In a study presented at the CHEST annual meeting, it was concluded that Omalizumab decreased asthma exacerbations and improved symptom control to a similar extent in patients with asthma chronic obstructive pulmonary disease (ACO) overlap as seen in patients with asthma but no COPD. The term “asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome” (ACOS) has been applied to the condition, in which a person has clinical features of both asthma and COPD.It is estimated that about 16% of patients with asthma or COPD have ACO.
Chronic obstructive pulmonary disease and asthma are the most frequent chronic respiratory diseases that affect the general population. For a long period of time, these two conditions were considered to be separate diseases. However, it became evident that some patients share symptoms and clinical findings from both diseases. These patients are considered to represent a distinct phenotype, called asthma-COPD overlap syndrome (ACOS). However, since approximately the one-third of the asthmatics smoke the ACOS may primarily define those patients.
In one of the largest observational cohorts to date of patients with ACO, it was found that at least some of the ACO patients in this study, showed preserved lung function after 48 weeks of omalizumab treatment.
Dr. Hanania et al.presented data from PROSPERO (Prospective Study to Evaluate Predictors of Clinical Effectiveness in Response to Omalizumab)which did not exclude patients with comorbid COPD. It was a 48-week multicenter, observational study of patients who were 12 years of age and older who were initiating omalizumab treatment for moderate to severe allergic asthma. Asthma control was assessed monthly using the Asthma Control Test (ACT).
The patients who Participated in the study were identified as having ACO based on two parameters: 1. A positive medical history of asthma and COPD, or 2. A medical history of asthma (but not COPD), at least a 10-pack per year smoking history, and a forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) of less than 0.7. Out of total 728 study participants included in this secondary analysis, 56 were classified as ACO according to the first definition (ACO cohort A) and 59 according to the second (ACO cohort B) and thirty-seven patients fell into both groups.
Additionally, all three groups showed clinically meaningful improvements in their ACT scores, with mean improvements of 4.1, 4.7, and 4.4 units for ACO cohort A, ACO cohort B, and non-ACO patients, respectively.
Postbronchodilator FEV1 at study end was improved by 36 mL in ACO cohort A and by 23 mL in the non-ACO cohort. But a 14 mL reduction in postbronchodilator FEV1 was noted in ACO cohort B, “a reminder that the cohort B population was those patients with fixed airway obstruction and smoking history,” said Dr. Hanania.
Mean age in the non-ACO population was 50 years, rising to 57.6 years in ACO cohort A and 55 years in ACO cohort B. All three groups had three or more asthma exacerbations in the 12 months before starting omalizumab, and all groups had mean ACT scores of less than 15 at baseline, indicating that they were all symptomatic.
Adverse events were consistent with the known safety profile of omalizumab.
“The significance of this study [is that] it’s one of the largest ACO cohorts that we know of and I think it encourages all of us to look at or re-visit both COPD therapies and asthma therapies in populations [not included] in clinical trials because, in real life, these are the patients we see … and we don’t have evidence,” Dr. Hanania said.
For more details click on the link: http://journal.chestnet.org/article/S0012-3692(17)32325-5/fulltext
Dr. Kamal Kant Kohli
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