Asthma–Chronic Obstructive Pulmonary Disease Overlap Syndrome Associated with Risk of Pulmonary Embolism

Abstract

PurposeWe conducted a cohort study to clarify this relationship between asthma–chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) and pulmonary embolism (PE).MethodsFrom the National Health Insurance Research Database of Taiwan, we identified patients who had a diagnosis of asthma and a diagnosis of COPD (defined as ACOS) and concurrent treatment between January 1999 and December 2009 (ACOS cohort: n = 14,150; non-ACOS cohort: n = 55,876). Cox proportional hazards regression analysis was performed to determine the adjusted hazard ratios (aHRs) for PE of the ACOS cohort compared with the non-ACOS cohort.ResultsComparing the ACOS cohort with the non-ACOS cohort, the aHR of PE was 2.08 (95% confidence intervals [CIs]: 1.56–2.76). The risk of PE was higher in ACOS cohort than non-ACOS cohort, regardless of age, sex, comorbidity, inhaled corticosteroids (ICSs) and oral steroids (OSs) used. For ages ranging from 20 to 65 years, the aHR of PE was 2.53 (95% CI: 1.44–4.44) in the ACOS cohort. ACOS patients using ICSs (aHR: 1.97, 95% CI: 1.29–3.01) or OSs (aHR: 1.97, 95% CI: 1.46–2.65), the risk of PE was higher than in the non-ACOS cohort. The risk of PE increased with the number of outpatient visits and hospitalizations necessitated, ranging from 2.32 (95% CI: 1.54–3.52) in patients having 3–9 visits to 4.20 (95% CI: 2.74–6.44) for those having >9 visits.ConclusionsACOS is associated with increased risk of PE, particularly patients with a high frequency of AE—even in young adults or people without comorbidities.

Association of asthma–chronic obstructive pulmonary disease overlap syndrome with coronary artery disease, cardiac dysrhythmia and heart failure: a population-based retrospective cohort study

“…Asthma–chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) 1 2 is a newly recognised, systemic inflammatory disease 3 4 that shares the characteristics of asthma and COPD. 5 6 ACOS is a form of airway and pulmonary vessel disease 7 8 that is associated with a disproportionate number of exacerbations and a higher overall healthcare burden 9 than either asthma or COPD alone.…”

Association between continuity of care and emergency department visits and hospitalization in senior adults with asthma-COPD overlap

“…First, the claims data did not include clinical data such as peak expiratory flow or forced expiratory volume to identify ACO [40]. Therefore, we used ICD-9-CM codes to define ACO as done in previous studies [4,6,29]. Second, the claims data lacks personal anthropometric measurements such as body mass index [39,40] and smoking status [39,51,52] that may affect healthcare outcomes.…”

“…There were 15,762 patients aged ≥65 years who either had at least 2 outpatient visits or 1 inpatient admission for COPD as a primary diagnosis (ICD-9-CM codes: 491.xx, 492.xx, 496.xx) [5,6,28,29] identified during the period from January 1, 2005, to December 31, 2011. The index date was set as the earliest date for patients who had a record during this period.…”

“…Patients who were not continuously enrolled in the NHI program (n = 954) until the end of study period were excluded. To identify ACO patients, patients without ≥2 outpatient visit claims or 1 inpatient admission for asthma (ICD-9-CM code 493.xx) in a prior year of index date [29,30] were excluded (n = 13,409). In order to calculate a stable COC value that requires ≥3 outpatient visits; therefore, patients had <3 outpatient visits during the COC period were excluded (n = 222).…”

Ashtma-Chronic obstructive pulmonary disease overlap syndrome (ACOS): current evidence and future research directions

“…Pulmonary embolism appears to be more frequent among patients with ACOS, compared to COPD alone. The risk of pulmonary embolism also increases with the number of outpatient visits and hospitalizations [67]. On the other hand ACOS patients appear to have less emphysema [47].…”