Prevalence Of asthma-COPD Overlap Research Articles

Undiagnosed Asthma-COPD overlap among patients diagnosed as Asthma and COPD in a referral hospital, India

Patients who have features of both Asthma & COPD are now known as Asthma COPD overlap (ACO). Prevalence of ACO based on the Global Initiative for Asthma (GINA) and Global initiative for obstructive lung disease (GOLD) Syndromic Approach is scarce. In this cross-sectional observational study, we recruited physician-diagnosed–pAsthma, pCOPD & pACO by simple random sampling. Clinical features, spirometry, 6-min walk test, Serum Immunoglobulin E, % blood eosinophils and chest x-rays were reviewed. Syndromic approach was applied, and the diagnosis was reclassified accordingly.In all, 877 patients were included (Male = 445, Female = 432). Physician diagnosis for these were: pAsthma–713, pCOPD–157 and pACO–7. They were reclassified using the Syndromic approach as: sAsthma, sCOPD and sACO. The 713 pAsthmatics were reclassified as follows: sAsthma–684 (95.94%), sCOPD–12 (1.68%) and sACO–17 (2.38%). Of the 157 pCOPD patients, 91 (57.96%) were reclassified as sCOPD, 23 (14.6%) as sACO, and 17 (927.38%) as sAsthma. Of the 7 previously diagnosed pACO patients, only 1 (14.28%) was reclassified as sACO, 5 (71.42%) as sAsthma and 1 (14.28%) as sCOPD. sCOPD patients had more exacerbations (52.88% vs 46.34%, p = 0.479), critical care admissions (16.35% vs 7.32%, p = 0.157) and intubations (17.31% vs 9.76%, p = 0.255) compared to sACO patients, the latter had more events than sAsthma patients: exacerbations 46.34% vs 10.11% (p < 0.001), critical care admissions 7.32% vs 1.64% (p = 0.010) and intubations 9.76% vs 1.5% (p < 0.001).The syndromic approach helped us to identify ACO and also more appropriately classified COPD & Asthma. There was a significant difference between physician diagnosis and diagnosis using Syndromic Approach. It revealed considerable misclassification of several Asthmatic and ACO subjects, who could have been denied inhaled corticosteroids, as they were wrongly categorised as COPD by physician diagnosis.

Clinical Implications of Bronchodilator Testing: Diagnosing and Differentiating COPD and Asthma-COPD Overlap.

Bronchodilation testing is an important component of spirometry testing, and omitting this procedure has potential clinical implications toward diagnosing respiratory diseases. We aimed to estimate the impact of bronchodilator testing in accurately diagnosing COPD and differentiating COPD from asthma-COPD overlap (ACO). The National Health and Nutrition Examination Survey data were analyzed from 2007-2012. Airflow limitation was defined by FEV1/FVC < 0.7. Subjects with pre-bronchodilator airflow limitation were classified into pre-but-not-post-bronchodilator airflow limitation and post-bronchodilator airflow limitation groups. Spirometry-confirmed COPD was defined by persistent airflow limitation on post-bronchodilator spirometry. The American Thoracic Society (ATS) and the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) definitions were used to identify possible ACO subjects. We identified 11,763 subjects ≥ 40 y of age eligible for spirometry; 625 of them had a pre-bronchodilator FEV1/FVC < 0.7 and completed post-bronchodilator spirometry that met ATS spirometry quality standards. A total of 244 (39%) of these subjects had only pre-not-post-bronchodilator airflow limitation, thereby not meeting the definition of spirometrically confirmed COPD. The prevalence of ACO was 7.6% using the modified ATS definition and 19.8% using the modified SEPAR criteria. When bronchodilator testing-based criteria were excluded from ATS and SEPAR definitions, the number of ACO subjects decreased by 39.3% and 12.3%, respectively. Spirometry with bronchodilation is an important element in the accurate diagnosis of ACO and COPD. Spirometry performed without bronchodilator testing may lead to an estimated misclassification of ACO by 7.6% to 19.8% and overdiagnosis of COPD by 39%.

Phenotype of Asthma-COPD Overlap in COPD and Severe Asthma Cohorts.

