UC Davis pulmonary specialists and WAF Board Members Samuel Louie and Amir Zeki have named asthma-COPD overlap syndrome, or ACOS.
The physicians recognized the high incidence of the condition — defined by the increased number and intensity of symptoms — after evaluating UC Davis patients with obstructive lung diseases and finding that ACOS was present in about a quarter of patients with severe asthma. They also observed that, on average, 1 in 5 patients with obstructive lung diseases have ACOS.
“It’s standard in our field to diagnose COPD or asthma but not both,” said Louie, professor of internal medicine. “That can lead to treatment plans that don’t fully address the breathing problems of a large group of patients and puts them at risk of losing rather than preserving lung health.”
In articles published in the Journal of Allergy, Expert Reviews in Clinical Pharmacology and Consultant 360, [I’ll create links to the articles] Louie and Zeki presented an diagnosis and treatment approach based on their experiences with patients who have asthma, COPD and ACOS. In May of this year, that approach was incorporated in part by the Global Initiative for Asthma (GINA) and the Global Initiative for Chronic Obstructive Lung Disease (GOLD).
“We don’t have complete consensus yet on the definition of ACOS, given the limited number of studies so far,” said Louie. “But this was a very important start.”
Different mechanisms, similar outcomes
Louie explained that asthma is the result of environmental triggers, including allergens and air pollution, which cause chronic inflammation and airflow obstruction. Adults with COPD have lung damage in the form of emphysema, typically due to smoking or environmental pollution, causing chronic and progressive shortness of breath. A majority of COPD patients also have chronic bronchitis, causing airway swelling, mucus and coughing.
Both diseases lead to acute exacerbations — episodes when breathing rapidly deteriorates, potentially leading to emergency department visits, hospitalizations and death. ACOS patients experience these episodes more frequently and with greater severity than those with asthma or COPD alone.
If you or someone you know suffers from severe Asthma and or COPD then you owe it to yourself and to others to listen in on this interview with Chris Garvey FNP, MSN, MPA, FAACVPR Manager, Seton Pulmonary & Cardiac Rehabilitation that took place at the California Thoracic Society (CTS) 2013 Conference Carmel California.
Key take aways:
•The importance of exercise
•Taking your meds
•The benefits of multidisciplinary teams
•Early identification
•Effective treatment based on evidence based guidelines to reduce Exacerbation’s
•Reduced cost of care
•Effective Care
•Understand your symptoms
•Education
•Honest and frank discussion your doctor and or health care provider
•Getting the right meds
•Follow up with your doctor and or health care provider
High Risk Factors in Asthma-COPD Overlap Syndrome: Highly Prevalent But Grossly Underappreciated
By Tinka Davi, World Asthma Foundation
The statistics are staggering:
Every four minutes someone dies of COPD or chronic obstructive pulmonary disease.
Every day nine people die from asthma.
But what takes a higher toll is a combination of the two diseases, which is recognized as Asthma-COPD Overlap Syndrome or ACOS.
Because this syndrome has not received much attention by the medical community, the frequency of deaths due to ACOS alone has not been compiled.
ACOS, which was formerly called “asthmatic bronchitis,” is a commonly experienced, yet loosely defined clinical entity. It accounts for approximately 15 to 25 percent of the general population of obstructive airway diseases who experience worse outcomes compared to asthma or COPD alone.
Patients with ACOS have the combined risk factors of smoking and atopy such as hay fever. These adults are generally younger than patients with COPD and experience acute exacerbations or attacks of their breathing requiring immediate attention with higher frequency and greater severity than lone COPD.
Physicians and other healthcare professionals at UC Davis have taken their clinical experience and research nationally to increase public awareness.
“ACOS is concerning because it’s much worse in terms of exacerbations, or acute attacks of breathlessness, as compared to COPD.” said Amir Zeki, MD, assistant professor of medicine pulmonary, critical, and sleep medicine at the Center for Comparative Respiratory Biology and Medicine at the University of California Davis School Of Medicine.
