Do we really need asthma-chronic obstructive pulmonary disease overlap syndrome?

Area of Science:

• Respiratory Medicine
• Clinical Immunology

Background:

• The co-occurrence of asthma and chronic obstructive pulmonary disease (COPD) in a single patient, termed asthma-COPD overlap syndrome (ACOS), presents diagnostic and therapeutic challenges.
• Current definitions of ACOS are conflicting, making it difficult to identify distinct clinical features and leading to a controversial status in respiratory medicine.

Purpose of the Study:

• To critically evaluate the concept and clinical utility of asthma-COPD overlap syndrome (ACOS).
• To advocate for the abandonment of the ACOS term and the development of a new classification system for airway diseases.

Main Methods:

• Review of existing literature and clinical definitions related to asthma, COPD, and ACOS.
• Analysis of the conceptual framework and therapeutic implications of the ACOS classification.

Main Results:

• Asthma, COPD, and ACOS are recognized as complex syndromes with diverse endotypes and phenotypes, not singular entities.
• The umbrella term ACOS oversimplifies these conditions, potentially impeding the move towards personalized and targeted therapeutic strategies.

Conclusions:

• The current concept of ACOS is problematic and conflicts with the trend towards precision medicine in respiratory diseases.
• Abandoning the term ACOS and developing a new taxonomy based on identified phenotypes and endotypes is crucial for advancing patient care.