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      Prevalence and Characteristics of Asthma–Chronic Obstructive Pulmonary Disease Overlap in Routine Primary Care Practices

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          The Asthma-COPD Overlap Syndrome.

          Although in textbooks asthma and chronic obstructive pulmonary disease (COPD) are viewed as distinct disorders, there is increasing awareness that many patients have features of both. This article reviews the asthma-COPD overlap syndrome.
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            The clinical features of the overlap between COPD and asthma

            Background The 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. Methods We performed a cross-sectional study comparing subjects with COPD and asthma to subjects with COPD alone in the COPDGene Study. Results 119 (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. Conclusion Subjects 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 registration ClinicalTrials.gov: NCT00608764
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              Bronchodilator reversibility testing in chronic obstructive pulmonary disease.

              A limited or absent bronchodilator response is used to classify chronic obstructive pulmonary disease (COPD) and can determine the treatment offered. The reliability of the recommended response criteria and their relationship to disease progression has not been established. 660 patients meeting European Respiratory Society (ERS) diagnostic criteria for irreversible COPD were studied. Spirometric parameters were measured on three occasions before and after salbutamol and ipratropium bromide sequentially or in combination over 2 months. Responses were classified using the American Thoracic Society/GOLD (ATS) and ERS criteria. Patients were followed for 3 years with post-bronchodilator FEV(1) and exacerbation history recorded 3 monthly and health status 6 monthly. FEV(1) increased significantly with each bronchodilator, a response that was normally distributed. Mean post-bronchodilator FEV(1) was reproducible between visits (intraclass correlation 0.93). The absolute change in FEV(1) was independent of the pre-bronchodilator value but the percentage change correlated with pre-bronchodilator FEV(1) (r=-0.44; p<0.0001). Using ATS criteria, 52.1% of patients changed responder status between visits compared with 38.2% using ERS criteria. Smoking status, atopy, and withdrawing inhaled corticosteroids were unrelated to bronchodilator response, as was the rate of decline in FEV(1), decline in health status, and exacerbation rate. In moderate to severe COPD bronchodilator responsiveness is a continuous variable. Classifying patients as "responders" and "non-responders" can be misleading and does not predict disease progression.
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                Author and article information

                Journal
                Annals of the American Thoracic Society
                Annals ATS
                American Thoracic Society
                2329-6933
                2325-6621
                September 2019
                September 2019
                : 16
                : 9
                : 1143-1150
                Affiliations
                [1 ]Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
                [2 ]Oxford University Medical School, Oxford, United Kingdom
                [3 ]Respiratory Effectiveness Group, Cambridge, United Kingdom
                [4 ]Centre of Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom
                [5 ]Observational and Pragmatic Research Institute, Singapore
                [6 ]Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa
                [7 ]Section of Respiratory Medicine and Allergology, Department of Clinical Sciences, and
                [8 ]Department of General Practice and Elderly Care Medicine, Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
                [9 ]Department of Respiratory Medicine, Laboratory for Translational Research in Obstructive Pulmonary Diseases, Ghent University Hospital, Ghent, Belgium
                [10 ]Department of Respiratory Medicine, Royal College of Surgeons, Dublin, Ireland
                [11 ]CIUSSS de l’Ouest-de-l’Île-de-Montréal, Montreal Chest Institute, Meakins-Christie Laboratories, Oscillometry Unit and Centre for Innovative Medicine, McGill University Health Centre and Centre Research Institute, Montreal, Quebec, Canada
                [12 ]Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, the Netherlands
                [13 ]Respiratory Medicine, Croix-Rousse University Hospital, Lyon, France
                [14 ]Department of Respiratory Medicine, Mater Dei Hospital, Msida, Malta
                [15 ]Family Physician Airways Group of Canada, University of Toronto, Toronto, Ontario, Canada
                [16 ]General Practitioners Research Institute, Groningen, the Netherlands
                [17 ]Pneumology Department, University Hospital Vall d'Hebron/Vall d’Hebron Research Institute (VHIR), CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
                [18 ]Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University, Nagoya, Japan
                [19 ]Universidade Federal de Santa Catarina, Florianópolis, Brazil
                [20 ]Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
                [21 ]Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain
                [22 ]Department of Medicine, Pulmonary and Critical Medicine, German Center for Lung Research, University of Marburg, Marburg, Germany
                [23 ]Primary Care Chronic Respiratory Diseases Research Unit, Instituto de Investigación Sanitaria de las Islas Baleres, IdISBa, Palma, Spain
                [24 ]Optimum Patient Care, Cambridge, United Kingdom
                [25 ]Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; and
                [26 ]Pneumologie et Soins Intensifs Respiratoires, Groupe Hospitalier Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
                Article
                10.1513/AnnalsATS.201809-607OC
                31162945
                5bc23b77-4912-4e05-b90e-ee6b149ff293
                © 2019
                History

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