الفهرس 
Definition & Pathogenesis
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Abstract
Patients with asthma-COPD overlap have more severe symptoms than those with either asthma or COPD alone, experiencing more frequent and more severe exacerbations and more frequent hospitalizations. This relatively recent interim disease has several phenotypes and consequently different prevalence ranged from 12% - 55% of patients of chronic obstructive airway diseases. Appropriate Asthma–COPD overlap diagnosis and management are needed to achieve control of such progressive disease.
The development of Asthma-COPD Overlap syndrome is mainly contributed to patient’s susceptibility (host factors) and exposure (environmental factors). Host factors such as hyperresponsiveness, family history of asthma, and low lung function are common risk factors for asthma and COPD. Environmental tobacco smoke and air pollution are environmental factors of increased interest.
Clinical pharmacists, as valuable partners in health care team, can play an important role in optimizing Asthma–COPD overlap management through providing adapted pharmacotherapy alongside comprehensive patient education on appropriate medication use and avoidance of airway obstruction triggers including environmental tobacco smoke and air pollutants. Such management approaches have proven to be effective for both asthma and COPD. However, effectiveness of such approaches in patients with Asthma–COPD overlap is yet to be shown in clinical trials. This study compares the effect of Asthma–COPD overlap patient care by clinical pharmacist intervention versus conventional care on disease control A 2-month ethically approved randomized, controlled trial was conducted in outpatient clinics of Ain Shams University Hospitals, Cairo, Egypt. Patients signed information consents then they were randomly assigned to receive conventional care (n=28) or a pre-defined pharmacist intervention (n=26). This intervention mainly focused on patient education, improving inhalation technique and medication assessment. Primary outcome was the level of disease control, as assessed by the COPD Assessment Test (CAT).
By the end of the study, the intervention patients who received a clinical pharmacist education and medication assessment significantly improved their CAT-scores than routine care group who did not receive clinical pharmacist intervention (p=0.0001). The intervention also reduced reliever medication use. Inhalation technique and adherence to medication were significantly better in the intervention group. patients in the intervention group experienced less exacerbations with decreased need for emergency department visits and/ hospitalization than conventional care patients despite similar doses of corticosteroids in both groups. This suggests that the improvement in symptom control seen in the intervention group can be attributed to beneficial patient education and not to changes in pharmacotherapy.