BackgroundAsthma and chronic obstructive pulmonary disease (COPD) are airway diseases with similar clinical manifestations, despite differences in pathophysiology. Asthma-COPD overlap (ACO) is a condition characterized by overlapping clinical features of both diseases. There have been few reports regarding the prevalence of ACO in COPD and severe asthma cohorts. ACO is heterogeneous; patients can be classified on the basis of phenotype differences. This study was performed to analyze the prevalence of ACO in COPD and severe asthma cohorts. In addition, this study compared baseline characteristics among ACO patients according to phenotype.MethodsPatients with COPD were prospectively enrolled into the Korean COPD subgroup study (KOCOSS) cohort. Patients with severe asthma were prospectively enrolled into the Korean Severe Asthma Registry (KoSAR). ACO was defined in accordance with the updated Spanish criteria. In the COPD cohort, ACO was defined as bronchodilator response (BDR) ≥ 15% and ≥ 400 mL from baseline or blood eosinophil count (BEC) ≥ 300 cells/μL. In the severe asthma cohort, ACO was defined as age ≥ 35 years, smoking ≥ 10 pack-years, and post-bronchodilator forced expiratory volume in 1 s/forced vital capacity < 0.7. Patients with ACO were divided into four groups according to smoking history (threshold: 20 pack-years) and BEC (threshold: 300 cells/μL).ResultsThe prevalence of ACO significantly differed between the COPD and severe asthma cohorts (19.8% [365/1,839] vs. 12.5% [104/832], respectively; P < 0.001). The percentage of patients in each group was as follows: group A (light smoker with high BEC) – 9.1%; group B (light smoker with low BEC) – 3.7%; group C (moderate to heavy smoker with high BEC) – 73.8%; and group D (moderate to heavy smoker with low BEC) – 13.4%. Moderate to heavy smoker with high BEC group was oldest, and showed weak BDR response. Age, sex, BDR, comorbidities, and medications significantly differed among the four groups.ConclusionThe prevalence of ACO differed between COPD and severe asthma cohorts. ACO patients can be classified into four phenotype groups, such that each phenotype exhibits distinct characteristics.

Prevalence of asthma COPD overlap (ACO) in COPD patients

Background: Asthma and COPD are the most common chronic respiratory diseases, affecting over 500 million people globally and resulting in enormous morbidity and rising health-care costs. These disorders are often encountered in clinical practise and frequently coexist.Objectives: To study the occurrence of Asthma COPD overlap in COPD patients.Methods: Significant reversibility was seen in 18% of the cases, No reversibility was seen in 32% of the cases and no significant reversibility was seen in 50% of the cases. Around 50 patients with COPD with included. A detailed clinical history was obtained which included demographic, Past history and Symptomology. The PFT, Chest X-ray and Absolute eosinophil count was obtained.Results: Significant reversibility was seen in 18% of the cases, No reversibility was seen in 32% of the cases and no significant reversibility was seen in 50% of the cases. Exacerbator with emphysema was seen in 30% of the cases, exacerbator with chronic bronchitis and Asthma with COPD overlap was seen in 24% of the cases.Conclusion: When compared to asthma and COPD alone, ACO has a rapid deterioration in lung function, more frequent exacerbations, increased health-care resource usage, a deteriorating quality of life, and a higher mortality rate. By changing the line of care and diagnosing ACO early on, one can avoid exacerbation and morbidity.

Prevalence and demographical variation of asthma COPD overlap (ACO) in previously diagnosed chronic obstructive pulmonary disease patients of Southern Rajasthan: A cross sectional study

Background: Asthma COPD overlap (ACO) is widely gaining recognition as separate phenotype of chronic obstructive airway disease with distinct treatment and prognosis. It is an important challenge of accurately diagnosing ACO. Aim: To estimate the prevalence of ACO among patients previously diagnosed as COPD and compare their demographical profile. Methodology: This was observational study of 351 patients with COPD visited at our center between 2018-2019. A detailed chart review including demographic, clinical, laboratory investigations, spirometry, and radiological findings were recorded in pre-structured proforma. The diagnosis of ACO was based on GINA/GOLD criteria 2019. Results: Of the total (n=351), ACO was diagnosed in 109 (31.05%) patients. Female predominance 61 (55.96%) patients were observed. There was a significantly higher incidence of wheeze, nasal symptoms, family history of atopy, as compared to obstructive airway disease. There was no significant difference in radiological findings between two groups. Conclusion: ACO represents a large proportion (31.05%) of bronchial asthma patients with female predominance, higher comorbidities. GINA/GOLD criteria 2019 are important questionnaire to differentiate ACO from COPD with limited role of chest imaging. The study results have implications for earlier identification and appropriate treatment of this distinct clinical phenotype.

