Miriam Barrecheguren1,2, Lancelot Pinto1, Seyed-Mohammad-Yousof Mostafavi-Pour-Manshadi1, Wan C Tan3, Pei Z Li1, Shawn D Aaron4, Andrea Benedetti1, Kenneth R Chapman5, Brandie Walker6, J Mark Fitzgerald3, Paul Hernandez7, François Maltais8, Darcy D Marciniuk9, Denis E O'Donnell10, Don D Sin3, Jean Bourbeau1. 1. Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada. 2. Pneumology Department, Vall d'Hebron University Hospital, Barcelona, Spain. 3. Providence Heart & Lung Institute, University of British Columbia, St Paul's Hospital, UBC James Hogg Research Centre, Vancouver, BC, Canada. 4. Ottawa University, Ottawa, ON, Canada. 5. University of Toronto, Toronto, ON, Canada. 6. University of Calgary, Calgary, AB, Canada. 7. Faculty of Medicine, Dalhousie University, Halifax, NS, Canada. 8. Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, QC, Québec, Canada. 9. Respiratory Research Center, University of Saskatchewan, Saskatoon, SK, Canada. 10. Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, ON, Canada.
Abstract
BACKGROUND AND OBJECTIVE: Lack of consensus on diagnosis of ACO limits our understanding of the impact, management and outcomes of ACO. The present observational study aims to describe the prevalence, clinical characteristics and course of individuals with ACO based on various definitions used in clinical practice. METHODS: We included individuals with COPD from the prospective, multisite CanCOLD study and defined subjects with ACO using seven definitions commonly used in the literature. RESULTS: Data including questionnaires, lung function and CT scans were analysed from 522 individuals with COPD who were randomly recruited from the population. Among them, 264 fulfilled at least one of the seven definitions of ACO. Prevalence of ACO varied from 3.8% to 31%. Regardless of the definition, individuals with ACO had worse outcomes (lung function and higher percentage of fast decliners, symptoms and exacerbations, health-related quality of life and comorbidities) than the remaining patients with COPD. Conversely, patients with non-ACO had higher emphysema and bronchiolitis scores. The three definitions that included atopy and/or physician diagnosis of asthma identified subjects who differed significantly from patients with COPD. The two ACO definitions with post-bronchodilator reversibility were concordant with COPD and were the least stable, with less than 50% of the patients from each group maintaining reversibility over visits. CONCLUSION: Atopy and physician-diagnosed asthma are more distinguishing characteristics to identify ACO. This finding needs to be validated using measures of airway inflammation and other specific biomarkers.
BACKGROUND AND OBJECTIVE: Lack of consensus on diagnosis of ACO limits our understanding of the impact, management and outcomes of ACO. The present observational study aims to describe the prevalence, clinical characteristics and course of individuals with ACO based on various definitions used in clinical practice. METHODS: We included individuals with COPD from the prospective, multisite CanCOLD study and defined subjects with ACO using seven definitions commonly used in the literature. RESULTS: Data including questionnaires, lung function and CT scans were analysed from 522 individuals with COPD who were randomly recruited from the population. Among them, 264 fulfilled at least one of the seven definitions of ACO. Prevalence of ACO varied from 3.8% to 31%. Regardless of the definition, individuals with ACO had worse outcomes (lung function and higher percentage of fast decliners, symptoms and exacerbations, health-related quality of life and comorbidities) than the remaining patients with COPD. Conversely, patients with non-ACO had higher emphysema and bronchiolitis scores. The three definitions that included atopy and/or physician diagnosis of asthma identified subjects who differed significantly from patients with COPD. The two ACO definitions with post-bronchodilator reversibility were concordant with COPD and were the least stable, with less than 50% of the patients from each group maintaining reversibility over visits. CONCLUSION: Atopy and physician-diagnosed asthma are more distinguishing characteristics to identify ACO. This finding needs to be validated using measures of airway inflammation and other specific biomarkers.
Authors: Barbara Bonnesen; Pradeesh Sivapalan; Anna Kjær Kristensen; Mats Christian Højbjerg Lassen; Kristoffer Grundtvig Skaarup; Ema Rastoder; Rikke Sørensen; Josefin Eklöf; Tor Biering-Sørensen; Jens-Ulrik Stæhr Jensen Journal: ERJ Open Res Date: 2022-09-26