78 To the Editor,
In fact, ACO is not a new concept. It was a concept known for many years by clinicians but not named. For the first time in 2014, the definition of Asthma-COPD overlap syndrome (ACOS) entered the guidelines. A chapter on ACOS was published by the science committees of the GINA and the GOLD (1). The definition of ACOS in these guideline is that the persistent airflow limitation with several features usually associated with asthma and several features usually associated with COPD. It was updated in 2015 but it is stated that ACOS is not a single disease (2).
GINA 2017 guidelines state that this condition is not a separate disease or syndrome and therefore should be defined as ACO and, ACO terminology has begun to be used (3). The workshop report of ATS-NHLBI on ACO has been published. One of the major conclusions of the workshop was that the condition doesn’t represent a single discrete disease entity (4). We see that ACO is no longer considered a separate disease or syndrome both in this workshop report and in the
GINA/GOLD guidelines. Beyond this, we don’t think it would be appropriate to use the ACO terminology alone. ACO should be considered as a phenotype of asthma or COPD. In other words, one of these diseases is dominant. The dominant disease is the main disease and the other is the phenotype of the main disease.
Using the terminology in this way may be a better guide to evaluate the pathophysiology, prognosis and treatment of ACO. However, the important point here is to determine which disease ACO is a phenotype of.
In a patient who is suspecting of having ACO, we need to use parameters that help clinicians to discriminate whether this is the asthma or the COPD phenotype.
Is Asthma-COPD overlap an asthma phenotype or a COPD phenotype?
doi • 10.5578/tt.66337 Tuberk Toraks 2018;66(1):78-79
Geliş Tarihi/Received:21.12.2017 • Kabul Ediliş Tarihi/Accepted: 27.12.2017
EDİTÖRE MEKTUP LETTER TO THE EDITOR
İnsu yIlMAz1 1 Division of Immunology and Allergy Diseases, Department of Chest Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey
1 Erciyes Üniversitesi Tıp Fakültesi, Göğüs Hastalıkları Anabilim Dalı, İmmünoloji ve Allerji Hastalıkları Bilim Dalı, Kayseri, Türkiye
Dr. İnsu YILmAz
Erciyes Üniversitesi Tıp Fakültesi, Göğüs Hastalıkları Anabilim Dalı, İmmünoloji ve Allerji Hastalıkları Bilim Dalı, KAYSERİ - TURKEY
e-mail: insu2004@yahoo.com
yazışma Adresi (Address for Correspondence)
Tuberk Toraks 2018;66(1):78-79
Yılmaz İ.
79 RE FE REN CES
1. Diagnosis of Diseases of Chronic Airflow Limitation:
Asthma COPD and Asthma-COPD Overlap Syndrome (ACOS) Based on the Global Strategy for Asthma Management and Prevention and the Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease 2014.
2. Diagnosis of Diseases of Chronic Airflow Limitation:
Asthma COPD and Asthma-COPD Overlap Syndrome (ACOS) Based on the Global Strategy for Asthma Management and Prevention and the Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease 2015.
3. Global initiative for asthma. Diagnosis and initial treatment of asthma, COPD and asthma-COPD overlap (ACO) 2017.
4. Woodruff PG, van den Berge M, Boucher RC, Brightling C, Burchard EG, Christenson SA, Han MK, Holtzman MJ, Kraft M, Lynch DA, Martinez FD, Reddel HK, Sin DD, Washko GR, Wenzel SE, Punturieri A, Freemer MM, Wise RA. ATS-NHLBI Asthma COPD Overlap (ACO) Workshop Report. Am J Respir Crit Care Med 2017 Jun 21.
