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Síndrome de sobreposição asma-DPOC : estado da arte
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É cada vez mais reconhecido que a asma e a DPOC são doenças heterogéneas com uma grande variabilidade interindividual no que respeita às suas manifestações clínicas, progressão da doença e resposta aos tratamentos disponíveis. As características destas duas entidades clínicas podem coexistir em doentes com sintomatologia de obstrução crónica das vias respiratórias, criando uma condição reconhecida por Síndrome de Sobreposição Asma-DPOC (ACOS – Asthma-COPD Overlap Syndrome).
Apesar de ter sido descrito, recentemente, em normas de orientação internacionais, esta síndrome continua a ser um desafio diagnóstico na prática clínica, dada a inexistência de critérios de diagnóstico válidos para o diferenciar da asma e DPOC. Dado os doentes com esta síndrome terem sido consistentemente excluídos dos ensaios clínicos sobre asma e DPOC com critérios de exclusão muito específicos, a abordagem no diagnóstico de ACOS depende sempre das características fenotípicas em que o doente está incluído.
O objetivo deste artigo é compreender, com base na revisão da literatura existente, as características chave da ACOS com destaque para a sua definição e diagnóstico, epidemiologia, mecanismos da doença, comorbilidades, mortalidade, impactos na qualidade de vida e económico e opções de tratamento existentes e potenciais. Essas características são analisadas e comparadas com os seus monocomponentes – asma e DPOC. Também é dado enfoque às novas pesquisas orientadas na deteção de critérios de diagnóstico objetivos e reprodutíveis.
Foram pesquisados artigos na base de dados electrónica PubMed e referências bibliográficas pertinentes.
Apesar da ACOS não se encontrar claramente definida na literatura, os doentes com esta síndrome correspondem a uma percentagem significativa de doentes com doença pulmonar obstrutiva crónica e apresentam um maior número de exacerbações e hospitalizações do que os doentes com asma ou DPOC.
É necessária a criação de critérios de diagnóstico estudados pela medicina baseada na evidência para facilitar o diagnóstico precoce da ACOS e otimizar as estratégias terapêuticas.
It is increasingly recognized that asthma and COPD are heterogeneous diseases with great inter-individual variability in terms of clinical manifestations, disease progression and response to available treatments. The characteristics of these two clinical entities may coexist in patients with symptoms of chronic obstruction of the airways, creating a condition known as Asthma-COPD (ACOS) Overlap Syndrome. Although it has recently been described in international guidelines, this syndrome remains a diagnostic challenge in clinical practice, given the lack of valid diagnostic criteria to differentiate it from asthma and COPD. Because patients with this syndrome have been consistently excluded from the clinical trials on asthma and COPD with very specific exclusion criteria, the approach in the diagnosis of ACOS always depends on the phenotypic characteristics in which the patient is included. The objective of this article is to understand, based on the review of the existing literature, the key characteristics of ACOS, highlighting its definition and diagnosis, epidemiology, disease mechanisms, comorbidities, mortality, impacts on quality of life and on economics and potential treatment options. These characteristics are analyzed and compared with their monocomponents - asthma and COPD. It also focuses on new research aimed at the detection of objective and reproducible diagnostic criteria. Articles were searched in the electronic database PubMed and relevant bibliographical references. Although ACOS is not clearly defined in the literature, patients with this syndrome account for a significant percentage of patients with chronic obstructive pulmonary disease and have a higher number of exacerbations and hospitalizations than patients with asthma or COPD. It is necessary to create diagnostic criteria studied by evidence-based medicine to facilitate the early diagnosis of ACOS and to optimize therapeutic strategies.
It is increasingly recognized that asthma and COPD are heterogeneous diseases with great inter-individual variability in terms of clinical manifestations, disease progression and response to available treatments. The characteristics of these two clinical entities may coexist in patients with symptoms of chronic obstruction of the airways, creating a condition known as Asthma-COPD (ACOS) Overlap Syndrome. Although it has recently been described in international guidelines, this syndrome remains a diagnostic challenge in clinical practice, given the lack of valid diagnostic criteria to differentiate it from asthma and COPD. Because patients with this syndrome have been consistently excluded from the clinical trials on asthma and COPD with very specific exclusion criteria, the approach in the diagnosis of ACOS always depends on the phenotypic characteristics in which the patient is included. The objective of this article is to understand, based on the review of the existing literature, the key characteristics of ACOS, highlighting its definition and diagnosis, epidemiology, disease mechanisms, comorbidities, mortality, impacts on quality of life and on economics and potential treatment options. These characteristics are analyzed and compared with their monocomponents - asthma and COPD. It also focuses on new research aimed at the detection of objective and reproducible diagnostic criteria. Articles were searched in the electronic database PubMed and relevant bibliographical references. Although ACOS is not clearly defined in the literature, patients with this syndrome account for a significant percentage of patients with chronic obstructive pulmonary disease and have a higher number of exacerbations and hospitalizations than patients with asthma or COPD. It is necessary to create diagnostic criteria studied by evidence-based medicine to facilitate the early diagnosis of ACOS and to optimize therapeutic strategies.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017
Palavras-chave
Asma Doença pulmonar obstrutiva crónica (DPOC) Síndrome de sobreposição asma-DPOC ACOS Pneumologia