Background: Although the overlap between asthma and COPD has been recognized for years this overlap has only recently been given a name, asthma-COPD overlap syndrome (ACOS), and better defined. Different definitions of the component diseases can affect prevalence and outcome measures of ACOS. Methods: We used data from the National Health and Nutrition Examination Survey (NHANES) from [2007][2008][2009][2010][2011][2012] to determine the population estimates of ACOS in U.S. adults using 2 different definitions of ACOS (ACOS1 =self-reported COPD and current asthma; ACOS2 = spirometric-confirmed COPD [pre-bronchodilator FEV1/FVC <70%] and current asthma) and to describe variation in other factors, such as lung function impairment and health care utilization, by ACOS definitions. Results: Among U.S. adults aged 20 and older, 1.6% had ACOS1, and 1.9% had ACOS2. Both case definitions were similar with regard to symptoms and impairment of lung function. ACOS1 individuals were more likely to have one or more overnight hospital stays relative to those with neither asthma nor COPD, (odds ratio [OR] 3.4, 95% confidence interval [CI] 2.5, 4.6) than ACOS2 (OR 1.6, 95% CI 0.9, 2.9). Conclusions: Different definitions of ACOS in population-based studies affect both estimates of disease prevalence and outcomes related to the disease. These definitions need to be carefully considered in the design of epidemiologic studies and clinical trials. AbstractAbbreviations: asthma-COPD overlap syndrome, ACOS; National Health and Nutrition Examination Survey, NHANES; odds ratio, OR; confidence interval, CI; Global Initiative for Asthma, GINA; Global initiative for chronic Obstructive Lung Disease, GOLD; forced expiratory volume in 1 second, FEV 1 ; forced vital capacity, FVC; fractional exhaled nitric oxide, FeNO; parts per billion, ppb; body mass index, BMI; lower limit of normal, LLN Funding Support: This study was funded by GlaxoSmithKline (Study number WEUSKOP7057). Date of Acceptance: October 28, 2016 Citation: Mannino DM, Gan WQ, Wurst K, Davis KJ. Asthma and chronic obstructive pulmonary disease overlap: The effect of definitions on measures of burden.
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