Prevalence and Characteristics of Asthma-COPD 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 Rhee & 5 others Joan B. Soriano, Claus Vogelmeier, Miguel Román-Rodriguez, Victoria Carter, Nicolas Roche

Research output: Contribution to journalArticle

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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Chronic Obstructive Pulmonary Disease
Primary Health Care
Asthma
Bronchodilator Agents
Population
Eczema
Vital Capacity

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

Cite this

Prevalence and Characteristics of Asthma-COPD Overlap in Routine Primary Care Practices. / Krishnan, Jerry A.; Nibber, Anjan; Chisholm, Alison; Price, David; Bateman, Eric D.; Bjermer, Leif; van Boven, Job FM; Brusselle, Guy; Costello, Richard W.; Dandurand, Ronald J.; Diamant, Zuzana; Van Ganse, Eric; Gouder, Caroline; van Kampen, Sanne C.; Kaplan, Alan; Kocks, Janwillem; Miravitlles, Marc; Niimi, Akio; Pizzichini, Emilio; Rhee, Chin Kook; Soriano, Joan B.; Vogelmeier, Claus; Román-Rodriguez, Miguel; Carter, Victoria; Roche, Nicolas.

In: Annals of the American Thoracic Society, Vol. 16, No. 9, 09.2019, p. 1143-1150.

Research output: Contribution to journalArticle

Krishnan, JA, Nibber, A, Chisholm, A, Price, D, Bateman, ED, Bjermer, L, van Boven, JFM, Brusselle, G, Costello, RW, Dandurand, RJ, Diamant, Z, Van Ganse, E, Gouder, C, van Kampen, SC, Kaplan, A, Kocks, J, Miravitlles, M, Niimi, A, Pizzichini, E, Rhee, CK, Soriano, JB, Vogelmeier, C, Román-Rodriguez, M, Carter, V & Roche, N 2019, 'Prevalence and Characteristics of Asthma-COPD Overlap in Routine Primary Care Practices', Annals of the American Thoracic Society, vol. 16, no. 9, pp. 1143-1150. https://doi.org/10.1513/AnnalsATS.201809-607OC
Krishnan, Jerry A. ; Nibber, Anjan ; Chisholm, Alison ; Price, David ; Bateman, Eric D. ; Bjermer, Leif ; van Boven, Job FM ; Brusselle, Guy ; Costello, Richard W. ; Dandurand, Ronald J. ; Diamant, Zuzana ; Van Ganse, Eric ; Gouder, Caroline ; van Kampen, Sanne C. ; Kaplan, Alan ; Kocks, Janwillem ; Miravitlles, Marc ; Niimi, Akio ; Pizzichini, Emilio ; Rhee, Chin Kook ; Soriano, Joan B. ; Vogelmeier, Claus ; Román-Rodriguez, Miguel ; Carter, Victoria ; Roche, Nicolas. / Prevalence and Characteristics of Asthma-COPD Overlap in Routine Primary Care Practices. In: Annals of the American Thoracic Society. 2019 ; Vol. 16, No. 9. pp. 1143-1150.
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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.",
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author = "Krishnan, {Jerry A.} and Anjan Nibber and Alison Chisholm and David Price and Bateman, {Eric D.} and Leif Bjermer and {van Boven}, {Job FM} and Guy Brusselle and Costello, {Richard W.} and Dandurand, {Ronald J.} and Zuzana Diamant and {Van Ganse}, Eric and Caroline Gouder and {van Kampen}, {Sanne C.} and Alan Kaplan and Janwillem Kocks and Marc Miravitlles and Akio Niimi and Emilio Pizzichini and Rhee, {Chin Kook} and Soriano, {Joan B.} and Claus Vogelmeier and Miguel Rom{\'a}n-Rodriguez and Victoria Carter and Nicolas Roche",
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TY - JOUR

T1 - Prevalence and Characteristics of Asthma-COPD Overlap in Routine Primary Care Practices

AU - Krishnan, Jerry A.

AU - Nibber, Anjan

AU - Chisholm, Alison

AU - Price, David

AU - Bateman, Eric D.

AU - Bjermer, Leif

AU - van Boven, Job FM

AU - Brusselle, Guy

AU - Costello, Richard W.

AU - Dandurand, Ronald J.

AU - Diamant, Zuzana

AU - Van Ganse, Eric

AU - Gouder, Caroline

AU - van Kampen, Sanne C.

AU - Kaplan, Alan

AU - Kocks, Janwillem

AU - Miravitlles, Marc

AU - Niimi, Akio

AU - Pizzichini, Emilio

AU - Rhee, Chin Kook

AU - Soriano, Joan B.

AU - Vogelmeier, Claus

AU - Román-Rodriguez, Miguel

AU - Carter, Victoria

AU - Roche, Nicolas

PY - 2019/9

Y1 - 2019/9

N2 - 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.

AB - 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.

KW - Asthma

KW - COPD

KW - Comorbidities

KW - Asthma-COPD overlap

KW - Primary care

KW - DIAGNOSIS

KW - asthma-COPD overlap

KW - GUIDELINES

KW - asthma

KW - BRONCHODILATOR REVERSIBILITY

KW - comorbidities

KW - primary care

KW - PATIENT

KW - HEALTH

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