• Massimo Guerriero, Marco Caminati, Giovanni Viegi, Gianenrico Senna, and Carlo Pomari.
• a Department of Computer Science , University of Verona , Verona , Italy.
• J Asthma. 2019 Jan 1; 56 (1): 27-33.

ObjectiveThere is controversy about the diagnostic criteria, prevalence, symptoms, and spirometry characteristics of asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO). Recent data indicate that the fixed method for diagnosing airway obstruction (AO) may overestimate ACO prevalence in the elderly, and a variable method may be more accurate. We aimed at estimating ACO prevalence in a general population sample and comparing patient and clinical features in subjects with ACO, COPD, and asthma.MethodsWe analyzed data from a cross-sectional study estimating COPD prevalence in randomly selected adults aged 20-79 years in Verona, Italy, and estimated prevalence and analyzed characteristics of asthma, COPD, and ACO. ACO was defined as AO (Forced Expiratory Volume in one second-FEV1/ Forced Vital Capacity-FVC < Lower Limit of Normal-LLN), highly positive bronchodilator test (≥15% increase in FEV1 and FVC ≥400 mL), and personal self-reported history of physician diagnosed asthma and atopy.ResultsOne thousand two hundred and thirty-six patients were included; 207 (16.7%) had asthma, COPD, or ACO (mean ages: 61.2, 59.7, and 57.2 years, respectively). The 3 groups had similar clinical and demographic variables; however, spirometry revealed differences between ACO and COPD patients, particularly post-bronchodilator FEV1 reversibility, which was detected in ACO and asthma patients but not in those with COPD.ConclusionACO prevalence in Northern Italy was estimated at 2.1%, in the range of values reported by previous studies. Marked differences between ACO and COPD revealed by spirometry may have important clinical implications in terms of treatment for patients with ACO.

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