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Allergy Asthma Immunol Res. 2018 May;10(3):225-235. doi: 10.4168/aair.2018.10.3.225.

Perceptions of Severe Asthma and Asthma-COPD Overlap Syndrome Among Specialists: A Questionnaire Survey.

Author information

1
Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
2
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
3
Department of Pulmonary, Allergy and Critical Care Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
4
Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
5
Department of Internal Medicine, CHA University School of Medicine, Seongnam, Korea.
6
Department of Internal Medicine, Hallym University College of Medicine, Anyang, Korea.
7
Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea.
8
Department of Internal Medicine, Inje University College of Medicine, Busan, Korea.
9
Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
10
Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea.
11
Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
12
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
13
Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.
14
Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. yscho@amc.seoul.kr.
15
Department of Internal Medicine, Konkuk University, School of Medicine, Seoul, Korea.
16
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
17
Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.
18
Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
19
Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea. hjyoon@hanyang.ac.kr.

Abstract

PURPOSE:

Severe asthma and asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) are difficult to control and are often associated with poor clinical outcomes. However, much is not understood regarding the diagnosis and treatment of severe asthma and ACOS. To evaluate the current perceptions of severe asthma and COPD among asthma and COPD specialists, we designed an e-mail and internet-based questionnaire survey.

METHODS:

Subjects were selected based on clinical specialty from among the members of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Academy of Tuberculosis and Respiratory Diseases. Of 432 subjects who received an e-mail invitation to the survey, 95 subjects, including 58 allergists and 37 pulmonologists, responded and submitted their answers online.

RESULTS:

The specialists estimated that the percentage of severe cases among total asthma patients in their practice was 13.9%±11.0%. Asthma aggravation by stepping down treatment was the most common subtype, followed by frequent exacerbation, uncontrolled asthma despite higher treatment steps, and serious exacerbation. ACOS was estimated to account for 20.7% of asthma, 38.0% of severe asthma, and 30.1% of COPD cases. A history of smoking, persistently low forced expiratory volume in 1 second (FEV1), and low FEV1 variation were most frequently classified as the major criteria for the diagnosis of ACOS among asthma patients. Among COPD patients, the highly selected major criteria for ACOS were high FEV1 variation, positive bronchodilator response, a personal history of allergies and positive airway hyperresponsiveness. Allergists and pulmonologists showed different assessments and opinions on asthma phenotyping, percentage, and diagnostic criteria for ACOS.

CONCLUSIONS:

Specialists had diverse perceptions and clinical practices regarding severe asthma and ACOS patients. This heterogeneity must be considered in future studies and strategy development for severe asthma and ACOS.

KEYWORDS:

Severe asthma; asthma-chronic obstructive pulmonary disease overlap syndrome; perception

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