Helen K Reddel1, Jørgen Vestbo2, Alvar Agustí3, Gary P Anderson4, Aruna T Bansal5, Richard Beasley6, Elisabeth H Bel7, Christer Janson8, Barry Make9, Ian D Pavord10, David Price11, Eleni Rapsomaniki12, Niklas Karlsson13, Donna K Finch14, Javier Nuevo15, Alex de Giorgio-Miller16, Marianna Alacqua17, Rod Hughes18, Hana Müllerová17, Maria Gerhardsson de Verdier19. 1. Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia. 2. University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK. 3. Respiratory Institute, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERES, Barcelona, Spain. 4. Dept of Pharmacology and Therapeutics, Lung Health Research Centre, University of Melbourne, Victoria, Australia. 5. Acclarogen, Cambridge, UK. 6. Medical Research Institute of New Zealand, Wellington, New Zealand. 7. Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands. 8. Dept of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden. 9. National Jewish Health and University of Colorado Denver, Denver, CO, USA. 10. Respiratory Medicine Unit and Oxford Respiratory NIHR BRC, Nuffield Dept of Medicine, University of Oxford, Oxford, UK. 11. Division of Applied Health Sciences, Observational and Pragmatic Research Institute, Singapore and Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK. 12. Data Scientist, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK. 13. Patient Centered Science, BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden. 14. Formerly of Early Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK. 15. Medical Department, Evidence Generation Manager, BioPharmaceuticals Medical, AstraZeneca, Madrid, Spain. 16. Medical & Scientific Affairs, BioPharmaceuticals Medical, AstraZeneca, Luton, UK. 17. Respiratory & Immunology, Medical and Payer Evidence Strategy, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK. 18. External Scientific Engagement, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK. 19. Respiratory Medical Evidence Strategy, BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden.
Abstract
BACKGROUND: Studies of asthma and chronic obstructive pulmonary disease (COPD) typically focus on these diagnoses separately, limiting understanding of disease mechanisms and treatment options. NOVELTY is a global, 3-year, prospective observational study of patients with asthma and/or COPD from real-world clinical practice. We investigated heterogeneity and overlap by diagnosis and severity in this cohort. METHODS: Patients with physician-assigned asthma, COPD or both (asthma+COPD) were enrolled, stratified by diagnosis and severity. Baseline characteristics were reported descriptively by physician-assigned diagnosis and/or severity. Factors associated with physician-assessed severity were evaluated using ordinal logistic regression analysis. RESULTS: Of 11 243 patients, 5940 (52.8%) had physician-assigned asthma, 1396 (12.4%) had asthma+COPD and 3907 (34.8%) had COPD; almost half were from primary care. Symptoms, health-related quality of life and spirometry showed substantial heterogeneity and overlap between asthma, asthma+COPD and COPD, with 23%, 62% and 64% of patients, respectively, having post-bronchodilator FEV1/FVC <lower limit of normal.Symptoms and exacerbations increased with greater physician-assessed severity, and were higher in asthma+COPD, but 24.3% with mild asthma and 20.4% with mild COPD had experienced ≥1 exacerbation in the past 12 months. Medication records suggested both under-treatment and over-treatment relative to severity. Blood eosinophil counts varied little across diagnosis/severity groups, but blood neutrophil counts increased with severity across all diagnoses. CONCLUSION: This analysis demonstrates marked heterogeneity within, and overlap between, physician-assigned diagnosis and severity groups in patients with asthma and/or COPD. Current diagnostic and severity classifications in clinical practice poorly differentiate between clinical phenotypes that may have specific risks and treatment implications.
BACKGROUND: Studies of asthma and chronic obstructive pulmonary disease (COPD) typically focus on these diagnoses separately, limiting understanding of disease mechanisms and treatment options. NOVELTY is a global, 3-year, prospective observational study of patients with asthma and/or COPD from real-world clinical practice. We investigated heterogeneity and overlap by diagnosis and severity in this cohort. METHODS:Patients with physician-assigned asthma, COPD or both (asthma+COPD) were enrolled, stratified by diagnosis and severity. Baseline characteristics were reported descriptively by physician-assigned diagnosis and/or severity. Factors associated with physician-assessed severity were evaluated using ordinal logistic regression analysis. RESULTS: Of 11 243 patients, 5940 (52.8%) had physician-assigned asthma, 1396 (12.4%) had asthma+COPD and 3907 (34.8%) had COPD; almost half were from primary care. Symptoms, health-related quality of life and spirometry showed substantial heterogeneity and overlap between asthma, asthma+COPD and COPD, with 23%, 62% and 64% of patients, respectively, having post-bronchodilator FEV1/FVC <lower limit of normal.Symptoms and exacerbations increased with greater physician-assessed severity, and were higher in asthma+COPD, but 24.3% with mild asthma and 20.4% with mild COPD had experienced ≥1 exacerbation in the past 12 months. Medication records suggested both under-treatment and over-treatment relative to severity. Blood eosinophil counts varied little across diagnosis/severity groups, but blood neutrophil counts increased with severity across all diagnoses. CONCLUSION: This analysis demonstrates marked heterogeneity within, and overlap between, physician-assigned diagnosis and severity groups in patients with asthma and/or COPD. Current diagnostic and severity classifications in clinical practice poorly differentiate between clinical phenotypes that may have specific risks and treatment implications.
Authors: Ridhwan Y Baba; Yian Zhang; Yongzhao Shao; Kenneth I Berger; Roberta M Goldring; Mengling Liu; Angeliki Kazeros; Rebecca Rosen; Joan Reibman Journal: Int J Environ Res Public Health Date: 2022-04-02 Impact factor: 3.390
Authors: Christina Bal; Marco Idzko; Sabina Škrgat; Andrea Koch; Katrin Milger; Christian Schulz; Sonja Zehetmayer; Eckard Hamelmann; Roland Buhl; Stephanie Korn Journal: Eur Respir J Date: 2022-06-02 Impact factor: 33.795