Solapamiento Asma-EPOC (ACO): un reto para el siglo XXI
Resumen
El solapamiento asma y EPOC (Asthma-COPD overlap, ACO), afecta a una proporción importante de pacientes con patología obstructiva de la vía aérea. El interés en el ACO está aumentando, a pesar de que persisten desafíos aún en su definición, diagnóstico y manejo terapéutico; principalmente debido a la ausencia de biomarcadores específicos que ayuden de manera inequívoca en su identificación. Igualmente, es difícil evaluar su prevalencia, debido a que los resultados de los distintos estudios varían en función de las definiciones y los métodos utilizados, pero se estima que afecta al 10-40 % de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) y al 15-35 % de los asmáticos. Suelen ser pacientes con mayor carga sintomática, más exacerbaciones y con un peor control de la enfermedad. Se recomienda un abordaje personalizado, con combinaciones terapéuticas adaptadas según el predominio de asma o EPOC y priorizando el uso de corticosteroides inhalados. Otro de los retos lo encontramos a la hora de evaluar su pronóstico; al contrario que en los estudios poblacionales, en los estudios de cohorte se sugiere una mortalidad menor en ACO respecto a pacientes con EPOC. Por lo tanto, es necesaria una detección precoz de este fenotipo para ofrecer un tratamiento dirigido que permita mejorar los resultados clínicos y avanzar en la investigación.
Abstract
Asthma-COPD overlap (ACO) affects a significant proportion of patients with obstructive airway diseases. Interest in ACO is increasing despite ongoing challenges in its definition, diagnosis, and therapeutic management, primarily due to the lack of specific biomarkers that can unequivocally aid in its identification. Estimating its prevalence is also challenging, as results vary across studies depending on the definitions and methods used. However, it is estimated to affect 10-40% of patients with chronic obstructive pulmonary disease (COPD) and 15-35% of those with asthma. These patients typically present with a higher symptom burden, more frequent exacerbations, and poorer disease control. A personalized approach is recommended, with therapeutic combinations tailored according to the predominant features of asthma or COPD, prioritizing the use of inhaled corticosteroids. Another challenge lies in evaluating prognosis; unlike findings in population-based studies, cohort studies suggest lower mortality in ACO compared to COPD patients. Therefore, early identification of this phenotype is essential to provide targeted treatment, improve clinical outcomes, and advance research efforts.
Resumen
El solapamiento asma y EPOC (Asthma-COPD overlap, ACO), afecta a una proporción importante de pacientes con patología obstructiva de la vía aérea. El interés en el ACO está aumentando, a pesar de que persisten desafíos aún en su definición, diagnóstico y manejo terapéutico; principalmente debido a la ausencia de biomarcadores específicos que ayuden de manera inequívoca en su identificación. Igualmente, es difícil evaluar su prevalencia, debido a que los resultados de los distintos estudios varían en función de las definiciones y los métodos utilizados, pero se estima que afecta al 10-40 % de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) y al 15-35 % de los asmáticos. Suelen ser pacientes con mayor carga sintomática, más exacerbaciones y con un peor control de la enfermedad. Se recomienda un abordaje personalizado, con combinaciones terapéuticas adaptadas según el predominio de asma o EPOC y priorizando el uso de corticosteroides inhalados. Otro de los retos lo encontramos a la hora de evaluar su pronóstico; al contrario que en los estudios poblacionales, en los estudios de cohorte se sugiere una mortalidad menor en ACO respecto a pacientes con EPOC. Por lo tanto, es necesaria una detección precoz de este fenotipo para ofrecer un tratamiento dirigido que permita mejorar los resultados clínicos y avanzar en la investigación.
Palabras clave:
EPOC, asma, ACO, tratamientoKeywords:
COPD, asthma, OCP, treatmentReferencias
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