BACKGROUND: Asthma chornic obstructive pulmonary disorder(COPD) overlap syndrome (ACOS) was formally described by the joint project of global initiative for asthma (GINA) and global Initiative for chronic obstructive lung disease (GOLD) as persistent airflow limitation with several features usually associated with both asthma and COPD. ACOS is identified by the features shared with both asthma and COPD.The underlying cause though remains unknown,hence the project did not offer current formal definition.
CASE: This is a case of a 29-year-old male, asthmatic with an eight-pack year smoking history who presented with chronic obstructive respiratory symptoms with non significant improvement on control of exacerbation despite standard maximal  therapy.Diagnostic tests such as pulmonary function Tests,2D Echo,chest CT scan and even assay for alpha 1 anti trypsin were done to rule out for other disease entities and prognosticate the patient's condition leading to the diagnosis of asthma COPD overlap syndrome (ACOS).
CONCLUSION: ACOS as a disease entity is still under debate and still has no current formal definition due to lack of specific biomarkers and lack of defining characteristics.Despite this,management should not be compromised since these patients often present with higher rates of exacerbations,hospitalization,associated co morbid illness and mortality.Treatment therefore is individualized.

Human ; Male ; Adult ; Asthma ; Trypsin ; Smoking ; Diagnostic Tests, Routine ; Pulmonary Disease, Chronic Obstructive ; Respiratory Function Tests ; Biomarkers

Introduction: The Third International Consensus Definitions for Sepsis and Septic Shock in 2016 promoted the new definition and prognostication scheme among patients with sepsis using the Sequential Organ Failure Assessment (SOFA) scoring system. This study determined the discriminative power of the second-day SOFA scoring system in predicting 30-day hospital mortality among adult Filipino patients who presented with sepsis in a tertiary government hospital in the urban setting in the Philippines. Methods: We evaluated 107 adult with sepsis presenting at the emergency department from June 1, 2017 to August 31, 2017 in a 300 bed capacity tertiary hospital. Receiving operating characteristic curves were generated to determine optimal cut off scores of the SOFA scoring system in predicting 30-day mortality. Binary logistic regression was performed to determine the association of the SOFA derivatives with hospital mortality. STATA 15 was used for data analysis. Results: Second-day SOFA scores had excellent predictive ability for 30-day mortality at a cutoff point of 5, with sensitivity and specificity at 84.21% and 84.81%, respectively as compared with other SOFA derivatives at a given point in time. Conclusion The utility of second-day SOFA Score at a lower cut off score of five, has s a good discriminative power in predicting the all cause mortality among adult septic patients. This lower cut off score indicated a lower threshold trigger in identifying patients needing more intensive monitoring given the association of higher mortality risk in comparison with other studies done abroad.
Sepsis ; Mortality ; Philippines