ACOS Often Underdiagnosed and Untreated in Elderly

Patients with asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome, known as ACOS, are currently under-diagnosed and undertreated , according to 2 new studies.

Because of the overlap in symptoms, asthma often goes undiagnosed in COPD patients, and although asthma-COPD syndrome is more common among elderly patients, they aren’t being treated accurately.

For the first study, researchers assessed 147 female and 55 male elderly patients in Brazil to determine whether they had asthma or COPD.
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Researchers administered a modified version of the asthma module of the International Study of Asthma and Allergies in Childhood (ISAAC) test to assess asthma prevalence and administered the Global Initiative for Chronic Obstructive Lung Disease (GOLD) to assess COPD prevalence.

After analyzing the results, researchers found that 11% of patients had definite asthma, 10% had COPD, 6% had ACOS, and 5% had probable asthma.

In addition, ACOS was most common in patients who were 60 to 69 years old (11%), and it affected more female (7%) than male (5%) patients.

“The study group had a significant prevalence of ACOS, which suggested that the methods that are used to diagnose ACOS need to be improved in order to provide a better quality of life to elderly patients with ACOS,” researchers concluded.1

For the second study, researchers examined electronic health records of 261 elderly veterans with COPD who underwent pulmonary function testing at the San Francisco VA Medical Center in 2013 and 2014.

Researchers assessed demographics data, presence of asthma, and smoking history.

After analyzing the records, researchers found that 68 veterans had ACOS (26%). Of those, 20 had highly positive bronchodilator tests and 19 had asthma. In addition, 7 of the 20 veterans with highly positive bronchodilator tests had asthma.

“ACOS is an under-recognized but common diagnosis in veterans with heavy smoking and COPD,” researchers concluded. “Given the therapeutic and prognostic implications of ACOS illustrated in previous studies, all patients with COPD, even those with history of heavy smoking, should be evaluated for ACOS.”2

—Amanda Balbi

References:

  1. de Freitas TA, Netto AG, Aarestrup B, Aarestrup FM. Prevalence of asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome in Brazilian elderly patients. J Allergy Clin Immunol. 2016;137(2):AB3. Suppl. http://dx.doi.org/10.1016/j.jaci.2015.12.010.
  2. Guenechea-Sola M, Dalton S, Geerts J, Zeng S, Arjomandi M. Asthma-COPD overlap syndrome: An underdiagnosed phenotype in heavy smokers. J Allergy Clin Immunol. 2016;137(2):AB102. Suppl. http://dx.doi.org/10.1016/j.jaci.2015.12.460.