Centre for Heart Lung Innovation, St Paul's Hospital and Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada.
Department of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky College of Medicine, Lexington, Ky.
J Allergy Clin Immunol Pract. 2020 Feb;8(2):483-495. doi: 10.1016/j.jaip.2019.10.044. Epub 2019 Nov 16.
Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) is a common clinical presentation of chronic airways disease in which patients show some features usually associated with asthma, and some usually associated with COPD. There is ongoing debate over whether ACO is a discrete clinical entity, or if it is part of a continuum of airways disease. Furthermore, there is considerable variation among current definitions of ACO, which makes diagnosis potentially challenging for clinicians. Treating ACO may be equally challenging because ACO is an understudied population, and the evidence base for its management comes largely from asthma and COPD studies, the relevance of which deserves careful consideration. In this review, we synthesize the various approaches to ACO diagnosis and evaluate the role of currently available diagnostic tests. We describe the potential benefits of existing asthma and COPD therapies in treating patients with ACO, and the value of a "treatable traits" approach to ACO management. Throughout the review, we highlight some of the pressing, unanswered questions surrounding ACO that are relevant to the clinical community. Ultimately, addressing these questions is necessary if we are to improve clinical outcomes for this complex and heterogeneous patient population.
哮喘-慢性阻塞性肺疾病（COPD）重叠（ACO）是一种常见的慢性气道疾病的临床表现，患者表现出一些通常与哮喘相关的特征，以及一些通常与 COPD 相关的特征。关于 ACO 是否是一种独立的临床实体，或者它是否是气道疾病连续体的一部分，目前仍存在争议。此外，目前 ACO 的定义存在很大差异，这使得临床医生在诊断时可能面临挑战。治疗 ACO 可能同样具有挑战性，因为 ACO 是一个研究不足的人群，其管理的证据基础主要来自哮喘和 COPD 研究，这些研究的相关性值得仔细考虑。在这篇综述中，我们综合了 ACO 诊断的各种方法，并评估了目前可用的诊断测试的作用。我们描述了现有哮喘和 COPD 治疗方法在治疗 ACO 患者中的潜在益处，以及采用“可治疗特征”方法管理 ACO 的价值。在整篇综述中，我们强调了一些围绕 ACO 的紧迫的、未解决的问题，这些问题与临床界有关。如果我们要改善这一复杂和异质的患者群体的临床结局，最终必须解决这些问题。
