• Marc Miravitlles, Bernardino Alcázar, Francisco Javier Alvarez, Teresa Bazús, Myriam Calle, Ciro Casanova, Carolina Cisneros, Juan P de-Torres, Luis M Entrenas, Cristóbal Esteban, Patricia García-Sidro, Borja G Cosio, Arturo Huerta, Milagros Iriberri, José Luis Izquierdo, Antolín López-Viña, José Luis López-Campos, Eva Martínez-Moragón, Luis Pérez de Llano, Miguel Perpiñá, José Antonio Ros, José Serrano, Juan José Soler-Cataluña, Alfons Torrego, Isabel Urrutia, and Vicente Plaza.
• Pneumology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain ; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
• Int J Chron Obstruct Pulmon Dis. 2015 Jan 1; 10: 1321-30.

BackgroundSome patients with COPD may share characteristics of asthma; this is the so-called asthma-COPD overlap syndrome (ACOS). There are no universally accepted criteria for ACOS, and most treatments for asthma and COPD have not been adequately tested in this population.Materials And MethodsWe performed a survey among pulmonology specialists in asthma and COPD aimed at collecting their opinions about ACOS and their attitudes in regard to some case scenarios of ACOS patients. The participants answered a structured questionnaire and attended a face-to-face meeting with the Metaplan methodology to discuss different aspects of ACOS.ResultsA total of 26 pulmonologists with a mean age of 49.7 years participated in the survey (13 specialists in asthma and 13 in COPD). Among these, 84.6% recognized the existence of ACOS and stated that a mean of 12.6% of their patients might have this syndrome. In addition, 80.8% agreed that the diagnostic criteria for ACOS are not yet well defined. The most frequently mentioned characteristics of ACOS were a history of asthma (88.5%), significant smoking exposure (73.1%), and postbronchodilator forced expiratory volume in 1 second/forced vital capacity <0.7 (69.2%). The most accepted diagnostic criteria were eosinophilia in sputum (80.8%), a very positive bronchodilator test (69.2%), and a history of asthma before 40 years of age (65.4%). Up to 96.2% agreed that first-line treatment for ACOS was the combination of a long-acting β2-agonist and inhaled steroid, with a long-acting antimuscarinic agent (triple therapy) for severe ACOS.ConclusionMost Spanish specialists in asthma and COPD agree that ACOS exists, but the diagnostic criteria are not yet well defined. A previous history of asthma, smoking, and not fully reversible airflow limitation are considered the main characteristics of ACOS, with the most accepted first-line treatment being long-acting β2-agonist/inhaled corticosteroids.

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