Chest
Volume 145, Issue 2, February 2014, Pages 297-304
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Original Research: Asthma
Increased Risk of Exacerbation and Hospitalization in Subjects With an Overlap Phenotype: COPD-Asthma

https://doi.org/10.1378/chest.13-0622Get rights and content

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.

Section snippets

Materials and Methods

The PLATINO study was a population-based survey carried out in Latin America; subjects performed spirometry with a portable spirometer (EasyOne spirometer; ndd Medical Technologies, Inc) at baseline and 15 min after the administration of 200 μg of salbutamol, according to the American Thoracic Society criteria of acceptability and reproducibility.10 Complete details of the methodology have been published elsewhere.11

The outcomes of this paper were self-reported exacerbations in the last year

Results

Out of the population of 5,044 subjects, 767 were classified as having one phenotype; 594 (11.7%) belonged to the COPD group, 84 (1.7%) to the asthmatic group, and 89 (1.8%) to the overlap group (Fig 1). The prevalence of these phenotypes using “medical diagnosis of asthma” is shown as e-Figure 1. e-Figure 2 shows the prevalence of these phenotypes calculated with a denominator of 767 (only those affected with asthma and COPD) rather than 5,044, as shown in Figure 1. The prevalence for overlap

Discussion

The principal findings of this study were as follows. First, using the GOLD criteria to define COPD, the presence of both wheezing and acute BD responsiveness to define asthma, and the combination of the two previous criteria for classifying the overlap COPD-asthma, we found that 1.7% of the PLATINO population belonged to the asthmatic group, around 12% to the COPD group, and 1.8% were classified in the overlap group. Second, subjects with COPD-asthma overlap had more respiratory symptoms;

Acknowledgments

Author contributions: Dr Menezes is guarantor of the manuscript and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Menezes: contributed by coordinating the PLATINO study, designed the analysis, wrote the manuscript, and revised and approved the article.

Dr Montes de Oca: contributed as the principal investigator in Caracas, designed the analysis, wrote the manuscript, and revised and approved the article.

Dr Pérez-Padilla: contributed as the principal

References (30)

  • DE Hilleman et al.

    Pharmacoeconomic evaluation of COPD

    Chest

    (2000)
  • M Miravitlles et al.

    Pharmacoeconomic evaluation of acute exacerbations of chronic bronchitis and COPD

    Chest

    (2002)
  • MP Rutten-van Mölken et al.

    Current and future medical costs of asthma and chronic obstructive pulmonary disease in The Netherlands

    Respir Med

    (1999)
  • N Zhong et al.

    Prevalence of chronic obstructive pulmonary disease in China: a large, population-based survey

    Am J Respir Crit Care Med

    (2007)
  • ED Bateman et al.

    Global strategy for asthma management and prevention: GINA executive summary

    Eur Respir J

    (2008)
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    *A complete list of PLATINO team participants is located in e-Appendix 1.

    Funding/Support: The PLATINO study was funded by Boehringer Ingelheim GmbH; GlaxoSmithKline supported the analysis presented in this paper.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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