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Background: Many studies have described asthma-COPD overlap (ACO) among patients diagnosed with asthma or chronic obstructive pulmonary disease (COPD), but less so in broad populations of patients with chronic airway obstruction. Objective: This study aimed to (i) examine the prevalence of ACO, asthma, and COPD phenotypes among subjects referred for pulmonary function testing (PFT), who had airway obstruction in spirometry (forced expiratory volume in 1 s [FEV1]/forced vital capacity [FVC] Methods: Cross-sectional study of patients who were referred for PFT at the Rokach Institute, in Jerusalem. Working definitions were as follows: (a) COPD: post-bronchodilator (BD) FEV1/FVC 1 or FVC of 12% and 200 mL; and (c) ACO: the combination of the 2. Demographics, smoking habits, episodes of exacerbation, health-related quality of life (HRQL), and respiratory medication utilization were analyzed. Results: Of 3,669 referrals from January 1 to April 30, 2017, 1,220 had airway obstruction of which 215 were included. Of these, 82 (38.1%) had ACO, 49 (22.8%) asthma, and 84 (39.1%) COPD. ACO subjects tended to (a) be predominantly female; (b) be older than asthmatics, (c) be smokers; (d) have worse HRQL in the activity domain; and (d) have more exacerbations. Treatment of ACO and COPD patients differed from that of asthmatics, but not from each other, in the proportion of subjects on maintenance treatment, use of LABA, LAMA, and ICS, alone or in combination, and in the number of inhaler devices used by patients. Conclusion: ACO represented >1/3 of patients referred for PFT. Despite a clearly identifiable phenotype, ACO patients received treatment similar to COPD patients, suggesting poor ACO identification. Our data emphasize the need to raise the awareness of ACO among clinicians, in order to guide better recognition and appropriate treatment in individual patients.

Density dependence variables (helium-to-air difference in forced expiratory flows at 50 and 25% vital capacity and volume of isoflow) were compared with spirographic performance (vital capacity, FEV 1.0) in 76 men aged 33-56 years. The group included nonsmokers, asymptomatic smokers, subjects with chronic expectoration, but normal ventilatory function and subjects with chronic expectoration and minimal obstructive ventilatory impairment. Low-level correlations were found (coefficients of less than 0.3) between delta He25% or volume of isoflow on one side and FEV1.0 or FEV1.0/VC. Some possibly confounding factors for these correlations are discussed. We conclude that density dependence variables are not consistently related to the FEV1.0 in subjects 'at risk' or with minimal airflow limitation.

Auscultatory percussion is a new method of physical examination developed by Guarino [Lancet i: 1332-1334, 1980]. It consists in tapping lightly the manubrium sterni with the distal phalanx of the middle finger while listening over the chest wall posteriorly with a stethoscope; a decrease in sound intensity is usually attributed to lung abnormalities. The aim of our study was to assess the validity of the method as compared to classical percussion, a point not entirely clear in the original study. Two observers independently examined 281 unselected patients (170 men; 111 women) referred for chest X-ray studies. Roentgenographic analysis, carried out by a third observer, revealed 12 categories of abnormalities in 96 patients. The validity of auscultatory and conventional percussion was calculated by taking the product of sensitivity and specificity of each method. For both observers and both methods, the values of this index were always found to be below 0.25, indicating that the results can be explained entirely by chance. When the roentgenographic category was taken into account, both methods of percussion were valid only to detect large pleural effusions. Auscultatory percussion failed completely to detect many other abnormalities including solitary nodules less than 6 cm in diameter. There is no single hypothesis to explain these results. Various possibilities are discussed.