Background: Asthmaââ?¬â??COPD overlap syndrome (ACOS) prevalence varies depending on the studied population\nand definition criteria. The prevalence and clinical characteristics of ACOS in an at-risk COPD primary care population\nfrom Latin America was assessed.\nMethods: Patients ââ?°Â¥40 years, current/ex-smokers and/or exposed to biomass, attending routine primary care visits\ncompleted a questionnaire and performed spirometry. COPD was defined as post-bronchodilator forced expiratory\nvolume in 1 s/forced vital capacity (FEV1/FVC) < 0.70; asthma was defined as either prior asthma diagnosis or wheezing\nin the last 12 months plus reversibility (increase in post-bronchodilator FEV1 or FVC ââ?°Â¥200 mL and ââ?°Â¥12%); ACOS was\ndefined using a combination of COPD with the two asthma definitions. Exacerbations in the past year among the\nsubgroups were evaluated.\nResults: One thousand seven hundred forty three individuals completed the questionnaire, 1540 performed acceptable\nspirometry, 309 had COPD, 231 had prior asthma diagnosis, and 78 asthma by wheezing + reversibility. ACOS prevalence\nin the total population (by post-bronchodilator FEV1/FVC < 0.70 plus asthma diagnosis) was 5.3 and 2.3% by postbronchodilator\nFEV1/FVC < 0.70 plus wheezing + reversibility. In the obstructive population (asthma or COPD), prevalence\nrises to 17.9 and 9.9% by each definition, and to 26.5 and 11.3% in the COPD population. ACOS patients defined by postbronchodilator\nFEV1/FVC < 0.7 plus wheezing + reversibility had the lowest lung function measurements. Exacerbations for\nACOS showed a prevalence ratio of 2.68 and 2.20 (crude and adjusted, p < 0.05, respectively) (reference COPD).\nConclusions: ACOS prevalence in primary care varied according to definition used. ACOS by post-bronchodilator FEV1/\nFVC < 0.7 plus wheezing + reversibility represents a clinical phenotype with more frequent exacerbations, which is\nprobably associated with a different management approach.
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