![]() 6 The key points of controversy on the utility of defining ACO include (1) the various definitions assume that patients that have features of both asthma and COPD represent a homogenous group, (2) each disease has a different mechanism and probably is composed of multiple endotypes with diverse disease manifestations, (3) the definitions lack assignment of how much weight each disease has on the clinical manifestations and outcomes, and (4) the definitions are sensitive but lack specificity. There is considerable debate on how to precisely define ACO. The reported prevalence of ACO increases with age and ranges between 1.6% and 4.5% in general population studies and up to 27% and 33% among asthma and COPD populations, respectively. The exact prevalence of asthma-COPD overlap (ACO) has been difficult to estimate both because of the heterogeneous study populations it represents and the lack of a universal definition. Although in their classic presentations asthma and COPD are usually easy to differentiate, many patients may demonstrate features of both. 1, 2, 3 It is therefore not surprising that these diseases are frequently encountered in clinical practice and often coexist. In this review, we provide an overview of available treatments for both asthma and COPD and explore their potential role in the treatment of patients with ACO.Īsthma and COPD are the most prevalent chronic respiratory conditions affecting > 500 million people worldwide and resulting in significant morbidity and an increasing health-care expenditure. ![]() The use of biomarkers, such as peripheral blood eosinophils, exhaled nitric oxide, and serum IgE, may help in selecting appropriate therapies for ACO. Furthermore, novel therapies approved for asthma, such as monoclonal antibodies, may have a role in patients with COPD and ACO. ![]() However, there is considerable overlap in the use of existing medications for both diseases. There are key distinctions in the therapy between asthma and COPD, particularly regarding the initial choice of therapy. Therefore, there is a critical need to set a framework for the therapeutic approach of such patients. Although the precise definition of asthma-COPD overlap (ACO) is still controversial, patients with overlapping features are frequently encountered in clinical practice, and may indeed have worse clinical outcomes and increased health-care utilization than those with asthma or COPD. Over the last few years, there has been a renewed interest in patients with characteristics of both asthma and COPD.
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