Clinical, functional and laboratory characteristics of patients with asthma-COPD overlap

Objective: to access some clinical, functional and laboratory features of patients with asthma-COPD overlap (ACO).Material and methods. Our study involved 120 patients and two ACO groups were created: asthmatic smokers - Group I and COPD patients with high degree of reversibility of airflow limitation and eosinophilic COPD (eosinophil blood count ≥2% and 200 cell/ml) - Group II. All the other COPD subjects – Group III. The spirometry testing were performed using computer spirograph «BTL-08SpiroPro» (Great Britain). Weight and body composition variables were measured with a body composition monitor (BC-601 Tanita, Japan). Blood eosinophils and total IgE levels were estimated. «Microsoft Excel», «Statistica» were used for mathematical and statistical analysis.Results. There were 28,3% of participants classified as ACO. The combination of long-acting beta-agonist and inhaled corticosteroids usage rate was higher among asthmatic smokers (2,3 and 1,8 times higher than in Group II and Group III respectively), as well as short acting beta-agonist and oral corticosteroid usage rates (1,7 and 2,3 times higher in Group I compared to Group II). The peripheral blood eosinophil and serum IgE levels were 1,8 and 3,3 times higher (p&lt;0,05) in Group II than in Group I and III. FEVI was higher in Group I by 7,6% and in Group II by 11,8% than in COPD. It has been demonstrated that among Group II subjects there was higher BMI( by 28,8% and 22,2% (p&lt;0,05)), the body fat percentage ( by 19,7% and 41,3% (р&lt;0,05)), the visceral fat level (by 16,7% and 20,3%(р&lt;0,05)) and the muscle mass(by 10,8% and 15,5%(р&lt;0,05)) than in asthmatic smokers and COPD patients respectively.Conclusion. The prevalence of ACO (asthmatic smokers, eosinophilic COPD and COPD with high degree of reversibility) among the examined subjects was 28,3%. COPD patients with high degree of reversibility and eosinophilic inflammation are characterized by higher blood eosinophil and total serum IgE levels, higher FEV1, amount of visceral fat, body fat percentage and especially muscle muss.

Clinical characteristics and risk of exacerbations associated with different diagnostic criteria of asthma-COPD overlap

IntroductionThere is currently no universally accepted definition of asthma−COPD overlap (ACO). ObjectiveTo compare the prevalence of ACO in patients with asthma or COPD, and to assess their clinical characteristics and the capacity of the different definitions to predict the risk of exacerbation. MethodProspective observational study with a 12-month follow-up in an asthma cohort and a COPD cohort. Four diagnostic criteria were compared: A) the Spanish 2012 consensus; B) the 2016 international consensus; C) the 2017 consensus between the Spanish COPD guidelines (GesEPOC) and GEMA asthma guidelines; and D) the single criterion of ≥300 eosinophils/μL, proposed by GOLD 2019. The risk of exacerbations was evaluated in each group. ResultsA total of 345 patients were included, 233 (67.5%) with COPD and 112 (32.5%) with asthma, aged 63 ± 14 years, 70.4% men. Fifteen (4.3%) patients met the criteria for ACO according to the criteria described under A above; 30 (8.7%) with the criteria of B; 118 (34.2%) with the criteria of C; and 97 (28.1%), with the D criterion. The ACO-COPD subtype were older, had worse lung function, and an increased risk of exacerbation compared with the ACO-asthma group. Of all the definitions evaluated, those which distinguished a higher risk of exacerbations were the GesEPOC-GEMA consensus and the GOLD proposal. ConclusionsThe prevalence of ACO varies enormously depending on the diagnostic criteria used. The ACO population is heterogeneous, and the ACO-COPD subtype is very different from the ACO-asthma subtype. The definitions that include eosinophilia identify ACO patients with a greater risk of exacerbation.

