Novel screening model may improve diagnosis of asthma–COPD overlap

The Chinese screening model for asthma-chronic obstructive pulmonary disease overlap (ACO) appears to be feasible, potentially offering a simple tool for clinicians to efficiently diagnose ACO, according to a recent study.

The authors developed a multicentre survey to examine the clinical criteria considered most important and applicable by pulmonologists for ACO screening. These experts were asked to complete the surveys twice. The model was established by using the expert grading method, analytic hierarchy process and receiver operating characteristic curve; a cross-sectional study of 1,066 patients validated this model.

The GINA/GOLD document was the gold standard in assessing the model.

The following criteria were considered significant for screening ACO: increased variability of symptoms, paroxysmal wheezing, dyspnoea, historical diagnosis of chronic obstructive pulmonary disease or asthma, allergic constitution, exposure to risk factors, the FEV₁/FVC <70 percent, and a positive bronchodilator test.

“According to the weight of each criterion, we confirmed that patients meeting six or more of these eight criteria should be considered to have ACO,” the authors said. “We called this Chinese screening model for ACO ‘CSMA’.”

The model identified patients with ACO with a sensitivity of 83.33 percent. On the other hand, a clinician-driven diagnosis had a sensitivity of only 42.73 percent.

“ACO is a syndrome with high prevalence,” the authors said. “However, a pragmatic diagnostic criterion to differentiate ACO is nonexistent.”