Increased risk of exacerbation and hospitalization in subjects with an overlap phenotype: COPD-asthma.

BACKGROUND Several COPD phenotypes have been described; the COPD-asthma overlap is one of the most recognized. The aim of this study was to evaluate the prevalence of three subgroups (asthma, COPD, and COPD-asthma overlap) in the Latin American Project for the Investigation of Obstructive Lung Disease (PLATINO) study population, to describe their main characteristics, and to determine the association of the COPD-asthma overlap group with exacerbations, hospitalizations, limitations due to physical health, and perception of general health status (GHS). METHODS The PLATINO study is a multicenter population-based survey carried out in five Latin American cities. Outcomes were self-reported exacerbations (defined by deterioration of breathing symptoms that affected usual daily activities or caused missed work), hospitalizations due to exacerbations, physical health limitations, and patients' perception of their GHS obtained by questionnaire. Subjects were classified in three specific groups: COPD--a postbronchodilator (post-BD) FEV₁/FVC ratio of < 0.70; asthma--presence of wheezing in the last year and a minimum post-BD increase in FEV₁ or FVC of 12% and 200 mL; and overlap COPD-asthma--the combination of the two. RESULTS Out of 5,044 subjects, 767 were classified as having COPD (12%), asthma (1.7%), and COPD-asthma overlap (1.8%). Subjects with COPD-asthma overlap had more respiratory symptoms, had worse lung function, used more respiratory medication, had more hospitalization and exacerbations, and had worse GHS. After adjusting for confounders, the COPD-asthma overlap was associated with higher risks for exacerbations (prevalence ratio [PR], 2.11; 95% CI, 1.08-4.12), hospitalizations (PR, 4.11; 95% CI, 1.45-11.67), and worse GHS (PR, 1.47; 95% CI, 1.18-1.85) compared with those with COPD. CONCLUSIONS The coexisting COPD-asthma phenotype is possibly associated with increased disease severity.

[1]  G. Valdivia,et al.  Diagnostic labeling of COPD in five Latin American cities. , 2007, Chest.

[2]  N. Anthonisen,et al.  Prevalence of asthma symptoms among adults aged 20-44 years in Canada. , 2001, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[3]  E. Rönmark,et al.  The costs of exacerbations in chronic obstructive pulmonary disease (COPD). , 2002, Respiratory medicine.

[4]  T. Haahtela,et al.  Overlap Syndrome of Asthma and COPD Predicts Low Quality of Life , 2011, The Journal of asthma : official journal of the Association for the Care of Asthma.

[5]  Cesar G Victora,et al.  Chronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): a prevalence study , 2005, The Lancet.

[6]  T L Petty,et al.  Obstructive lung disease and low lung function in adults in the United States: data from the National Health and Nutrition Examination Survey, 1988-1994. , 2000, Archives of internal medicine.

[7]  R. de Marco,et al.  The Coexistence of Asthma and Chronic Obstructive Pulmonary Disease (COPD): Prevalence and Risk Factors in Young, Middle-aged and Elderly People from the General Population , 2013, PloS one.

[8]  J. Soriano,et al.  Characterisation of the overlap COPD-asthma phenotype. Focus on physical activity and health status. , 2013, Respiratory medicine.

[9]  Shengming Liu,et al.  Prevalence of chronic obstructive pulmonary disease in China: a large, population-based survey. , 2007, American journal of respiratory and critical care medicine.

[10]  Joan B Soriano,et al.  The proportional Venn diagram of obstructive lung disease: two approximations from the United States and the United Kingdom. , 2003, Chest.

[11]  Edwin K Silverman,et al.  Chronic obstructive pulmonary disease phenotypes: the future of COPD. , 2010, American journal of respiratory and critical care medicine.

[12]  D. Mannino,et al.  International variation in the prevalence of COPD (The BOLD Study): a population-based prevalence study , 2007, The Lancet.

[13]  A L Hansell,et al.  Proportional classifications of COPD phenotypes , 2008, Thorax.

[14]  R. Buhl,et al.  Clinical application of a simple questionnaire for the differentiation of asthma and chronic obstructive pulmonary disease. , 2004, Respiratory medicine.

[15]  D. Jarvis,et al.  Physician-diagnosed asthma and drug utilization in the European Community Respiratory Health Survey. , 1997, The European respiratory journal.

[16]  J. Jardim,et al.  Valores de referencia espirométrica en 5 grandes ciudades de Latinoamérica para sujetos de 40 o más años de edad , 2006 .

[17]  J C Jager,et al.  Current and future medical costs of asthma and chronic obstructive pulmonary disease in The Netherlands. , 1999, Respiratory medicine.

[18]  D. Maldonado,et al.  Prevalence of COPD in five Colombian cities situated at low, medium, and high altitude (PREPOCOL study). , 2008, Chest.

[19]  E. Antón,et al.  Prevalence and characteristics of three clinical phenotypes of chronic obstructive pulmonary disease (COPD). , 2013, Respiratory medicine.

[20]  C. Victora,et al.  The Platino project: methodology of a multicenter prevalence survey of chronic obstructive pulmonary disease in major Latin American cities , 2004, BMC medical research methodology.

[21]  S. Tortolero,et al.  Prevalence and risk factors of asthma and wheezing among US adults: an analysis of the NHANES III data , 2003, European Respiratory Journal.

[22]  D. Jarvis,et al.  Variation in bronchial responsiveness in the European Community Respiratory Health Survey (ECRHS). , 1997, The European respiratory journal.

[23]  Deborah Jarvis,et al.  Variations in the prevalence of respiratory symptoms, self-reported asthma attacks, and use of asthma medication in the European Community Respiratory Health Survey (ECRHS). , 1996, The European respiratory journal.

[24]  G. Valdivia,et al.  [Spirometric reference values in 5 large Latin American cities for subjects aged 40 years or over]. , 2006, Archivos de bronconeumologia.

[25]  John L. Hankinson,et al.  Standardization of Spirometry, 1994 Update. American Thoracic Society. , 1995, American journal of respiratory and critical care medicine.

[26]  R. Pauwels,et al.  Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. , 2001, American journal of respiratory and critical care medicine.

[27]  M. Malesker,et al.  Pharmacoeconomic evaluation of COPD. , 2000, Chest.

[28]  Joyce D. Schroeder,et al.  The clinical features of the overlap between COPD and asthma , 2011, Respiratory research.

[29]  L. Punnett,et al.  National income, self-reported wheezing and asthma diagnosis from the World Health Survey , 2009, European Respiratory Journal.

[30]  P. J. Barnes,et al.  Global strategy for asthma management and prevention: GINA executive summary , 2008, European Respiratory Journal.

[31]  Ramon Gisbert,et al.  Pharmacoeconomic evaluation of acute exacerbations of chronic bronchitis and COPD. , 2002, Chest.