Características clínicas y riesgo de agudizaciones asociados con diferentes criterios diagnósticos del solapamiento asma-EPOC

IntroductionThere is currently no universally accepted definition of asthma-COPD overlap (ACO). ObjectiveTo compare the prevalence of ACO in patients with asthma or COPD, and to assess their clinical characteristics and the capacity of the different definitions to predict the risk of exacerbation. MethodProspective observational study with a 12-month follow-up in an asthma cohort and a COPD cohort. Four diagnostic criteria were compared: A) the Spanish 2012 consensus; B) the 2016 international consensus; C) the 2017 consensus between the Spanish COPD guidelines (GesEPOC) and GEMA asthma guidelines; and D) the single criterion of ≥300eosinophils/μL, proposed by GOLD 2019. The risk of exacerbations was evaluated in each group. ResultsA total of 345 patients were included, 233 (67.5%) with COPD and 112 (32.5%) with asthma, aged 63±14 years, 70.4% men. Fifteen (4.3%) patients met the criteria for ACO according to the criteria described under A above; 30 (8.7%) with the criteria of B; 118 (34.2%) with the criteria of C; and 97 (28.1%), with the D criterion. The ACO-COPD subtype were older, had worse lung function, and an increased risk of exacerbation compared with the ACO-asthma group. Of all the definitions evaluated, those which distinguished a higher risk of exacerbations were the GesEPOC-GEMA consensus and the GOLD proposal. ConclusionsThe prevalence of ACO varies enormously depending on the diagnostic criteria used. The ACO population is heterogeneous, and the ACO-COPD subtype is very different from the ACO-asthma subtype. The definitions that include eosinophilia identify ACO patients with a greater risk of exacerbation.

Identification of Asthma-COPD Overlap, Asthma, and Chronic Obstructive Pulmonary Disease Phenotypes in Patients with Airway Obstruction: Influence on Treatment Approach

Background: Many studies have described asthma-COPD overlap (ACO) among patients diagnosed with asthma or chronic obstructive pulmonary disease (COPD), but less so in broad populations of patients with chronic airway obstruction. Objective: This study aimed to (i) examine the prevalence of ACO, asthma, and COPD phenotypes among subjects referred for pulmonary function testing (PFT), who had airway obstruction in spirometry (forced expiratory volume in 1 s [FEV₁]/forced vital capacity [FVC] <0.7); and (ii) delineate the therapeutic approach of each group. Methods: Cross-sectional study of patients who were referred for PFT at the Rokach Institute, in Jerusalem. Working definitions were as follows: (a) COPD: post-bronchodilator (BD) FEV₁/FVC <0.70; (b) asthma: physician-diagnosed asthma before age 40 and/or minimum post-BD increase in FEV₁ or FVC of 12% and 200 mL; and (c) ACO: the combination of the 2. Demographics, smoking habits, episodes of exacerbation, health-related quality of life (HRQL), and respiratory medication utilization were analyzed. Results: Of 3,669 referrals from January 1 to April 30, 2017, 1,220 had airway obstruction of which 215 were included. Of these, 82 (38.1%) had ACO, 49 (22.8%) asthma, and 84 (39.1%) COPD. ACO subjects tended to (a) be predominantly female; (b) be older than asthmatics, (c) be smokers; (d) have worse HRQL in the activity domain; and (d) have more exacerbations. Treatment of ACO and COPD patients differed from that of asthmatics, but not from each other, in the proportion of subjects on maintenance treatment, use of LABA, LAMA, and ICS, alone or in combination, and in the number of inhaler devices used by patients. Conclusion: ACO represented >1/3 of patients referred for PFT. Despite a clearly identifiable phenotype, ACO patients received treatment similar to COPD patients, suggesting poor ACO identification. Our data emphasize the need to raise the awareness of ACO among clinicians, in order to guide better recognition and appropriate treatment in individual patients.

The Prevalence of Asthma-COPD Overlap (ACO) Among Patients with Asthma.

Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) is defined as a persistent airflow limitation with features of both asthma and COPD. However, in Turkey, there are limited data about ACO. The aims of the present study were to determine the prevalence of ACO among patients with asthma, to compare the clinical characteristics of patients with ACO and asthma, and to determine the threshold values for the diagnosis of ACO. The study group comprised 338 patients admitted to the outpatient clinics between 2010 and 2017 and who had undergone at least three pulmonary function tests within the last 2 years. Patients aged >40 years with a smoking history of >10 pack-years or biomass exposure, with at least three features of both diseases, and with reversible and persistent airflow limitation were diagnosed with ACO. The study is a retrospective study so we did not get informed concent. Asthma-chronic obstructive pulmonary disease overlap was diagnosed in 40 (11.8%) patients. Patients with ACO had fewer allergic comorbidities, worse spirometric parameters, and required higher doses of inhaled corticosteroids than patients with asthma only (p<0.05). No significant differences were observed between the groups regarding survival or number of hospitalizations and attacks (p>0.05). Threshold values were determined as age ≥57.5 years, smoking history ≥14 pack-years, and diagnosis at age ≥40.5 years. The frequency of ACO was observed to be very high in patients with asthma. In patients >57.5 years old, with a smoking history of >14.5 pack-years, and diagnosed with asthma at >40.5 years old, the probability of ACO diagnosis increases.

Prevalence and Characteristics of Asthma-Chronic Obstructive Pulmonary Disease Overlap in Routine Primary Care Practices.

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.

Female-specific risk factors associated with risk of ACO (asthma COPD overlap) in aboriginal people

Objective: Sex differences in incidence, susceptibility and severity of many chronic respiratory diseases have been long recognized. Asthma-COPD Overlap (ACO) is newly recognized disease with its management guidelines reported in 2015. The objective of this analysis is to identify the female-specific risk factors associated with ACO in Aboriginal people.Methods: The Aboriginal Peoples Survey 2012 (N = 28,410) is the fourth cycle of a national cross-sectional survey representative of the First Nations living off reserve, Metis and Inuit. The 2012 APS collected information on employment, education, health status, housing, family background and income. Survey Logistic Regression was used to identify the significant risk factors for ACO in the multivariate analysis.Results: The prevalence of ACO was 1.65% and 3.53% in males and females, respectively. The following factors were significantly associated with increased risk of ACO in both males and females: increased age, living in Quebec, living in a rented dwelling and dwelling in need of major repairs. However, four factors including marital status (being widowed, separated, or divorced), smoking status (being a current daily smoker), having a diagnosis of diabetes and working 40 h and over a week were significantly associated with increased risk of ACO in females not males.Conclusion:The results of our study may offer useful evidence for future development of female-specific prevention and public health intervention programs in aboriginal communities to reduce the burden of ACO.

ACO: Time to move from the description of different phenotypes to the treatable traits.

BackgroundAsthma-COPD overlap (ACO) is a term that encompasses patients with characteristics of two conditions, smoking asthmatics or COPD patients with asthma-like features such as high bronchodilator response or blood eosinophil count ≥300 cells/μL. The aim of this study was to compare the different phenotypes inside the ACO definition in a real-life population cohort.MethodsWe analyzed patients from the MAJORICA cohort who had a diagnosis of asthma and/or COPD based on current guidelines, laboratory data in 2014 and follow-up until 2015. Prevalence of ACO according to the different criteria, demographic, clinical and functional characteristics, prescriptions and use of health resources data were compared between three groups.ResultsWe included 603 patients. Prevalence of smoking asthmatics was 14%, COPD patients with high bronchodilator response 1.5% and eosinophilic COPD patients 12%. Smoking asthmatics were younger and used more rescue inhalers, corticosteroids and health resources. Conversely, eosinophilic COPD patients were older than the other groups, often treated with corticosteroids and had lower use of health resources. Most of the COPD patients with high bronchodilator response were included in the eosinophilic COPD group.ConclusionsACO includes two conditions (smoking asthmatics and eosinophilic COPD patients) with different medication requirement and prognosis that should not be pooled together. Use of ≥300 blood eosinophils/μL as a treatable trait should be recommended.

