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Prevalence and characteristics of asthma-chronic obstructive pulmonary disease overlap in routine primary care practices

Krishnan, Jerry A. ; Nibber, Anjan ; Chisholm, Alison ; Price, David ; Bateman, Eric D. ; Bjermer, Leif LU ; Van Boven, Job F.M. ; Brusselle, Guy ; Costello, Richard W. and Dandurand, Ronald J. , et al. (2019) In Annals of the American Thoracic Society 16(9). p.1143-1150
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 withACOin 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 crosssectional study of individuals ≥40 years old and with ≥2 outpatient primary care visits over a 2-year period in theUKOptimum Patient Care Research Database. Patients were... (More)

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 withACOin 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 crosssectional study of individuals ≥40 years old and with ≥2 outpatient primary care visits over a 2-year period in theUKOptimum 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.ACOwas defined as the presence of all of the following 1) age ≥40 years, 2) current or former smoking, 3) postbronchodilator 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.

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publication status
published
subject
keywords
Asthma, Asthma-COPD overlap, Comorbidities, COPD, Primary care
in
Annals of the American Thoracic Society
volume
16
issue
9
pages
8 pages
publisher
American Thoracic Society
external identifiers
  • pmid:31162945
  • scopus:85071785500
ISSN
2325-6621
DOI
10.1513/AnnalsATS.201809-607OC
language
English
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yes
id
08fabc99-4d7f-4ecb-97c3-4c56e49797e5
date added to LUP
2019-09-30 13:18:40
date last changed
2020-07-08 05:05:01
@article{08fabc99-4d7f-4ecb-97c3-4c56e49797e5,
  abstract     = {<p>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 withACOin 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 crosssectional study of individuals ≥40 years old and with ≥2 outpatient primary care visits over a 2-year period in theUKOptimum 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.ACOwas defined as the presence of all of the following 1) age ≥40 years, 2) current or former smoking, 3) postbronchodilator airflow limitation (forced expiratory volume in 1 second/ forced vital capacity &lt;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&lt;0.001) or asthma only (14%; P&lt;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.</p>},
  author       = {Krishnan, Jerry A. and Nibber, Anjan and Chisholm, Alison and Price, David and Bateman, Eric D. and Bjermer, Leif and Van Boven, Job F.M. and Brusselle, Guy and Costello, Richard W. and Dandurand, Ronald J. and Diamant, Zuzana and Van Ganse, Eric and Gouder, Caroline and Van Kampen, Sanne C. and Kaplan, Alan and Kocks, Janwillem and Miravitlles, Marc and Niimi, Akio and Pizzichini, Emilio and Rhee, Chin Kook and Soriano, Joan B. and Vogelmeier, Claus and Roman-Rodriguez, Miguel and Carter, Victoria and D'Urzo, Anthony D. and Roche, Nicolas},
  issn         = {2325-6621},
  language     = {eng},
  number       = {9},
  pages        = {1143--1150},
  publisher    = {American Thoracic Society},
  series       = {Annals of the American Thoracic Society},
  title        = {Prevalence and characteristics of asthma-chronic obstructive pulmonary disease overlap in routine primary care practices},
  url          = {http://dx.doi.org/10.1513/AnnalsATS.201809-607OC},
  doi          = {10.1513/AnnalsATS.201809-607OC},
  volume       = {16},
  year         = {2019},
}