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 mechanismsand treatment options. NOVELTY is a global, 3-year, prospective observational study of patients with asthma and/or COPD from real-world clinical practice. We investigatedheterogeneity 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 reporteddescriptively 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%) hadasthma+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 hadexperienced ≥1 exacerbation in the past 12 months. Medication records suggested both under-treatment and over-treatment relative to severity. Blood eosinophil counts varied littleacross diagnosis/severity groups, but blood neutrophil counts increased with severity acrossall 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
Number of pages78
JournalEuropean Respiratory Journal
Volume58
Issue number2
Early online date1 Jul 2021
DOIs
Publication statusE-pub ahead of print - 1 Jul 2021

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