Asthma-COPD Overlap-A Discordance Between Patient Populations Defined by Different Diagnostic Criteria

Adam Barczyk; Marta Maskey-Warzęchowska; Katarzyna Górska; Marek Barczyk; Krzysztof Kuziemski; Paweł Śliwiński; Halina Batura-Gabryel; Robert Mróz; Aleksander Kania; Andrzej Obojski; Maciej Tażbirek; Natalia Celejewska-Wójcik; Katarzyna Guziejko; Beata Brajer-Luftmann; Damian Korzybski; Iwona Damps-Kostańska; Rafał Krenke

doi:10.1016/j.jaip.2019.04.022

Asthma-COPD Overlap-A Discordance Between Patient Populations Defined by Different Diagnostic Criteria

J Allergy Clin Immunol Pract. 2019 Sep-Oct;7(7):2326-2336.e5. doi: 10.1016/j.jaip.2019.04.022. Epub 2019 Apr 26.

Authors

Adam Barczyk¹, Marta Maskey-Warzęchowska², Katarzyna Górska³, Marek Barczyk⁴, Krzysztof Kuziemski⁵, Paweł Śliwiński⁶, Halina Batura-Gabryel⁷, Robert Mróz⁸, Aleksander Kania⁹, Andrzej Obojski¹⁰, Maciej Tażbirek¹, Natalia Celejewska-Wójcik⁹, Katarzyna Guziejko⁸, Beata Brajer-Luftmann⁷, Damian Korzybski⁶, Iwona Damps-Kostańska⁵, Rafał Krenke³

Affiliations

¹ Department of Pneumology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
² Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland. Electronic address: mmaskey@op.pl.
³ Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland.
⁴ Institute of Informatics, Silesian University of Technology, Gliwice, Poland.
⁵ Department of Allergology, Medical University of Gdańsk, Gdańsk, Poland.
⁶ 2nd Department of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland.
⁷ Department of Pulmonology, Allergology and Pulmonary Oncology, Medical University of Poznań, Poznań, Poland.
⁸ II Department of Lung Diseases and Tuberculosis, Medical University of Białystok, Białystok, Poland.
⁹ II Department of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland.
¹⁰ Department of Internal Medicine and Allergology, Wrocław Medical University, Wrocław, Poland.

PMID: 31034998
DOI: 10.1016/j.jaip.2019.04.022

Abstract

Background: The concordance between asthma-chronic obstructive pulmonary disease overlap (ACO) defined according to Global Inititative for Asthma (GINA)/Global Initiative for Chronic Obstructive Lung Disease (GOLD) and other diagnostic criteria is unknown.

Objective: To assess the concordance between different ACO definitions and to estimate the definition-based ACO prevalence and characteristics.

Methods: A prospective, real-life study based on a 32-item data set was performed in a mixed population of patients with asthma and chronic obstructive pulmonary disease (COPD). Five different definitions of ACO, including the GINA/GOLD criteria, were analyzed.

Results: A total of 1609 patients were included in the final analysis. Application of Venn diagram for ACO populations resulted in 31 ACO subpopulations, which were further reduced to 6 separate populations by introducing a rank order for the analyzed definitions to classify patients from intersecting groups. Overall, the level of agreement between different ACO definitions was poor. Cohen kappa coefficient for the agreement between ACO GINA/GOLD definition and other ACO definitions varied from 0.06 to 0.21. Only 2 patients (0.12%) met all the ACO definitions. Definition-based ACO prevalence ranged between 3.8% (Spanish criteria) and 18.4% (clinician's diagnosis). A total of 573 (33.4%) patients met the criteria from at least 1 ACO definition. Patients who could not be classified as suffering from "pure" asthma, "pure" COPD, or ACO accounted for as much as 27.5% of the whole investigated group. The most severe symptoms were observed in patients with ACO defined as COPD and asthma diagnosed at age less than 40 years.

Conclusions: The current ACO definitions identify distinct populations that share only a small number of common features and present with different disease phenotypes. ACO prevalence is highly variable, depending on the definition applied.

Keywords: Asthma-COPD overlap; GINA/GOLD; Venn diagrams.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Asthma / diagnosis*
Asthma / epidemiology
Asthma / physiopathology
Diagnosis, Differential
Female
Humans
Male
Middle Aged
Prevalence
Pulmonary Disease, Chronic Obstructive / diagnosis*
Pulmonary Disease, Chronic Obstructive / epidemiology
Pulmonary Disease, Chronic Obstructive / physiopathology