Asthma-COPD Overlap Shows Favorable Clinical Outcomes Compared to Pure COPD in a Korean COPD Cohort

Abstract

PurposeComparisons of the characteristics of chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap syndrome (ACOS) have been the focus of several studies since the diseases were defined by the Global Initiative for Asthma and Global Initiative for Chronic Obstructive Lung Disease guidelines. However, no consensus is available yet. In this study, we aimed to compare the characteristics of asthma-COPD overlap (ACO) and COPD.MethodsWe retrospectively reviewed 1,504 patients with COPD in a Korean COPD Subtype Study cohort. The occurrence of ACO was defined as a positive response to a bronchodilator (an increase in forced expiratory volume in 1 second [FEV1] of 12% and 200 mL).ResultsAmong 1,504 patients with COPD, 223 (14.8%) were diagnosed with ACO. Men (95.5%) and current smokers (32.9%) were more prevalent in the ACO group compared with the pure COPD group (90.5% and 25.3%, respectively; P=0.015 and P=0.026, respectively). Patients with ACO had a better quality of life (St. George's Respiratory Questionnaire for COPD score=31.0±18.0 [mean±standard deviation]) than those with pure COPD (35.3±19.1) (P=0.002). Although the prevalence of acute exacerbation was not different between the 2 groups, patients with severe exacerbation required hospital admission significantly more frequently in the pure COPD group than in the ACO group. Patients with ACO showed a higher likelihood of FEV1 recovery than those with pure COPD (P<0.001).ConclusionsWe suggest that ACO is characterized by less severe symptoms, and therefore it might lead to rare severe exacerbation and the possibility of lung function recovery.

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

“…The frequency of AE-COPD in the ACOS cohort compared with that in the non-ACOS cohort (eg, patients with only COPD, patients with only asthma and patients without asthma or COPD) that was determined in our study is different from those reported in previous studies. 1 2 24 In our previous study, 7 the frequency of AE-COPD was higher in the ACOS cohort than in the non-ACOS cohort (patients without asthma or COPD). The results of this study revealed that the frequency of CAD and CD events did not differ between the ACOS cohort with a higher frequency of AE-COPD and the non-ACOS cohort (aHRs for CAD and CD=1.05 and 1.11, respectively; all p>0.05).…”

“…This strategy may have counterbalanced 2 the risk of CAD and CD in the ACOS cohort with AE-COPD. 1 Studies conducted in Korea 1 and Japan 47 have reported that the lung function of patients with ACOS may be recovered by medication. Meanwhile, the ACOS cohort appeared to be more responsive to bronchodilators 34 and inhaled corticosteroids 48 compared with the COPD-only cohort; this finding supports the results of our study.…”

“…This was probably the most substantial limitation of this study. However, the ACOS cohort was derived from COPD groups 23 aged ≥40 years, as it was in studies conducted in Japan 2 and Korea, 1 9 and was based on ICD-9-CM codes used in a study recently conducted in the USA. 24 The Non-Interventional Study of COPD Patients with Asthma Overlap Syndrome in Vietnam and Taiwan (ClinicalTrials.gov identifier: NCT02878252) may address this point in the near future.…”

“…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.…”

Associations among chronic obstructive pulmonary disease with asthma, pneumonia, and corticosteroid use in the general population

“…COPD with asthma cohort exhibit lower forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) [12] and eosinophilic inflammation in the airway [54]. In COPD with asthma cohort, ICSs and OSs may attenuate eosinophilic [53] inflammation in the airway [54] and may have the lower frequency of AE [55], thus improving pulmonary function and quality of life. A favorable longitudinal change in lung function in COPD with asthma cohort with ICSs use is the slower decline of lung function (FEV1/FVC) in these patients compared with COPD cohort [13], supporting our result.…”