Samuel Louie, MD and Amir Zeki, MD
Exacerbation is an acute flare up or worsening of the disease usually over two to three days that causes patients with asthma, COPD or both to seek immediate medical attention and a change in their daily medications.
An exacerbation is a flare up or worsening of the disease, otherwise known as an “attack.”
With an acute attack, the risk of hospitalization, need for steroids, days of missed work or school increases with ACOS, Zeki said. The prevalence of frequent exacerbations in ACOS is nearly two-and-a-half times higher than COPD and risk of severe exacerbations in ACOS is twice as high as COPD.
Zeki and Samuel Louie, MD are collaborating efforts to educate the medical field and the public about ACOS.
Louie, professor of medicine, is director of the UC Davis Asthma Network (UCAN) since 1998 and director of the UC Davis Reversible Obstructive Airway Disease (ROAD) Center, which serves adults and adolescents in Northern California who have difficult to control asthma, bronchiectasis and COPD.
“We are entering a new era of public awareness of people living with chronic lung disease such as asthma and COPD,” Louie said. “Our mission at UC Davis is to transform health care by integrating and provide quality patient care services these conditions, which promote patient education and safety, social networking, and to align our goals with national efforts to transform people’s lives. But we can achieve success without recognizing the clear and present danger from not recognizing the Asthma-COPD Overlap syndrome.”
The incidence of ACOS is becoming more prevalent. “One in five patients in our clinic will likely have ACOS,” Zeki said.
Louie agrees. “When patients learn what they have, they begin to look for more information and help. That is where we have to be ready to provide comprehensive services that are integrated and coordinated to help patients and their families navigate the complex modern health care system,” he said.
That’s why the two physicians are zealous in their efforts in providing ACOS education, not only for patients but to the medical community which is not as familiar with the syndrome as it is with asthma or COPD. They’d also like to see extensive research for treatment options.
“There’s no cure for asthma and there’s no cure for COPD, but we can treat them to improve their quality of life and prevent acute exacerbations,” Zeki said.
However, standard treatment options are not as aggressive as needed to treat the asthma-COPD syndrome.
“It really all begins with empathy.” Louie said. “Empathy within healthcare providers for how asthma, COPD and ACOS patients suffer when they are given prescription drugs without education on an individual level. We have to ignite that empathy by increasing awareness and providing education.”
The two physicians are board members of the World Asthma Foundation, which provides educational resources that inform patients, medical professionals and the general public about the latest clinical advances, management and treatment options for asthma disorders, including ACOS.
“I am convinced that every patient who lives with asthma, COPD or ACOS has character and intelligence but what they often lack is willpower.” Louie said. “And when physicians and their colleagues think COPD is ‘irreversible,’ that is like a nail in the coffin to patients, but nothing could be further from the truth. There are no cures as Dr. Zeki said, but then there is no cure for diabetes or heart disease either.
“People with asthma, COPD and ACOS deserve better. It requires that we all take responsibility, patients too, but physicians must take their empathy one step further and realize how reversible asthma, COPD and ACOS can be” Louie said.
Willaim Cullifer, executive director of the World Asthma Foundation, said, “This is a fascinating new development in the understanding of asthma and COPD and it’s fantastic to be on the forefront of educating the public and the healthcare community about this issue.”
With their concern and enthusiasm for serving ACOS patients as well as those living with asthma alone or COPD alone, the dedicated physicians are bound to make a difference, hopefully in their lifetimes.
“My hope is to gain a better understanding of this syndrome, which may indeed be on the continuum of airway diseases such as COPD and asthma,” Zeki said. “We hope to garner the support and funding needed to study it given its high prevalence and public health significance.”
“When you get done taking care of the disease, you’re taking care of people,” Louie said.
“We must fight indifference. The only way to do that is to get the word out that we all have much more to achieve together to empower patients with reversible obstructive airway diseases.” Louie said.
