Asthma and COPD Overlap Syndrome (ACOS): A Systematic Review and Meta Analysis

<div><p>Background</p><p>The combination of asthma and chronic obstructive pulmonary disease (COPD), or ACOS is a recently defined syndrome. The epidemiology of the condition is poorly described and previous research has suggested ACOS is associated with worse outcomes than either condition alone. We therefore decided to complete a systematic review of the published literature.</p><p>Methods</p><p>This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta- Analyses guidelines. A structured search was performed in the PubMed, Embase, and Medline databases up to Feb 2015 to identify studies reporting incidence, prevalence, health care utilization, morbidity, or mortality in COPD and asthma.</p><p>Results</p><p>A total of 19 studies were included in the present study. The pooled prevalence of overlap among COPD was 27% (95% CI: 0.16–0.38, p<0.0001) and 28% (95% CI: 0.09–0.47, p = 0.0032) in the population and hospital-based studies, respectively. We found no significant difference between ACOS and COPD in terms of gender, smoking status, lung function and 6mWD. However, in comparison to subject with only COPD, ACOS subjects were significantly younger, had higher BMI, healthcare utilization, and lower HRQoL.</p><p>Conclusion</p><p>ACOS is a common condition that exists in a substantial proportion of subjects with COPD. ACOS represents a distinct clinical phenotype with more frequent exacerbations, hospitalization, worse health-related quality of life, and higher healthcare costs than either disease alone. There is a critical need to better define the management and treatment of this syndrome.</p></div

Forest Plot: polled prevalence of overlap among COPD patients in population based studies.

<p>Study 1 = Shirtcliffe et al [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0136065#pone.0136065.ref010" target="_blank">10</a>], study 2 = Menezes et al [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0136065#pone.0136065.ref011" target="_blank">11</a>], study 3 = Marsh et al [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0136065#pone.0136065.ref012" target="_blank">12</a>], study 4 = Johannessen et al [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0136065#pone.0136065.ref016" target="_blank">16</a>], study 5 = Danielsson et al [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0136065#pone.0136065.ref017" target="_blank">17</a>], study 6 = Methvin et al [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0136065#pone.0136065.ref018" target="_blank">18</a>], study 7 = Miravitlles et al [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0136065#pone.0136065.ref019" target="_blank">19</a>], study 8 = Y. Zhou+CESCOPD et al [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0136065#pone.0136065.ref020" target="_blank">20</a>], study 9 = Jyrki-Tapani al [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0136065#pone.0136065.ref021" target="_blank">21</a>].</p

Forest Plot: polled prevalence of overlap among COPD patients in hospital based studies.

<p>Study 1 = Kauppi et al [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0136065#pone.0136065.ref013" target="_blank">13</a>], study 2 = Hardin et al [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0136065#pone.0136065.ref014" target="_blank">14</a>], study 3 = Alonso JL et al [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0136065#pone.0136065.ref015" target="_blank">15</a>], study 4 = Fabbri et al [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0136065#pone.0136065.ref022" target="_blank">22</a>].</p

Review process (PRISMA Flow Diagram): details of review process.

<p>Review process (PRISMA Flow Diagram): details of review process.</p

Characteristics of included studies.

<p>Abbreviations and definitions: COPD = chronic obstructive pulmonary disease; FEV1 = forced expiratory volume in 1 second; FVC = forced vital capacity, ICD: International Classification of Diseases.</p><p>Characteristics of included studies.</p