Asthma and Chronic Obstructive Pulmonary Disease Overlap According to the Japanese Respiratory Society Diagnostic Criteria: The Prospective, Observational ACO Japan Cohort Study

Abstract

Introduction Patients with asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) present with chronic respiratory symptoms with features of both asthma and COPD. New ACO diagnostic criteria (2018) were suggested by the Japanese Respiratory Society (JRS). This prospective, multicenter, observational cohort study was conducted to investigate the proportion of patients who meet the JRS ACO diagnostic criteria among COPD patients in clinical practice. Methods This 2-year ongoing study enrolled consecutive outpatients aged ≥ 40 years with COPD who visited one of 27 Japanese centers at which the medical examinations/tests required for ACO diagnosis were routinely conducted. At registration, the proportion of ACO or non-ACO patients was determined using the JRS diagnostic criteria, and the characteristics of the two groups were compared using analysis of variance and chi-square test. Results Of 708 COPD patients analyzed at registration, 396 (55.9%) had the data necessary for ACO diagnosis to be conducted, and 312 (44.1%) were lacking these data. Of the 396 patients who had the data necessary for ACO diagnosis, 101 (25.5%) met the diagnostic criteria for ACO, and 295 (74.5%) did not (non-ACO patients). ACO patients were younger, had a greater rate of asthma based on a physician’s diagnosis, and used more medications, including inhaled corticosteroids ( p < 0.05), compared with non-ACO patients. Conclusions We have determined the proportion of patients with the data necessary to diagnose ACO using the JRS criteria, and the proportion of these who met the ACO criteria among the COPD population at the time of registration. Patients, including those lacking necessary examination/test data at registration, will continue to undergo follow-up to explore changes in their testing and ACO diagnostic status over time. Analyses of study data over 2 years will provide relevant information on the ACO symptoms, clinical course, and real-world treatment patterns. Trial registration ClinicalTrials.gov identifier, NCT03577795. Electronic supplementary material The online version of this article (10.1007/s12325-020-01573-x) contains supplementary material, which is available to authorized users.

Narrative review of current COPD status in Japan

“…This suggests that a prior history of asthma could be associated with the development of airway diseasedominant COPD. Moreover, the Japanese Respiratory Society (JRS) proposed the diagnostic criteria of asthma-COPD overlap (ACO) in 2018, conducted a multicentre study including 708 patients with COPD, and found that 255 (36%) had a physician's diagnosis of asthma (32).…”

“…Furthermore, of 396 whose data are sufficient to evaluate the new ACO criteria, 25.5% fulfilled the criteria of ACO (32).…”

Real-World Status of Medical Care and Treatment of Chronic Obstructive Pulmonary Disease by Respiratory Specialists in Japan

“…The details of the statistical analysis have been published elsewhere [9]. The planned sample size was 700 patients determined on the basis of the proportions of patients meeting the ACO diagnostic criteria reported in previous studies [10][11][12].…”

The Response to Biologics is Better in Patients with Severe Asthma Than in Patients with Asthma–COPD Overlap Syndrome

“… 1 Whichever the case, ACO is challenging for the clinician. 2 To choose the best therapeutic option is particularly difficult, given the lack of specific studies and the fact that most clinical trials for asthma excluded patients with features of COPD, and vice versa. Although biologics have demonstrated to be effective in T2-high asthma patients, 2 there is little experience with these drugs in ACO.…”

“…Another difference is that prior reports were restricted to the use of omalizumab while in this study different monoclonal antibodies were employed. All these drugs have demonstrated effectiveness in patients with asthma 2 but, in COPD patients, only mepolizumab and benralizumab were tested to date. 8 Mepolizumab 100 mg reduces the rate of moderate or severe exacerbations by 19% in COPD patients with an eosinophil count of at least 150/μL and benralizumab 100 mg reduces the rate of severe exacerbations requiring hospitalization in patients with ≥220/μL blood eosinophils (benralizumab 10 mg probably has the same effect on this specific subset).…”