Christine Jenkins1,2, J Mark FitzGerald3, Fernando J Martinez4, Dirkje S Postma5, Stephen Rennard6,7, Thys van der Molen8, Asparuh Gardev9, Eduardo Genofre10, Peter Calverley11. 1. The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia. 2. Department of Thoracic Medicine, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia. 3. Institute for Heart and Lung Health, University of British Columbia, Vancouver, British Columbia, Canada. 4. Division of Pulmonary and Critical Care Medicine, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York. 5. Department of Pulmonary Medicine and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. 6. Pulmonary and Critical Care Medicine, University of Nebraska Medical Center, Omaha, Nebraska. 7. Early Clinical Development, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom. 8. Department of Primary Care, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands. 9. Global Medical Affairs, AstraZeneca, Cambridge, United Kingdom. 10. Global Medical Affairs, AstraZeneca, Gothenburg, Sweden. 11. Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom.
Abstract
INTRODUCTION: Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) is a heterogenous condition with clinical features shared by both asthma and COPD. OBJECTIVES: This online global survey of respiratory/allergy specialists and primary care practitioners (PCPs) was performed to understand current clinical approaches to the differential diagnosis and management of asthma, COPD and ACO. METHODS: Respondents were recruited through: (a) a global online physician respondent community (49,980 PCPs and 7205 specialists); (b) market research agents; (c) experts; (d) professional societies; (e) colleague invitation. Respondents were presented with a survey including hypothetical clinical scenarios of diagnostic uncertainty to identify management approaches. RESULTS: 891 responses (447 PCPs and 444 specialists) were collected across 13 countries. Reported features used for diagnosis of asthma and COPD were consistent with practice guidelines, but there was variability in those selected for ACO diagnosis. Features typically selected by specialists focused on spirometry/history, while PCPs focused on previous treatment/symptoms. Most respondents could correctly diagnose patients with features of ACO; however, features selected for theoretical diagnosis were often different to those selected in the case scenarios. Additionally, treatment selection was often inconsistent with guidelines, with over half of respondents not recommending inhaled corticosteroids in a patient with ACO and dominant features of asthma. CONCLUSION: While most PCPs and respiratory/allergy specialists can reach a working diagnosis of ACO, there remains uncertainty around which diagnostic features are most important and what constitutes optimal management. It is imperative that clinical studies including patients with ACO are initiated, allowing the generation of evidence-based management strategies.
INTRODUCTION:Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) is a heterogenous condition with clinical features shared by both asthma and COPD. OBJECTIVES: This online global survey of respiratory/allergy specialists and primary care practitioners (PCPs) was performed to understand current clinical approaches to the differential diagnosis and management of asthma, COPD and ACO. METHODS: Respondents were recruited through: (a) a global online physician respondent community (49,980 PCPs and 7205 specialists); (b) market research agents; (c) experts; (d) professional societies; (e) colleague invitation. Respondents were presented with a survey including hypothetical clinical scenarios of diagnostic uncertainty to identify management approaches. RESULTS: 891 responses (447 PCPs and 444 specialists) were collected across 13 countries. Reported features used for diagnosis of asthma and COPD were consistent with practice guidelines, but there was variability in those selected for ACO diagnosis. Features typically selected by specialists focused on spirometry/history, while PCPs focused on previous treatment/symptoms. Most respondents could correctly diagnose patients with features of ACO; however, features selected for theoretical diagnosis were often different to those selected in the case scenarios. Additionally, treatment selection was often inconsistent with guidelines, with over half of respondents not recommending inhaled corticosteroids in a patient with ACO and dominant features of asthma. CONCLUSION: While most PCPs and respiratory/allergy specialists can reach a working diagnosis of ACO, there remains uncertainty around which diagnostic features are most important and what constitutes optimal management. It is imperative that clinical studies including patients with ACO are initiated, allowing the generation of evidence-based management strategies.
Keywords:
allergists; clinical decision-making; general practitioners; lung diseases; obstructive; pulmonologists; quality of health care; surveys and questionnaires
Authors: Anna Jetske Baron; Bertine M J Flokstra-de Blok; Ellen van Heijst; Roland A Riemersma; Agnes M M Sonnenschein-van der Voort; Esther I Metting; Janwillem W H Kocks Journal: Int J Chron Obstruct Pulmon Dis Date: 2020-07-06
Authors: Mohit Bhutani; David B Price; Tonya A Winders; Heinrich Worth; Kevin Gruffydd-Jones; Ruth Tal-Singer; Jaime Correia-de-Sousa; Mark T Dransfield; Rudi Peché; Daiana Stolz; John R Hurst Journal: Adv Ther Date: 2022-04-28 Impact factor: 4.070