Prevalence and characteristics of asthma-chronic obstructive pulmonary disease overlap among asthma and chronic obstructive pulmonary disease patients in a tertiary care center in Northeast India

Introduction: There is an increasing awareness of a subgroup of patients with chronic airway obstruction which shares several features of asthma as well as chronic obstructive pulmonary disease (COPD) known as asthma-COPD overlap (ACO). There are limited studies on the characteristics of this subgroup while the disease tends to be more severe in them compared to those with asthma or COPD alone. The aim of this study is to determine the prevalence and clinical and sociodemographic profile of ACO. Materials and Methods: This is a single-center, cross-sectional study over a 2-year period from September 2016 to October 2018. Patients above 40 years of age attending our center for the treatment of asthma or COPD in the study period were enrolled. Using the stepwise syndromic approach stated in the recent Global Initiative for Asthma guidelines, they were classified into the groups: asthma, COPD, or ACO. Results: Of the 164 patients enrolled, 37 (22.6%) were found to have ACO. Among patients with ACO, 21 (56.8%) were female (P = 0.016). The prevalence was highest in the age group of 51–60 years, and 31 (83.8%) were smokers/ex-smokers. Majority (43.5%) had normal body mass index. The mean forced expiratory volume in 1 (FEV1) (pre- and postbronchodilation) was lower for patients with ACO (1.4 ± 0.482 and 1.6 ± 0.391) compared to asthma/COPD alone (1.7 ± 0.663 and 1.8 ± 0.682) but was not clinically significant. The postbronchodilation FEV1/forced vital capacity was significantly lower for ACO (69.4 ± 13.2) compared to asthma/COPD alone (72.9 ± 12.7). Twenty-five (67.5%) patients had reversibility. Conclusion: Using the syndromic approach, the prevalence of ACO was found to be 22.6%. Significantly more females and smokers/ex-smokers present with ACO. Patients with ACO have worse lung function than those with asthma/COPD alone.

Prevalence and features of asthma‐COPD overlap in the United States 2007–2012

Perceived to be distinct, asthma and chronic obstructive pulmonary disease (COPD) can co-exist and potentially have a worse prognosis than the separate diseases. Yet, little is known about the exact prevalence and the characteristics of the Asthma-COPD overlap (ACO) in the US population. To determine ACO prevalence in the United States, identify ACO predictors, examine ACO association with asthma and COPD severity, and describe distinctive spirometry and laboratory features of ACO. Data on adult participants to the National Health and Nutrition Examination Surveys conducted from 2007 to 2012 was analyzed. ACO was defined as current asthma and post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) <0.7. Overall, 7,570 participants representing 98.58 million Americans were included in our study. From 2007 to 2012, the crude and age-standardized ACO prevalence were, respectively, 0.96% (95% CI: 0.65%-1.26%) and 1.05% (0.74%-1.37%). In asthma, ACO predictors included older age, male gender, and smoking. In COPD, ACO predictors were non-Hispanic Black race/ethnicity and obesity. ACO was associated with increased ER visits for asthma (OR = 3.46, 95% CI: 1.48-8.06]) and oxygen therapy in COPD (OR = 11.17, 95% CI: 5.17-24.12]). In spirometry, FEV1 and peak expiratory flow were lower in ACO than in asthma or COPD alone. Age-adjusted prevalence of ACO in the United States was 1.05% in 2007-2012, representing 0.94 (95% CI: 0.62-1.26) million Americans. It is much lower than previously reported. The overlap was associated with higher asthma and COPD severity as well as decreased lung function compared with COPD or asthma alone.

Journal Club - Asthma/Chronic Obstructive Pulmonary Disease Overlap: Fact or Fiction?

With the development of biologics and the advent of “precision medicine” there is great interest in defining phenotypes and indeed endotypes that may identify responders based on clinical characteristics and/or underlying biological mechanisms. Recently, the Food and Drug Administration (FDA) voted against approval of mepolizumab for use in chronic obstructive pulmonary disease (COPD) stating that there was insufficient evidence to support mepolizumab as an add-on therapy for COPD patients guided by eosinophil levels. The FDA committee pointed to a lack of consensus over the definition and possible relevance of a so-called “eosinophilic COPD phenotype.” They pointed to the variability in blood eosinophils making it a challenge to use it as a potential marker to identify appropriate candidates for therapeutic trials. The committee recommended greater research with larger numbers and better patient characterization, including more female patients, (an important recommendation particularly given that women are known to have higher rates of airway hyper-responsiveness than men). Refining the characterization of the asthma/COPD overlap (ACO) group is key to moving forward in studying the use of biologics in this population. Recent studies have pointed to the benefits of long-acting muscarinic antagonists (LAMA) bronchodilators, originally only indicated for COPD, to be efficacious in some asthma patients (tiotropium has been approved by the FDA for asthma and COPD).1,2 Conversely, there have been several trials that have looked at the use of TH-2 pathway biologics typically reserved for asthma patients, (omalizumab,3 mepolizumab4-6and benralizumab7), in COPD patients thought to demonstrate potential overlap features (history of allergies, elevated immunoglobulin E [IgE], high eosinophil counts, asthma history, smoking history, partial reversibility). The various criteria used to define the ACO group have typically utilized some combination of these features. This is the backdrop for reviewing several recent papers that have focused on assessing the prevalence of ACO according to different ACO criteria and/or examined various potential clinical characteristics and/or biomarkers that may lead to greater discrimination in defining the potential endotypes within the ACO group. I present this particular collection of recent studies from this year mostly to demonstrate the highly variable, (and in some instances questionable), criteria for defining ACO patients. With more biologics for airway disease in the pipeline it is critical that we further refine our precision in defining the heterogeneity of the endotypes (or treatable traits) within the ACO group for better patient selection in clinical trials. Note: Abstracts are presented in their original, published format and have not been edited to match JCOPDF style.

