Prospective development of practical screening strategies for diagnosis of asthma-COPD overlap

ACO is a syndrome with high prevalence. However, a pragmatic diagnostic criterion to differentiate ACO is non-existent. We aimed to establish an effective model for screening ACO.

A multicentre survey was developed to assess the clinical criteria considered important and applicable by pulmonologists for screening ACO. These experts were asked to take the surveys twice. The expert grading method, analytic hierarchy process and ROC curve were used to establish the model, which was then validated by a cross-sectional study of 1066 patients. The GINA/GOLD document was the gold standard in assessing this model.

Increased variability of symptoms, paroxysmal wheezing, dyspnoea, historical diagnosis of COPD or asthma, allergic constitution, exposure to risk factors, the FEV₁ /FVC < 70% and a positive BDT were important for screening ACO. According to the weight of each criterion, we confirmed that patients meeting six or more of these eight criteria should be considered to have ACO. We called this Chinese screening model for ACO 'CSMA'. It differentiated patients with ACO with a sensitivity of 83.33%, while the sensitivity of clinician-driven diagnosis had a sensitivity of only 42.73%.

CSMA is a workable model for screening ACO and provides a simple tool for clinicians to efficiently diagnose ACO.