Asthma-COPD overlap: A Portuguese survey

Detalhes bibliográficos
Autor(a) principal: Padrão, E.
Data de Publicação: 2018
Outros Autores: Araújo, D., Todo-Bom, A., Cordeiro, C. Robalo, Sousa, J. Correia de, Cardoso, J., Morais-Almeida, M., Costa, R., Pavão, F., Leite, R. B., Marques, A.
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://hdl.handle.net/10316/108001
https://doi.org/10.1016/j.rppnen.2017.11.009
Resumo: Introduction: The overlap between asthma and chronic obstructive pulmonary disease (COPD) (ACO) has been discussed for many years but clinical recommendations for this entity have been diverse. This study is intended to reach a consensus on diagnosis, treatment and patient orientation for ACO, within the Portuguese medical community. Methods: This study was conducted by a multidisciplinary panel of experts from three distinct medical specialties (Pulmonology, Family Medicine and Immunoallergology). This panel selected a total of 190 clinicians, based on their expertise in obstructive airway diseases, to participate in a Delphi structured survey with three rounds of questionnaires. These results were ultimately discussed, in a meeting with the panel of experts and some of the study participants, and consensus was reached in terms of classification criteria, treatment and orientation of ACO patients. Results: The majority of clinicians (87.2%) considered relevant the definition of an overlap entity between asthma and COPD. A consensus was achieved on the diagnosis of ACO --- presence of simultaneous clinical characteristics of asthma and COPD together with a fixed airflow obstruction (FEV1/FVC < 0.7) associated with 2 major criteria (previous history of asthma; presence of a previous history of smoking exposure and/or exposure to biomass combustion; positive bronchodilation test (increase in FEV1 of at least 200mL and 12%) on more than 1 occasion) plus 1 minor criteria (history of atopy; age ≥40 years; peripheral eosinophilia (>300 eosinophils/ L or >5% of leukocytes); elevation of specific IgEs or positive skin tests for common allergens). A combination of inhaled corticosteroid (ICS) with long-acting beta2-agonist (LABA) or long-acting muscarinic antagonist (LAMA) was considered as first line pharmacological treatment. Triple therapy with ICS plus LABA and LAMA should be used in more severe or symptomatic cases. Non-pharmacological treatment, similar to what is recommended for asthma and COPD, was also considered highly important. A hospital referral of ACO patients should be made in symptomatic or severe cases or when there is a lack of diagnostic resources. Conclusions: This study highlights the relevance of defining ACO, within the Portuguese medical community, and establishes diagnostic criteria that are important for future interventional studies. Recommendations on treatment and patient’s orientation were also achieved.
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spelling Asthma-COPD overlap: A Portuguese surveyAsthmaCOPDOverlapDefinitionDiagnosisManagementDelphi surveyIntroduction: The overlap between asthma and chronic obstructive pulmonary disease (COPD) (ACO) has been discussed for many years but clinical recommendations for this entity have been diverse. This study is intended to reach a consensus on diagnosis, treatment and patient orientation for ACO, within the Portuguese medical community. Methods: This study was conducted by a multidisciplinary panel of experts from three distinct medical specialties (Pulmonology, Family Medicine and Immunoallergology). This panel selected a total of 190 clinicians, based on their expertise in obstructive airway diseases, to participate in a Delphi structured survey with three rounds of questionnaires. These results were ultimately discussed, in a meeting with the panel of experts and some of the study participants, and consensus was reached in terms of classification criteria, treatment and orientation of ACO patients. Results: The majority of clinicians (87.2%) considered relevant the definition of an overlap entity between asthma and COPD. A consensus was achieved on the diagnosis of ACO --- presence of simultaneous clinical characteristics of asthma and COPD together with a fixed airflow obstruction (FEV1/FVC < 0.7) associated with 2 major criteria (previous history of asthma; presence of a previous history of smoking exposure and/or exposure to biomass combustion; positive bronchodilation test (increase in FEV1 of at least 200mL and 12%) on more than 1 occasion) plus 1 minor criteria (history of atopy; age ≥40 years; peripheral eosinophilia (>300 eosinophils/ L or >5% of leukocytes); elevation of specific IgEs or positive skin tests for common allergens). A combination of inhaled corticosteroid (ICS) with long-acting beta2-agonist (LABA) or long-acting muscarinic antagonist (LAMA) was considered as first line pharmacological treatment. Triple therapy with ICS plus LABA and LAMA should be used in more severe or symptomatic cases. Non-pharmacological treatment, similar to what is recommended for asthma and COPD, was also considered highly important. A hospital referral of ACO patients should be made in symptomatic or severe cases or when there is a lack of diagnostic resources. Conclusions: This study highlights the relevance of defining ACO, within the Portuguese medical community, and establishes diagnostic criteria that are important for future interventional studies. Recommendations on treatment and patient’s orientation were also achieved.Elsevier2018-01-12info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttp://hdl.handle.net/10316/108001http://hdl.handle.net/10316/108001https://doi.org/10.1016/j.rppnen.2017.11.009eng25310437Padrão, E.Araújo, D.Todo-Bom, A.Cordeiro, C. RobaloSousa, J. Correia deCardoso, J.Morais-Almeida, M.Costa, R.Pavão, F.Leite, R. B.Marques, A.info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-08-04T08:55:24Zoai:estudogeral.uc.pt:10316/108001Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T21:24:16.397997Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Asthma-COPD overlap: A Portuguese survey
title Asthma-COPD overlap: A Portuguese survey
spellingShingle Asthma-COPD overlap: A Portuguese survey
Padrão, E.
