Mortality in Asthma-Chronic Obstructive Pulmonary Disease Overlap in the United States

Kumbhare, Suchit; Strange, Charlie

doi:10.14423/smj.0000000000000807

Cited by 10 publications

(8 citation statements)

References 395 publications

(519 reference statements)

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“…In contrast, most cohort studies show lower mortality in ACO than in COPD, probably due to the better response of these patients to medical treatment compared to COPD alone. Regarding population-based studies, Kumbhare et al 67 investigated mortality among patients with obstructive lung disease, based on self-reported diagnoses of asthma, COPD and ACO, compared to the US general population. The ACO group was younger and had a higher proportion of ex-smokers than the group with COPD.…”

Section: Prognosis Of Acomentioning

confidence: 99%

Update on Asthma–COPD Overlap (ACO): A Narrative Review

Mekov¹,

Núñez²,

Sin³

et al. 2021

COPD

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Although chronic obstructive pulmonary disease (COPD) and asthma are well-characterized diseases, they can coexist in a given patient. The term asthma–COPD overlap (ACO) was introduced to describe patients that have clinical features of both diseases and may represent around 25% of COPD patients and around 20% of asthma patients. Despite the increasing interest in ACO, there are still substantial controversies regarding its definition and its position within clinical guidelines for patients with obstructive lung disease. In general, most definitions indicate that ACO patients must present with non-reversible airflow limitation, significant exposure to smoking or other noxious particles or gases, together with features of asthma. In patients with a primary diagnosis of COPD, the identification of ACO has therapeutic implication because the asthmatic component should be treated with inhaled corticosteroids and some studies suggest that the most severe patients may respond to biological agents indicated for severe asthma. This manuscript aims to summarize the current state-of-the-art of ACO. The definitions, prevalence, and clinical manifestations will be reviewed and some innovative aspects, such as genetics, epigenetics, and biomarkers will be addressed. Lastly, the management and prognosis will be outlined as well as the position of ACO in the COPD and asthma guidelines.

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Section: Prognosis Of Acomentioning

confidence: 99%

Update on Asthma–COPD Overlap (ACO): A Narrative Review

Mekov¹,

Núñez²,

Sin³

et al. 2021

COPD

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“…Most diagnoses were not specialist verified, most were cross-sectional, though two had follow-up, one up to 15 years. [15][16][17][18][19] In contrast, our study had a large sample size of unselected patients (all patients in Danish COPD outpatient clinics), and complete follow-up throughout the observation period. The patients in our country´s COPD outpatient clinics visit a respiratory medicine specialist at least annually, and the diagnoses of COPD and asthma are thus specialist confirmed, spirometry supported, and prescription collection history was compatible with diagnoses of obstructive pulmonary disease.…”

Section: Discussionmentioning

confidence: 97%

“…These studies pointed to a possibly higher risk for cardiovascular disease in patients with asthma. [15][16][17][18][19] However, many of these studies were based on small populations, with substantial loss to follow-up and insufficient confounder control.…”

Section: Introductionmentioning

confidence: 99%

Major cardiovascular events in patients with severe COPD with and without asthma: a nationwide cohort study

et al. 2022

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BackgroundChronic low-grade inflammation as in asthma may lead to a higher risk of cardiovascular events. We evaluated if patients with chronic obstructive pulmonary disease (COPD) and asthma have a higher risk of acute cardiovascular events than patients with COPD without asthma.MethodsNationwide multi-center retrospective cohort study of Danish outpatients with a specialist diagnosis of COPD with or without asthma. Patients with both COPD and asthma were propensity score matched 1: 2 to patients with COPD without asthma. The primary endpoint was severe major adverse cardiac events (MACE), defined as mortal cardiovascular events and events requiring revascularization or hospitalization.ResultsA total of 52 386 Danish patients with COPD were included, 34.7% had pre-existing cardiovascular disease, and 20.1% had asthma in addition to their COPD. Patients with pre-existing cardiovascular disease were then propensity score matched: 3690 patients with COPD and asthma versus 7236 patients with COPD without asthma. Similarly, for patients without pre-existing cardiovascular disease (6775 matched with 13 205).The risk of MACE was higher among patients with asthma and COPD versus COPD without asthma: Hazard ratio (HR): 1.25 (CI 1.13–1.39, p<0.0001) for patients with pre-existing cardiovascular disease and HR 1.22 (CI 1.06–1.41, p=0.005) for patients without pre-existing cardiovascular disease.ConclusionAmong patients with COPD, asthma as a comorbid condition is associated with substantially increased risk of cardiovascular events. The signal was an increased risk of 20–25%. Based on our study and other smaller studies, asthma can be considered a risk factor for cardiovascular events among COPD patients.

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“…There are studies that reported comparable mortality rates between ACO and COPD patients [ 84 , 85 ]. In contrast, some studies reported higher mortality rates in ACO subjects, while other studies reported lower mortality rates in patients with ACO compared to COPD alone [ 86 , 87 ].…”

Section: Treatment—prognosismentioning

confidence: 99%

Asthma-COPD Overlap Syndrome: Recent Insights and Unanswered Questions

Fouka

Papaioannou

Hillas

et al. 2022

JPM

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The term asthma-COPD overlap (ACO) has been used to identify a heterogeneous condition in which patients present with airflow limitation that is not completely reversible and clinical and inflammatory features of both asthma and chronic obstructive pulmonary disease (COPD). ACO diagnosis may be difficult in clinical practice, while controversy still exists regarding its definition, pathophysiology, and impact. Patients with ACO experience a greater disease burden compared to patients with asthma or COPD alone, but in contrast they show better response to inhaled corticosteroid treatment than other COPD phenotypes. Current management recommendations focus on defining specific and measurable treatable clinical traits, according to disease phenotypes and underlying biological mechanisms for every single patient. In this publication, we review the current knowledge on definition, pathophysiology, clinical characteristics, and management options of ACO.

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Mortality in Asthma-Chronic Obstructive Pulmonary Disease Overlap in the United States

Cited by 10 publications

References 395 publications

Update on Asthma–COPD Overlap (ACO): A Narrative Review

Update on Asthma–COPD Overlap (ACO): A Narrative Review

Major cardiovascular events in patients with severe COPD with and without asthma: a nationwide cohort study

Asthma-COPD Overlap Syndrome: Recent Insights and Unanswered Questions

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