Comparison of Clinical Characteristics and Short-Term Prognoses Within Hospitalized Chronic Obstructive Pulmonary Disease Patients Comorbid With Asthma, Bronchiectasis, and Their Overlaps: Findings From the ACURE Registry.

Chen Wang,Chen Liang,Ting Yang,Jieping Lei,Sinan Wu,Ke Huang

doi:10.3389/fmed.2022.817048

Abstract

IntroductionReal-world evidence and comparison among commonly seen chronic obstructive pulmonary disease (COPD) phenotypes, i.e., asthma–COPD overlap (ACO), bronchiectasis–COPD overlap (BCO), and their coexistence (ABCO) have not been fully depicted, especially in Chinese patients.MethodsData were retrieved from an ongoing nationwide registry in hospitalized patients due to acute exacerbation of COPD in China (ACURE).ResultsOf the eligible 4,813 patients with COPD, 338 (7.02%), 492 (10.22%), and 63 (1.31%) were identified as ACO, BCO, and ABCO phenotypes, respectively. Relatively, the ABCO phenotype had a younger age with a median of 62.99 years [interquartile range (IQR): 55.93–69.48] and the COPD phenotype had an older age with a median of 70.15 years (IQR: 64.37–76.82). The BCO and COPD phenotypes were similar in body mass index with a median of 21.79 kg/m2 (IQR: 19.47–23.97) and 21.79 kg/m2 (IQR: 19.49–24.22), respectively. The COPD phenotype had more male gender (79.90%) and smokers (71.12%) with a longer history of smoking (median: 32.45 years, IQR: 0.00–43.91). The ACO and ABCO phenotypes suffered more prior allergic episodes with a proportion of 18.05 and 19.05%, respectively. The ACO phenotype exhibited a higher level of eosinophil and better lung reversibility. Moreover, the four phenotypes showed no significant difference neither in all-cause mortality, intensive care unit admission, length of hospital stay, and COPD Assessment Test score change during the index hospitalization, and nor in the day 30 outcomes, i.e., all-cause mortality, recurrence of exacerbation, all-cause, and exacerbation-related readmission.ConclusionsThe ACO, BCO, ABCO, and COPD phenotypes exhibited distinct clinical features but had no varied short-term prognoses. Further validation in a larger sample is warranted.

Highlights

Real-world evidence and comparison among commonly seen chronic obstructive pulmonary disease (COPD) phenotypes, i.e., asthma–COPD overlap (ACO), bronchiectasis–COPD overlap (BCO), and their coexistence (ABCO) have not been fully depicted, especially in Chinese patients
The ABCO phenotype had a younger age with a median of 62.99 years [interquartile range (IQR): 55.93–69.48] and the COPD phenotype had an older age with a median of 70.15 years (IQR: 64.37–76.82)
Of the overall 4,813 eligible patients with an exacerbation of the chronic pulmonary disease (AECOPD), 63 (1.31%) patients were comorbid both with asthma and bronchiectasis (ABCO), 338 (7.02%) and 492 (10.22%) patients were identified as ACO and BCO phenotypes, respectively, and 3,920 (81.45%) patients did not coexist with asthma or bronchiectasis (Figure 1)

Summary

Introduction

Real-world evidence and comparison among commonly seen chronic obstructive pulmonary disease (COPD) phenotypes, i.e., asthma–COPD overlap (ACO), bronchiectasis–COPD overlap (BCO), and their coexistence (ABCO) have not been fully depicted, especially in Chinese patients. Patients with chronic obstructive pulmonary disease (COPD), comorbid with asthma (asthma–COPD overlap, ACO) or bronchiectasis (bronchiectasis–COPD overlap, BCO) as well as their coexistence (ABCO), are commonly seen phenotypes, which have been broadly discussed whether they were distinct disease entities, but there is no concluded consensus yet [1]. Alshabanat A et al reported a pooled prevalence of ACO phenotype among patients with COPD was 27% and 28% in population- and hospital-based studies, respectively. For the BCO phenotype, Ni et al [22] reported a pooled prevalence of 54.3% (ranging from 25.6 to 69%) in patients with COPD

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