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BackgroundPatients with symptoms of both asthma and chronic obstructive pulmonary disease (COPD) may be classified with the term asthma-COPD overlap (ACO). ACO is of considerable interest as it is currently poorly characterised and has been associated with worse health outcomes and higher healthcare costs compared with COPD or asthma alone. Patients with ACO in Asia remain poorly described, and there is limited information regarding their resource utilisation compared with patients with asthma or COPD only. This study investigated the characteristics, disease burden and medical resource utilisation of patients with ACO in Taiwan.MethodsThis was a retrospective cohort study of patients identified from National Health Insurance (NHI) claims data in Taiwan in 2009–2011. Patients were classified into incident ACO, COPD or asthma cohorts according to International Classification of Disease, ninth revision, clinical modification codes in claims. Eligible patients were ≥40 years of age with 12 months’ continuous enrolment in the NHI programme pre- and post-index date (date of the first relevant medical claim).ResultsPatients with ACO (N = 22,328) and COPD (N = 69,648) were older and more likely to be male than those with asthma (N = 50,293). Patients with ACO had more comorbidities and exacerbations, with higher medication use: short-acting β2-agonist prescriptions ranged from 30.4% of patients (asthma cohort) to 43.6% (ACO cohort), and inhaled corticosteroid/long-acting β2-agonist combination prescriptions ranged from 11.1% (COPD cohort) to 35.0% (ACO cohort) in the 12 months following index. Patients with ACO generally had the highest medication costs of any cohort (long-acting muscarinic antagonist costs ranged from $227/patient [asthma cohort] to $349/patient [ACO cohort]); they also experienced more respiratory-related hospital visits than patients with asthma or COPD (mean outpatient/inpatient visits per patient post-index: 9.1/1.9 [ACO cohort] vs 5.7/1.4 [asthma cohort] and 6.4/1.7 [COPD cohort]).ConclusionsPatients with ACO in Taiwan experience a greater disease burden with greater healthcare resource utilisation, and higher costs, than patients with asthma or COPD alone.Electronic supplementary materialThe online version of this article (10.1186/s12890-017-0571-7) contains supplementary material, which is available to authorized users.

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Post-earthquake reconnaissance has reported the vulnerability of older reinforced concrete (RC) columns lacking details for ductile response. Research was undertaken to investigate the full-range structural hysteretic behavior of older RC columns. A two-dimensional specimen frame, composed of nonductile and ductile columns to allow for load redistribution, was subjected to a unidirectional base motion on a shaking table until global collapse was observed. The test demonstrates two types of column failure, including flexure-shear and pure flexural failure. Test data are compared with various simplified assessment models commonly used by practicing engineers and researchers to identify older buildings that are at high risk of structural collapse during severe earthquake events. Comparison suggests that ASCE/SEI 41-06 produces very conservative estimates on load-deformation relations of flexure-shear columns, while the recently proposed ASCE/SEI 41-06 update imposes significant modifications on the predictive curve, so that improved accuracy has been achieved.

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