COPD, ACO and the Chronic Airflow Obstruction Phenotype

This is a Twitter summary from the 2018 WSAAI meeting. This summary was compiled from the tweets posted by @MatthewBowdish, an allergist/immunologist, who attended the 2018 Western Society of Allergy, Asthma and Immunology (WSAAI) meeting. The tweets were labeled #WSAAI. The text was edited and modified by me.

Mario Castro on “new Directions in COPD, ACO and the Chronic Airflow Obstruction Phenotype”.


70% of patients with COPD are younger than 65 yo. COPD is now the 3rd leading cause of death in the US. COPD is now the second leading cause of disability in US. Leading cause of COPD in US is smoking, in the world it’s exposure to the burning of biomass.



Lung volumes can be altered in COPD patients both at rest and during exercise. Pulmonary rehab is essential for overcoming alteration of lung volumes in COPD.


Dynamic hyperinflation links dyspnea and activity limitation in COPD: https://twitter.com/MatthewBowdish/status/956289244581933056



Initial pharmacological management of COPD recommended by GOLD 2018: based on wich group the patient is in: A, B,C, or D: https://twitter.com/MatthewBowdish/status/956291265078808576


Simvastatin and leukotriene inhibitors are not effective in COPD and Dr Castro stops these medications in his COPD patients.


UPLIFT Trial: using long-term LAMA tiotropium showed  improved FEV1 vs. control but has no impact on rate of decline in pre/post-bronchodilator FEV1.


Non-pharmacological management of COPD: smoking cessation, patient education, vaccination (PCV13 & 23), pulmonary rehab, oxygen therapy, and surgical as well as non-surgical alternatives.


Asthma-COPD Overlap (ACO)


COPD-Asthma Overlap – 25% of patients with COPD report a history of asthma. Asthma and COPD have common origins (“Dutch hypothesis”).


Patients with features of both asthma and COPD have worse outcomes than those with asthma or COPD alone in terms of freq exacerbations, poor QoL, more rapid dec in lung fxn, higher mortality and great health care utilization.


Major criteria in Asthma-COPD Overlap (ACO): previous h/o asthma before 40yo, bronchodilator response to salbutamol greater than 15% and 400mL, and sputum eosinophilia.


Minor criteria in ACO: IgE greater than 100 IU or history of atopy, 2 separated bronchodilator responses to salbutamol greater than 12% and 200 mL, and blood eosinophils >5%.


Asthma-COPD overlap (ACO) is not a single disease entity.


Potential phenotype-targeted therapies in severe asthma: https://twitter.com/MatthewBowdish/status/956298377557245953

Dr Castro will utilize COPD Action Plans on some of their patients, especially those who have been admitted for COPD exacerbations.

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