Jerry A Krishnan1, Anjan Nibber2, Alison Chisholm3, David Price4,5, Eric D Bateman6, Leif Bjermer7, Job F M van Boven8, Guy Brusselle9, Richard W Costello10, Ronald J Dandurand11, Zuzana Diamant12, Eric Van Ganse13, Caroline Gouder14, Sanne C van Kampen3, Alan Kaplan15, Janwillem Kocks5,16, Marc Miravitlles17, Akio Niimi18, Emilio Pizzichini19, Chin Kook Rhee20, Joan B Soriano21, Claus Vogelmeier22, Miguel Román-Rodriguez23, Victoria Carter5,24, Anthony D D'Urzo25, Nicolas Roche26. 1. Department of Medicine, University of Illinois at Chicago, Chicago, Illinois. 2. Oxford University Medical School, Oxford, United Kingdom. 3. Respiratory Effectiveness Group, Cambridge, United Kingdom. 4. Centre of Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom. 5. Observational and Pragmatic Research Institute, Singapore. 6. Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa. 7. Section of Respiratory Medicine and Allergology, Department of Clinical Sciences, and. 8. Department of General Practice and Elderly Care Medicine, Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. 9. Department of Respiratory Medicine, Laboratory for Translational Research in Obstructive Pulmonary Diseases, Ghent University Hospital, Ghent, Belgium. 10. Department of Respiratory Medicine, Royal College of Surgeons, Dublin, Ireland. 11. CIUSSS de l'Ouest-de-l'Île-de-Montréal, Montreal Chest Institute, Meakins-Christie Laboratories, Oscillometry Unit and Centre for Innovative Medicine, McGill University Health Centre and Centre Research Institute, Montreal, Quebec, Canada. 12. Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, the Netherlands. 13. Respiratory Medicine, Croix-Rousse University Hospital, Lyon, France. 14. Department of Respiratory Medicine, Mater Dei Hospital, Msida, Malta. 15. Family Physician Airways Group of Canada, University of Toronto, Toronto, Ontario, Canada. 16. General Practitioners Research Institute, Groningen, the Netherlands. 17. Pneumology Department, University Hospital Vall d'Hebron/Vall d'Hebron Research Institute (VHIR), CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain. 18. Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University, Nagoya, Japan. 19. Universidade Federal de Santa Catarina, Florianópolis, Brazil. 20. Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. 21. Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain. 22. Department of Medicine, Pulmonary and Critical Medicine, German Center for Lung Research, University of Marburg, Marburg, Germany. 23. Primary Care Chronic Respiratory Diseases Research Unit, Instituto de Investigación Sanitaria de las Islas Baleres, IdISBa, Palma, Spain. 24. Optimum Patient Care, Cambridge, United Kingdom. 25. Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; and. 26. Pneumologie et Soins Intensifs Respiratoires, Groupe Hospitalier Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France.
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: To estimate the prevalence and describe characteristics of individuals with ACO in primary care practices among patients currently diagnosed with asthma, COPD, or both; and to compare the prevalence and characteristics of ACO among the three source populations. Methods: The Respiratory Effectiveness Group conducted a cross-sectional study of individuals ≥40 years old and with ≥2 outpatient primary care visits over a 2-year period in the UK Optimum Patient Care Research Database. Patients were classified into one of three source populations based on diagnostic codes: 1) COPD only, 2) both asthma and COPD, or 3) 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 airflow limitation (forced expiratory volume in 1 second/forced vital capacity <0.7), and 4) ≥12% and ≥200 ml reversibility in post-bronchodilator forced expiratory volume in 1 second. 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% confidence interval, 18-23%). Patients with ACO had a mean age of 70 years (standard deviation, 11 yr), 60% were men, 73% were former smokers (the 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 Respiratory Effectiveness Group ACO Working group criteria. The prevalence and characteristics of patients with ACO varies across the three source populations.
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: To estimate the prevalence and describe characteristics of individuals with ACO in primary care practices among patients currently diagnosed with asthma, COPD, or both; and to compare the prevalence and characteristics of ACO among the three source populations. Methods: The Respiratory Effectiveness Group conducted a cross-sectional study of individuals ≥40 years old and with ≥2 outpatient primary care visits over a 2-year period in the UK Optimum Patient Care Research Database. Patients were classified into one of three source populations based on diagnostic codes: 1) COPD only, 2) both asthma and COPD, or 3) 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 airflow limitation (forced expiratory volume in 1 second/forced vital capacity <0.7), and 4) ≥12% and ≥200 ml reversibility in post-bronchodilator forced expiratory volume in 1 second. 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% confidence interval, 18-23%). Patients with ACO had a mean age of 70 years (standard deviation, 11 yr), 60% were men, 73% were former smokers (the 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 Respiratory Effectiveness Group ACO Working group criteria. The prevalence and characteristics of patients with ACO varies across the three source populations.
Entities:
Keywords:
COPD; asthma; asthma–COPD overlap; comorbidities; primary care
Authors: Peng Zhang; Rocio Lopez; Amy H Attaway; Steve N Georas; Sumita B Khatri; Simon Abi-Saleh; Joe G Zein Journal: J Allergy Clin Immunol Pract Date: 2020-11-09
Authors: Lynn M Baniak; Paul W Scott; Eileen R Chasens; Christopher C Imes; Bomin Jeon; Xiaojun Shi; Patrick J Strollo; Faith S Luyster Journal: J Clin Sleep Med Date: 2022-06-01 Impact factor: 4.324
Authors: Nirupama Putcha; Ashraf Fawzy; Elizabeth C Matsui; Mark C Liu; Russ P Bowler; Prescott G Woodruff; Wanda K O'Neal; Alejandro P Comellas; MeiLan K Han; Mark T Dransfield; J Michael Wells; Njira Lugogo; Li Gao; C Conover Talbot; Eric A Hoffman; Christopher B Cooper; Laura M Paulin; Richard E Kanner; Gerard Criner; Victor E Ortega; R Graham Barr; Jerry A Krishnan; Fernando J Martinez; M Bradley Drummond; Robert A Wise; Gregory B Diette; Craig P Hersh; Nadia N Hansel Journal: Chest Date: 2020-05-23 Impact factor: 10.262
Authors: Gabriel Izbicki; Valerie Teo; Jenifer Liang; Grant M Russell; Anne E Holland; Nicholas A Zwar; Billie Bonevski; Ajay Mahal; Paula Eustace; Eldho Paul; Kirsten Phillips; Sally Wilson; Johnson George; Michael J Abramson Journal: Int J Chron Obstruct Pulmon Dis Date: 2019-12-03