Heterogeneity within and between physician-diagnosed asthma and/or COPD: NOVELTY cohort

Helen K. Reddel* (Corresponding Author), Jørgen Vestbo, Alvar Agusti, Gary P Anderson, Aruna T Bansal, Richard Beasley, Elisabeth H Bel, Christer Janson, Barry Make, Ian D. Pavord, David Price, Eleni Rapsomaniki, Niklas Karlsson, Donna K Finch, Javier Nuevo, Alex de Giorgio-Miller, Marianna Alacqua, Rod Hughes, Hana Müllerová, Maria Gerhardsson de VerdierNOVELTY study investigators

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Studies of asthma and chronic obstructive pulmonary disease (COPD) typically focus on these diagnoses separately, limiting understanding of disease mechanisms and treatment options. NOVELTY is a global, 3-year, prospective observational study of patients with asthma and/or COPD from real-world clinical practice. We investigated heterogeneity and overlap by diagnosis and severity in this cohort. Methods: Patients with physician-assigned asthma, COPD or both (asthma+COPD) were enrolled, stratified by diagnosis and severity. Baseline characteristics were reported descriptively by physician-assigned diagnosis and/or severity. Factors associated with physician-assessed severity were evaluated using ordinal logistic regression analysis. Results: Of 11243 patients, 5940 (52.8%) had physician-assigned asthma, 1396 (12.4%) had asthma+COPD and 3907 (34.8%) had COPD; almost half were from primary care. Symptoms, health-related quality of life and spirometry showed substantial heterogeneity and overlap between asthma, asthma+COPD and COPD, with 23%, 62% and 64% of patients, respectively, having post-bronchodilator FEV1/FVC <lower limit of normal. Symptoms and exacerbations increased with greater physician-assessed severity, and were higher in asthma+COPD, but 24.3% with mild asthma and 20.4% with mild COPD had experienced ≥1 exacerbation in the past 12 months. Medication records suggested both under-treatment and over-treatment relative to severity. Blood eosinophil counts varied little across diagnosis/severity groups, but blood neutrophil counts increased with severity across all diagnoses. Conclusion: This analysis demonstrates marked heterogeneity within, and overlap between, physician-assigned diagnosis and severity groups in patients with asthma and/or COPD. Current diagnostic and severity classifications in clinical practice poorly differentiate between clinical phenotypes that may have specific risks and treatment implications
Original languageEnglish
JournalEuropean Respiratory Journal
DOIs
Publication statusPublished - 25 Feb 2021

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