1 Dr. Tobias Bonten AIOS Huisartsgeneeskunde, Postdoc en Epidemioloog Longziekten en Public Health & Eerstelijns Geneeskunde LEIDS UNIVERSITAIR MEDISCH CENTRUM Gerichte therapie bij Astma COPD overlap syndroom (potentiële) belangenverstrengeling Geen Disclosure belangen spreker
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Gerichte therapie bij Astma COPD overlap syndroom · 3 Achtergrond • Asthma vs. COPD Asthma COPD Diagnose Laboratorium Allergie (IgE, eosinophielen) Geen Pulmonary function Normaal
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Dr. Tobias Bonten
AIOS Huisartsgeneeskunde, Postdoc en Epidemioloog
Longziekten en Public Health & Eerstelijns Geneeskunde
Pulmonary function Normaal of reversibele obstructie
Irreversibeleobstructie
Achtergrond
• Astma EN COPD? Astma COPD overlap syndroom (ACOS)
?
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ACOS ?
2. Australian Asthma management HandbookPooling of features corresponding to asthma and COPD, followed by a trial of Inhalation Corticosteroids
1. GINA/GOLD (guideline)List 9 features: similar number of asthma and COPD features ACOS more likely; spirometry recommended
3. Japanese Respiratory Society COPD guidelinesAsthma component: paroxysmal dyspnoea, cough and wheeze worse at night and early morning, atopy, sputum/blood eosinophilia.
4. Spanish COPD consensus document- Major criteria:
- Increase FEV1 ≥ 15% and ≥400ml- Eosinophilia- History of asthma
- Minor criteria:- Total IgE- Atopy- ≥2 ocassions: FEV1 ≥ 12% and ≥200ml
ACOS if 2 major 1 major + 2 minor
5. Czech Pneumological and Physiological Society- Major criteria:
- Increase FEV1 ≥ 15% and ≥400ml- Positive provocation test- FeNO ≥ 45-50 ppb and/or sputum eosinophils ≥3%- History of asthma
- Minor criteria:- FEV1 ≥ 12% and ≥200ml- Total IgE- Atopy and COPD diagnosis
ACOS if 2 major 1 major + 2 minor
Gibson PG, et al. Thorax 2015
ACOS fenotypen…?
Bateman, Lancet Respir Med 2015
CHAOS instead of ACOS?
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Overzicht
1. Is ACOS klinisch relevant?
2. Hoe vaak komt ACOS voor?
3. Identificeren van ACOS in de eerste lijn
4. Adviezen over behandeling van ACOS
9-Feb-179 Insert > Header & footer
Overzicht
1. Is ACOS klinisch relevant?
2. Hoe vaak komt ACOS voor?
3. Identificeren van ACOS in de eerste lijn
4. Adviezen over behandeling van ACOS
9-Feb-1710 Insert > Header & footer
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ACOS – klinisch relevant?
Nielsen M, et al. Int J COPD 2015
Frequency of exacerbations among ACOS patients is higher than in Asthma or COPD
ACOS – klinisch relevant? Eigen onderzoek bij 864 patienten met Astma/COPD
1. COPD AND Asthma in registry
2. COPD AND Asthma in registry OR ACOS as text in EMR
3. Self-reported COPD AND Asthma
4. FEV1/FVC < 0.7 AND ≥10 pack-years AND asthma <40 years
5. COPD in registry OR self-reported + FEV1/FVC < 0.7
AND
Asthma in registry OR Self-reported
6. COPD in registry OR Self-reported + FEV1/FVC < 0.7
AND
Asthma in registry OR Self-reported OR FENO ≥ 45 ppb
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ACOS – klinisch relevant?
• 864 patiënten met Astma/COPD
• Follow-up 1.8jr
• Exacerbatie: voorschrift corticosteroid of antibioticum door huisarts
* adjusted for: age, sex, bmi, current smoking, FEV1/FVC ratio at baseline, ICS use, number of exacerbations in previous year
ACOS – klinisch relevant?
* adjusted for: age, sex, bmi, current smoking, FEV1/FVC ratio at baseline, ICS use, number of exacerbations in previous year
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Survival is worse among ACOS patients than in Asthma or COPD, depending on age of asthma onset
Lange P, Lancet Resp Med 2016
ACOS – klinisch relevant?
ACOS – relevant for society?
Gerhardsson de Verdier M, Val Health 2015
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Overzicht
1. Is ACOS klinisch relevant?
2. Hoe vaak komt ACOS voor?
3. Identificeren van ACOS in de eerste lijn
4. Adviezen over behandeling van ACOS
9-Feb-1717 Insert > Header & footer
Eerdere studies Karakteristieken en ACOS prevalentie
Study Population Age Prevalence (%) Definition
Brzostek Smoking >45 100 Doctor diagnosed asthma + COPD