Asthma
COPD
Overlap
Definition
Diagnosis
Management
Delphi survey
title_short Asthma-COPD overlap: A Portuguese survey
title_full Asthma-COPD overlap: A Portuguese survey
title_fullStr Asthma-COPD overlap: A Portuguese survey
title_full_unstemmed Asthma-COPD overlap: A Portuguese survey
title_sort Asthma-COPD overlap: A Portuguese survey
author Padrão, E.
author_facet Padrão, E.
Araújo, D.
Todo-Bom, A.
Cordeiro, C. Robalo
Sousa, J. Correia de
Cardoso, J.
Morais-Almeida, M.
Costa, R.
Pavão, F.
Leite, R. B.
Marques, A.
author_role author
author2 Araújo, D.
Todo-Bom, A.
Cordeiro, C. Robalo
Sousa, J. Correia de
Cardoso, J.
Morais-Almeida, M.
Costa, R.
Pavão, F.
Leite, R. B.
Marques, A.
author2_role author
author
author
author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Padrão, E.
Araújo, D.
Todo-Bom, A.
Cordeiro, C. Robalo
Sousa, J. Correia de
Cardoso, J.
Morais-Almeida, M.
Costa, R.
Pavão, F.
Leite, R. B.
Marques, A.
dc.subject.por.fl_str_mv Asthma
COPD
Overlap
Definition
Diagnosis
Management
Delphi survey
topic Asthma
COPD
Overlap
Definition
Diagnosis
Management
Delphi survey
description Introduction: The overlap between asthma and chronic obstructive pulmonary disease (COPD) (ACO) has been discussed for many years but clinical recommendations for this entity have been diverse. This study is intended to reach a consensus on diagnosis, treatment and patient orientation for ACO, within the Portuguese medical community. Methods: This study was conducted by a multidisciplinary panel of experts from three distinct medical specialties (Pulmonology, Family Medicine and Immunoallergology). This panel selected a total of 190 clinicians, based on their expertise in obstructive airway diseases, to participate in a Delphi structured survey with three rounds of questionnaires. These results were ultimately discussed, in a meeting with the panel of experts and some of the study participants, and consensus was reached in terms of classification criteria, treatment and orientation of ACO patients. Results: The majority of clinicians (87.2%) considered relevant the definition of an overlap entity between asthma and COPD. A consensus was achieved on the diagnosis of ACO --- presence of simultaneous clinical characteristics of asthma and COPD together with a fixed airflow obstruction (FEV1/FVC < 0.7) associated with 2 major criteria (previous history of asthma; presence of a previous history of smoking exposure and/or exposure to biomass combustion; positive bronchodilation test (increase in FEV1 of at least 200mL and 12%) on more than 1 occasion) plus 1 minor criteria (history of atopy; age ≥40 years; peripheral eosinophilia (>300 eosinophils/ L or >5% of leukocytes); elevation of specific IgEs or positive skin tests for common allergens). A combination of inhaled corticosteroid (ICS) with long-acting beta2-agonist (LABA) or long-acting muscarinic antagonist (LAMA) was considered as first line pharmacological treatment. Triple therapy with ICS plus LABA and LAMA should be used in more severe or symptomatic cases. Non-pharmacological treatment, similar to what is recommended for asthma and COPD, was also considered highly important. A hospital referral of ACO patients should be made in symptomatic or severe cases or when there is a lack of diagnostic resources. Conclusions: This study highlights the relevance of defining ACO, within the Portuguese medical community, and establishes diagnostic criteria that are important for future interventional studies. Recommendations on treatment and patient’s orientation were also achieved.
publishDate 2018
dc.date.none.fl_str_mv 2018-01-12
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
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status_str publishedVersion
dc.identifier.uri.fl_str_mv http://hdl.handle.net/10316/108001
http://hdl.handle.net/10316/108001
https://doi.org/10.1016/j.rppnen.2017.11.009
url http://hdl.handle.net/10316/108001
https://doi.org/10.1016/j.rppnen.2017.11.009
dc.language.iso.fl_str_mv eng
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dc.relation.none.fl_str_mv 25310437
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dc.publisher.none.fl_str_mv Elsevier
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