Prevalence and characteristics of asthma-chronic obstructive pulmonary disease overlap in routine primary care practices

Jerry A. Krishnan, Anjan Nibber, Alison Chisholm, David Price, Eric D. Bateman, Leif Bjermer, Job FM van Boven, Guy Brusselle, Richard W. Costello, Ronald J. Dandurand, Zuzana Diamant, Eric Van Ganse, Caroline Gouder, Sanne C. van Kampen, Alan Kaplan, Janwillem Kocks, Marc Miravitlles, Akio Niimi, Emilio Pizzichini, Chin Kook RheeJoan B. Soriano, Claus Vogelmeier, Miguel Román-Rodriguez, Victoria Carter, Nicolas Roche

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Abstract

RATIONALE: Adults may exhibit characteristics of both asthma and chronic obstructive pulmonary disease (COPD), a situation recently described as asthma-COPD overlap (ACO). There is a paucity of information about ACO in primary care.

OBJECTIVES: 1) Estimate the prevalence and describe characteristics of individuals with ACO in primary care practices among patients currently diagnosed with asthma, COPD, or both; and 2) Compare the prevalence and characteristics of ACO between the three source populations.

METHODS: The Respiratory Effectiveness Group (REG) conducted a cross-sectional study of individuals ≥40 years old and with ≥2 outpatient primary care visits over a 2-year period in the United Kingdom's Optimum Patient Care Research Database (OPCRD). Patients were classified into one of three source populations based on diagnostic codes: (A) COPD only; (B) both asthma and COPD; or (C) asthma only. ACO was defined as the presence of all of the following: (1) age ≥40 years; (2) current or former smoking, (3) post-bronchodilator (BD) airflow limitation (forced expired volume in the first second [FEV1] / forced vital capacity [FVC] < 0.7), and (4) ≥12% and ≥200 mL reversibility in post-BD FEV1.

RESULTS: Among 2,165 individuals (1,015 COPD only, 395 with both asthma and COPD, and 755 asthma only), the overall prevalence of ACO was 20% (95% CI 18 to 23%). Patients with ACO had a mean age of 70 years (standard deviation 11 years), 60% were men, 73% were former smokers (rest were current smokers), and 66% were overweight or obese. Comorbid conditions were common in patients with ACO, including diabetes (53%), cardiovascular disease (36%), hypertension (30%), eczema (23%), and rhinitis (21%). The prevalence of ACO was higher in patients with a diagnosis of both asthma and COPD (32%) compared with a diagnosis of COPD only (20%, p<0.001) or asthma only (14%, p<0.001). Demographic and clinical characteristics of ACO varied across these three source populations.

CONCLUSIONS: One in five individuals with a diagnosis of COPD, asthma, or both asthma and COPD in primary care settings have ACO based on the REG ACO Working group criteria. The prevalence and characteristics of patients with ACO varies across the three source populations.

Original languageEnglish
Pages (from-to)1143-1150
Number of pages8
JournalAnnals of the American Thoracic Society
Volume16
Issue number9
Early online date4 Jun 2019
DOIs
Publication statusPublished - Sep 2019

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Keywords

  • Asthma
  • COPD
  • Comorbidities
  • Asthma-COPD overlap
  • Primary care
  • DIAGNOSIS
  • asthma-COPD overlap
  • GUIDELINES
  • asthma
  • BRONCHODILATOR REVERSIBILITY
  • comorbidities
  • primary care
  • PATIENT
  • HEALTH

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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