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Letter to the Editor
Are the Diagnostic Criteria for Asthma–COPD Overlap Syndrome Appropriate in Biomass Smoke-induced Chronic Obstructive Pulmonary Disease?
¿Son adecuados los criterios diagnósticos del fenotipo mixto EPOC-asma en la enfermedad pulmonar obstructiva crónica por humo de biomasa?
Rafael Golpe
Corresponding author
, Luis Pérez de Llano
Servicio de Neumología, Hospital Universitario Lucus Augusti, Lugo, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Our scientific community agrees that some patients present overlapping features of chronic obstructive pulmonary disease &#40;COPD&#41; and asthma&#46; The Spanish COPD guidelines &#40;GesEPOC&#41;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> call this the mixed COPD&#8211;asthma phenotype&#44; but it is known internationally as asthma&#8211;COPD overlap syndrome &#40;ACOS&#41;&#46; Its prevalence has not been well defined&#44; and various studies report differences in sex and age&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Variations in the prevalence of ACOS are primarily due to discrepancies among the consensus-based diagnostic criteria&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#44;3</span></a> Indeed&#44; in a Canadian study&#44; prevalence ranged between 5&#37; and 27&#37; depending on the diagnostic criteria applied&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> According to clinical guidelines&#44; significant criteria for establishing a diagnosis of ACOS include a previous diagnosis of asthma and&#44; particularly&#44; early onset of respiratory symptoms&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The studies cited above mainly focus on COPD caused by tobacco smoke&#46; We know&#44; however&#44; that exposure to biomass smoke is a major cause of COPD&#44; although the characteristics of this entity remain to be defined&#46; Specifically&#44; little information is available on the prevalence of ACOS in COPD caused by biomass smoke&#46; In a study conducted by our group&#44; we found a 21&#46;3&#37; prevalence of ACOS in patients with COPD caused by biomass smoke&#44; compared to 5&#37; in COPD caused by tobacco&#44; but these differences may be related to an uneven gender distribution in study groups&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> In this study&#44; we used modified GesEPOC criteria to diagnose ACOS&#59; however&#44; the retrospective nature of the study was a major limitation&#44; and prevented us from systematically investigating all possible diagnostic criteria in each case&#46; The diagnostic factor most frequently used was personal history of asthma&#44; based primarily on onset of respiratory symptoms before the age of 40 years&#46; However&#44; this criterion may not be applicable to COPD caused by biomass smoke&#44; since&#44; unlike tobacco&#44; exposure to this noxious substance typically begins in early childhood&#44; a crucial stage in the development of the respiratory system&#46; For this reason&#44; early onset is a specific feature of COPD caused by biomass smoke&#44; and does not constitute a reliable indicator of coexisting asthma in this population&#46; ACOS&#44; then&#44; may have been overdiagnosed in our series&#44; and we must question whether the usual diagnostic criteria are applicable in this COPD subtype&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We believe research should be undertaken to identify biomarkers that would allow ACOS to be reliably differentiated in populations with different risk factors for the disease&#46; The clinical implications are obvious&#44; because ACOS patients and particularly those with COPD caused by biomass smoke have typically been excluded from clinical studies&#44; resulting in a scarcity of scientific evidence on which to base therapeutic decisions&#46;</p></span>"
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Article information
ISSN: 15792129
Original language: English
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