Abstract
Background: Literature suggests that patients with Asthma/COPD overlap (ACO) have worse outcomes, poorer quality of life, and increased mortality compared to COPD alone.
Objective: To describe features of ACO, explore different definitions of asthma, and evaluate outcomes compared to COPD alone.
Methods: 1976 COPD subjects from Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) cohort were stratified by self-reported physician diagnosis of asthma. Demographics, co-morbidities, smoking, exacerbations, medication use, and St.George's Respiratory Questionnaire (SGRQ) were compared. Negative binomial regression and multiple regression adjusting for age, gender, FEV1%, and exacerbation history were used to examine exacerbations and SGRQ, respectively.
Results: 1483 had COPD alone and 493 had ACO. Compared with COPD, ACO subjects were significantly younger, female (46% vs 30%), used more corticosteroids and long acting bronchodilators, reported more symptoms (SGRQ symptoms LS Mean difference: 4.9 95% CI: 2.8-7.0) and poorer quality of life (SGRQ total LS Mean difference: 3.1 95% CI: 1.2-5.0), and had a higher exacerbation rate (RR: 1.32 95% CI: 1.19-1.46). Adjusting for lung function and reversibility produced similar results. Results remained consistent when sensitivity analyses varying the definition of asthma were performed. No clinically meaningful differences in blood eosinophils or other biomarkers or mortality were observed.
Conclusion: ECLIPSE confirmed that ACO results in a higher disease burden and worse outcomes than COPD alone. ACO patients may need closer medical supervision, irrespective of the severity of airflow limitation. Funded by GSK (SCO104960, NCT00292552).
- Copyright ©ERS 2015