Comparison of Acute Respiratory Events Between Asthma–COPD Overlap Syndrome and COPD Patients

Abstract

Epidemiologic studies investigating the differences in respiratory outcomes between asthma–chronic obstructive pulmonary disease overlap syndrome (ACOS) and chronic obstructive pulmonary disease (COPD) in an Asian population are lacking.We conducted a population-based cohort study to compare the incidence of acute respiratory events between ACOS and COPD cohorts in Taiwan. This study investigated the incidence of acute respiratory events, namely, pneumonia, acute exacerbation, acute respiratory failure, and cardiopulmonary arrest, in 8571 patients with physician-diagnosed ACOS between 2000 and 2007 from the Longitudinal Health Insurance Database. The comparison cohort comprised 17,088 COPD patients, frequency-matched according to age, sex, and the index-year. The duration of follow-up was measured for each patient from the index date to 5 years thereafter. We used univariable and multivariable Poisson regression models to analyze the risk of acute respiratory events by including the variables of sex, age, and comorbidity.The overall prevalence of ACOS was approximately 17.4% in patients with COPD. The prevalence of ACOS increased with age. During the 5-year follow-up, a greater incidence of acute respiratory events was observed in the ACOS cohort than in the COPD cohort (11.5 and 4.62, per 100 person-years, respectively) with an adjusted incidence rate ratio (IRR) of 1.72 (95% confidence interval [CI] = 1.63–1.81). Compared with the COPD cohort, the ACOS patients had a 1.13-fold adjusted IRR of pneumonia (95% CI = 1.07–1.20) and a 2.58-fold adjusted IRR of acute exacerbation (95% CI = 2.43–2.74). Clinicians should be aware of frequent exacerbation of ACOS and prescribe appropriate treatment.

Asthma-COPD overlap szindróma

“…A cardiovascularis betegségek tekintetében más tanulmány is alacsonyabb arányról számolt be a COPD-vel összehason-lítva, azonban az asthmás csoporthoz képest jelentősebb arányban volt jelen [57]. A pneumonia előfordulása az ACOS-betegeknél gyakoribb és nagyobb exacerbatiós rátával járt együtt, mint a COPD-s betegeknél [65]. Egy másik vizsgálat alapján a leggyakoribb halálok az ACOSbetegeknél malignitás miatt következett be, hasonló arányban, mint az asthmabetegeknél (57,4% vs. 54,5%).…”

Current situation of asthma-COPD overlap syndrome (ACOS) in Chinese patients older than 40 years with airflow limitation: rationale and design for a multicenter, cross-sectional trial (study protocol)

“…Physicians should have patient spirometric information available in the patient's medical files [post-bronchodilator forced expiratory volume (post-BD FEV 1 % pred.) and post-bronchodilator forced vital capacity (post-BD FEV 1 /FVC)] and spirometries must be according to the guidelines (20). A total of 2,000 participants who meet the entry criteria will be enrolled in the study.…”

“…In our opinion, insights from the current study will aid in redefining the guidelines in China for optimum benefits in the management of ACOS as it exhibits greater risks of acute respiratory events in all age groups for both women and men (20).…”

“…Appropriate diagnosis and treatment on time will have implications on improving QoL of patients and reducing the financial impact;  Patients with ACOS require 2-to 6-fold more healthcare resources compared with either disease alone (5,20). Although asthma and COPD are two different entities, both the GINA and GOLD define ACOS as a syndrome characterized by persistent airflow limitation with several features usually associated with asthma and COPD.…”

“…Concurrent doctordiagnosed asthma and COPD have been reported in 15% to 20% of the patients. COPD gene and EPI-SCAN studies reported that approximately 13% and 17.4% of patients with COPD, respectively, have a history of asthma, and 22.8% of the patients with an FEV 1 /FVC of <0.7 reported of having a previous diagnosis of asthma in the PLATINO study (5,(20)(21)(22)(23)(24)(25)(26)(27). This is the first multicenter, observational cross-sectional trial conducted to determine the current situation, main clinical practices, and features of ACOS, asthma, and COPD in Chinese patients (>40 years of age) with airflow limitation.…”