The clinical features of the overlap between COPD and asthma

Abstract

BackgroundThe coexistence of COPD and asthma is widely recognized but has not been well described. This study characterizes clinical features, spirometry, and chest CT scans of smoking subjects with both COPD and asthma.MethodsWe performed a cross-sectional study comparing subjects with COPD and asthma to subjects with COPD alone in the COPDGene Study.Results119 (13%) of 915 subjects with COPD reported a history of physician-diagnosed asthma. These subjects were younger (61.3 vs 64.7 years old, p = 0.0001) with lower lifetime smoking intensity (43.7 vs 55.1 pack years, p = 0.0001). More African-Americans reported a history of asthma (33.6% vs 15.6%, p < 0.0001). Subjects with COPD and asthma demonstrated worse disease-related quality of life, were more likely to have had a severe COPD exacerbation in the past year, and were more likely to experience frequent exacerbations (OR 3.55 [2.19, 5.75], p < 0.0001). Subjects with COPD and asthma demonstrated greater gas-trapping on chest CT. There were no differences in spirometry or CT measurements of emphysema or airway wall thickness.ConclusionSubjects with COPD and asthma represent a relevant clinical population, with worse health-related quality of life. They experience more frequent and severe respiratory exacerbations despite younger age and reduced lifetime smoking history.Trial registrationClinicalTrials.gov: NCT00608764

Effects of Allergic Phenotype on Respiratory Symptoms and Exacerbations in Patients with Chronic Obstructive Pulmonary Disease

“…Even when including subjects from NHANES with doctor-diagnosed asthma, the role of the allergic phenotype on health outcomes was not substantially altered. Whether the contribution of allergic disease to worse COPD outcomes is a result of a direct interplay between allergic inflammation and the inflammatory process of COPD or whether allergic disease is a marker of subjects with unrecognized concomitant asthma remains unclear (28). Regardless, our samples represent real-life populations of smokers who do not carry a diagnosis of asthma but who may benefit from further investigation of an allergic contribution to their respiratory symptoms.…”

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)

“…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.…”

Addressing unmet needs in the treatment of COPD

“…ACOS cannot be sufficiently distinguished from pure asthma or COPD through use of lung function tests alone and instead may require a combination of approaches, such as questionnaires, analysis of medical history and lung function assessments [27,31]. ACOS reportedly accounts for 10-20% of obstructive airway disease [32][33][34] and is associated with increased risk of exacerbation and hospitalisation [35]. ACOS influences treatment options; patients with ACOS require treatment that controls both asthma and COPD, through use of an ICS and appropriate bronchodilator therapy [31].…”

“…Patients with ACOS often have severe COPD according to the GOLD classification [33]. Effective bronchodilation, such as that provided by a dual bronchodilator, may be appropriate for these patients in addition to an ICS.…”