and no clear therapy recommendations, as ACO is underrepresented in therapeutic studies. The current clinical consequence of this dilemma should be to differentiate the leading obstructive airway disease asthma or COPD and to treat the predominant phenotype.



Publikationsverlauf

Artikel online veröffentlicht:
20. Oktober 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • Literatur

  • 1 Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. 2021 Im Internet (Stand: 16.07.2021): www.ginasthma.org
  • 2 Global Strategy for Prevention. Diagnosis and Management of COPD. 2021 Im Internet (Stand: 16.07.2021) www.goldcopd.org
  • 3 Vogelmeier C, Buhl R, Burghuber O. et al. Leitlinie zur Diagnostik und Therapie von Patienten mit chronisch obstruktiver Bronchitis und Lungenemphysem (COPD). Pneumologie 2018; 72: 253-308
  • 4 Buhl R, Bals R, Baur X. et al. S2k-Leitlinie zur Diagnostik und Therapie von Patienten mit Asthma. Pneumologie 2017; 71: 849-919
  • 5 Pizarro C, Skowasch D. COPD: die wichtigsten Komorbiditäten. Dtsch Med Wochenschr 2019; 144: 28-33
  • 6 Fujii W, Kapellos TS, Baßler K. et al Alveolar macrophage transcriptomic profiling in COPD shows major lipid metabolism changes. ERJ Open Res 2021; in press DOI: 10.1183/23120541.00915-2020.
  • 7 Global Initiative for Asthma (GINA). Diagnosis and initial treatment of asthma, COPD, and asthma-COPD-overlap. 2017 Im Internet (Stand: 16.07.2021): https://ginasthma.org/asthma-copd-and-asthma-copd-overlap-syndrome-acos/
  • 8 Miravitlles M. Asthma-COPD overlap (ACO) PRO-CON debate. ACO: Call me by my name. J COPD 2020; 17: 471-473
  • 9 Postma DS, Rabe KF. The asthma-COPD overlap syndrome. N Engl J Med 2015; 373: 1241-1249
  • 10 Akmatov MK, Ermakova T, Holstiege J. et al. Comorbidity profile of patients with concurrent diagnoses of asthma and COPD in Germany. Scientific Report 2020; 10: 17945
  • 11 Milne S, Minnino D, Sin DD. Asthma-COPD overlap and chronic airflow obstruction: definitions, management, and unanswered questions. J Allergy Clin Immunol Pract 2020; 8: 483-495
  • 12 Tu X, Donovan C, Kim RY. et al. Asthma-COPD overlap: current understanding and the utility of experimental models. Eur Respir Rev 2021; 30: 190185
  • 13 Sin DD, Miratlles M, Mannino DM. et al. What is asthma-COPD overlap syndrome? Toward a consensus definition from a round table discussion. Eur Repir J 2016; 48: 664-673
  • 14 Lee SY, Park HY, Kim EK. et al. Combination therapy of inhaled steroids and long-acting beta2-agonists in asthma-COPD overlap syndrome. Int J Chron Obstruct Pulmon Dis 2016; 11: 2797-2803
  • 15 Su VY, Yang KY, Yang YH. et al. Use of ICS/LABA combinations or LAMA is associated with a lower risk of acute exacerbation in patients with coexistent COPD and asthma. J Allergy Clin Immunol Pract 2018; 6: 1927-1935
  • 16 Park SJ, Kim S, Kim JH. et al. A Randomized, Noninferiority Trial Comparing ICS + LABA with ICS + LABA + LAMA in Asthma-COPD Overlap (ACO) Treatment: The ACO Treatment with Optimal Medications (ATOMIC) Study. J Allergy Clin Immunol Pract 2021; 9: 1304-1311
  • 17 Papi A. Asthma COPD Overlap PRO-CON debate. ACO: The mistaken term. J COPD 2020; 17: 474-476
  • 18 Agusti A, Fabbri LM, Singh D. et al. Inhaled corticosteroids in COPD: friend or foe?. Eur Respir J 2018; 52: 1801219
  • 19 Rabe KF, Martinez FJ, Ferguson GT. et al. Inhaled triple therapy at two glucocorticoid doses in moderate-to-very severe COPD. N Engl J Med 2020; 383: 35-48
  • 20 Lee LA, Bailes Z, Barnes N. et al. Efficacy and safety of once-daily single-inhaler triple therapy (FF/UMEC/VI) versus FF/VI in patients with inadequately controlled asthma (CAPTAIN): a double-blind, randomised, phase 3A trial. Lancet Respir Med 2021; 9: 69-84