| Study | Major criteria | Minor criteria | Diagnosis |
| Gibson, 2009[1] | - Clinical symptoms of chronic airway disease, FEV1/FVC <70%
- FEV1 <80%
- Bronchial hyper-responsiveness defined as a PD15 <12 mL (provocative dose of hypertonic saline that induces a 15% fall in FEV1)
| | 3 major criteria |
| Soler-Cataluna, 2011[2] | COPD plus: - Positive bronchodilator test defined by increase in FEV1 ≥15% and ≥400 mL
- Sputum eosinophilia
- History of asthma
| COPD plus: - High total serum IgE
- Personal history of atopy
- Positive bronchodilator test, ie, increase in FEV1 ≥12% and ≥200 mL over baseline on ≥2 occasions
| 2 major criteria OR 1 major criteria AND 2 minor criteria |
| Koblizek, 2013[3] | COPD plus: - Positive bronchodilator test defined by increase in FEV1 >15% and >400 mL
- Methacholine challenge test positivity
- FENO ≥45 to 50 ppb and/or sputum eosinophils >3%
- History of asthma
| COPD plus: - Mildly positive bronchodilator test, ie, increase in FEV1 >12% and >200 mL
- Elevated IgE
- History of atopy
| 2 major criteria OR 1 major criteria AND 2 minor criteria |
| GINA/GOLD Criteria, 2015[4] | More likely COPD if: - Onset age >40 years
- Persistence of symptoms
- Daily symptoms with exertional dyspnea and good/bad days
- Chronic cough and sputum precede onset of dyspnea, unrelated to triggers
- Documented persistent airflow limitation (post-bronchodilator FEV1/FVC <70%)
- Lung function abnormal between symptoms
- Previous doctor diagnosis of COPD, chronic bronchitis or emphysema
- Heavy exposure to a risk factor (tobacco smoke, biomass fuel)
- Symptoms slowly worsening over time (progressive course over years)
- Rapid-acting bronchodilator treatment provides only limited relief
- Chest radiograph with features of severe hyperinflation
| More likely asthma if: - Onset age <20 years
- Variation in symptoms within short periods
- Worsening of symptoms at night/early morning
- Symptoms triggered by exercise, emotions/laughter, dust, or exposure to allergens
- Documented airflow limitation variability (peak flow, spirometry)
- Lung function normal between symptoms
- Prior doctor diagnosis of asthma
- Family history of asthma or atopy/eczema
- No worsening of symptoms over time (symptoms vary either seasonally or from year to year)
- May improve spontaneously or have an immediate response to bronchodilators or to inhaled steroids over weeks
- Chest radiograph normal
| If ≥3 items are present for either asthma or COPD, the patient is likely to have that disease A similar number of items for asthma and COPD is suggestive for ACO |
| Cosio, 2016[5] | COPD plus: - History of asthma
- Bronchodilator response to salbutamol >15% and 400 mL
| COPD plus: - IgE >100 IU
- History of atopy
- Two separated bronchodilator responses to salbutamol >12% and 200 mL
- Blood eosinophils >5%
| 1 major criteria OR 2 minor criteria |
| Sin, 2016[6] | COPD plus: - FEV1/FVC <0.7 or LLN in patients ≥40 years of age
- ≥10 pack years of tobacco smoking OR equivalent indoor or outdoor air pollution exposure
- Documented history of asthma before 40 years of age OR bronchodilator reversibility >400 mL in FEV1
| COPD plus: - Documented history of atopy or allergic rhinitis
- Bronchodilator reversibility of FEV1 ≥200 mL and 12% from baseline on ≥2 visits
- Peripheral blood eosinophil count of ≥300 cells/mL
| 3 major criteria AND 1 minor criteria |
| Cataldo, 2017[7] | ACO in a COPD patient: - High degree of variability in airway obstruction over time: FEV1 variation ≥400 mL
- High degree of response to bronchodilators: >200 mL and 12% above baseline
| ACO in a COPD patient: - Personal or family history of atopy and/or IgE sensitivity to one or more airborne allergens
- Elevated blood or sputum eosinophils or increased FENO
- Asthma diagnosed before the age of 40
- Symptom variability
- Age (in favor of asthma)
| 2 major criteria AND 1 minor criteria |
ACO in an asthma patient: - Persistence over time of airflow obstruction (FEV1/FVC <0.7 or <LLN)
- Exposure to noxious particles or gases, with ≥10 pack years for smokers
| ACO in an asthma patient: - Lack of response on acute bronchodilator tests
- Reduced lung diffusion capacity
- Little variability in airway obstruction
- Age in favor of COPD (>40 years)
- Presence of emphysema on chest CT scan
|
| Miravittles, 2017[8] | - Age >35 years
- Postbronchodilator FEV1/FVC <70%
- ≥10 pack years tobacco smoke
| - Current diagnosis of asthma
- No current diagnosis of asthma but a bronchodilator response to albuterol ≥15% and 400 mL and/or blood eosinophils ≥300 cells/microL
| 3 major criteria AND 1 minor criteria |