The Prevalence and Symptom Profile of Asthma–COPD Overlap: The HUNT Study

ABSTRACTThe concept of asthma and COPD as separate conditions has been questioned, and the term asthma–COPD overlap syndrome has been introduced. We assessed the prevalence, symptoms, and lifestyle factors of asthma–COPD overlap (ACO) in a large Norwegian population-based study.From 2006 to 2008, a total of 50,777 residents of Nord-Trøndelag participated in the Nord-Trøndelag Health Study, Norway. They completed questionnaires regarding respiratory symptoms, disease status, and medication use. We estimated the prevalence and 95% confidence intervals of ACO. Additionally, spirometry was used to estimate the prevalence of ACO in a subgroup.The prevalence of self-reported ACO was 1.9%, and in age groups <40, 40–60 and ≥60 years it was 0.7%, 1.4%, and 3.2%, respectively. Among those reporting COPD, the proportion of ACO was 0.56. In the spirometry subgroup when ACO was defined as doctor diagnosed asthma ever and FEV1/FVC < 0.70, the prevalence of ACO was 2.0%. All respiratory symptoms, separately or in combination, as well as medication use were reported most frequently in those with ACO compared to the other groups. Strikingly, we observed a two-fold higher proportion of allergic rhinitis in ACO compared to COPD only.In this Norwegian population, the prevalence of self-reported ACO was 1.9%, and the corresponding proportion of ACO among those with COPD was 0.56. Participants with ACO generally had the highest proportions of respiratory symptoms compared to asthma or COPD.

Prevalence, clinical characteristics and morbidity of the Asthma-COPD overlap in a general population sample

ABSTRACTObjective: Although asthma and chronic obstructive pulmonary disease (COPD) have been regarded as distinct conditions, emerging literature suggests that overlapping phenotypes, called asthma-COPD overlap (ACO), exists. The aim of this study was to describe prevalence, patient characteristics and morbidity of ACO. Methods: From a cross-sectional population sample, the West Sweden Asthma Study, subjects with suspected asthma, chronic bronchitis or COPD, and a random sample, were invited to clinical examinations. ACO was defined as doctor-diagnosed asthma, or clear clinical signs of asthma at examination, with a FEV1/FVC < 0.7. Results: Subjects were categorized as ACO (N = 181), COPD only (N = 89), asthma only (N = 651) or healthy (n = 1036) based on clinical examinations. Prevalence of ACO was 3.4% in the random sample (N = 1172) and 18.1% among asthmatics (N = 138) in the random sample. Subjects with ACO (mean age 59 years, 54% women) had an age and gender distribution in between asthma only (45 years, 63% women) and COPD only (62 years, 41% women). Ever-smoking was reported by 71%, 48% and 74% in the ACO, asthma only and COPD only groups, respectively. Subjects with ACO had worse lung function (mean FEV1% of predicted normal 76%) than asthma only (100%) and COPD only (87%) and reported more respiratory symptoms. Also respiratory related emergency visits were more common in ACO compared to asthma only and COPD only, respectively. Conclusions: ACO is present in 3.4% of the population and common among subjects with both asthma and COPD. Subjects with ACO had worse lung function and more symptoms than subjects with asthma or COPD only.