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Comparative Study
. 2017 Feb 10:12:571-579.
doi: 10.2147/COPD.S123167. eCollection 2017.

Incidence and long-term outcome of severe asthma-COPD overlap compared to asthma and COPD alone: a 35-year prospective study of 57,053 middle-aged adults

Camilla Boslev Baarnes  1 , Zorana Jovanovic Andersen  2 , Anne Tjønneland  3 , Charlotte Suppli Ulrik  4
Affiliations
Comparative Study

Incidence and long-term outcome of severe asthma-COPD overlap compared to asthma and COPD alone: a 35-year prospective study of 57,053 middle-aged adults

Camilla Boslev Baarnes et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Background: Incidence and prognosis for severe asthma-COPD overlap is poorly characterized. We investigated incidence and long-term outcome for patients with asthma-COPD overlap compared to asthma and COPD alone.

Materials and methods: A total of 57,053 adults (aged 50-64 years) enrolled in the Danish Diet, Cancer, and Health cohort (1993-1997) were followed in the National Patients Registry for admissions for asthma (DJ45-46) and COPD (DJ40-44) and vital status. Asthma-COPD overlap was defined as at least one hospital admission for asthma and one for COPD (different time points), and incident asthma-COPD overlap as at least one of the diagnoses occurring after enrollment into the Diet, Cancer, and Health cohort.

Results: A total of 1,845 (3.2%) and 4,037 (7.1%) participants had admissions for asthma and COPD, respectively, with 662 (1.2%) participants with asthma-COPD overlap. Incidence rate of asthma-COPD overlap per 1,000 person-years was higher in women (0.73) than in men (0.54) (P<0.02). Mortality rate was higher in asthma-COPD overlap (25.9 per 1,000 person-years) compared with COPD (23.1, P<0.05) and asthma (7.9, P<0.001) alone. Compared to COPD alone, mortality was higher in women with asthma-COPD overlap (19.6 and 25.5, respectively; P<0.01), and the excess mortality rate for asthma-COPD overlap patients was most prominent for younger age groups (12.9 compared to 7.2 and 4.6 for COPD and asthma alone, respectively; P<0.01).

Conclusion: This large population-based study revealed a higher incidence of severe asthma-COPD overlap in women compared to men, and furthermore that all-cause mortality is higher in women and younger subjects with asthma-COPD overlap compared with those with asthma or COPD alone.

Keywords: ACOS; COPD; asthma; asthma–COPD overlap; incidence; mortality; outcome.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in relation to this work.

Figures

Figure 1
Figure 1
Flowchart describing participants included in the present study from the Diet, Cancer, and Health cohort. Notes: Based on discharge diagnoses of asthma and/or COPD, either as a primary diagnosis or as a secondary diagnosis to acute respiratory failure (1978–2013). Data from the Diet, Cancer, and Health cohort: Tjønneland et al and Bonnelykke et al.
Figure 2
Figure 2
Incident cases of COPD, asthma, and asthma–COPD overlap. Note: Participants with first-ever hospital admission for asthma, COPD, or both, ie, asthma–COPD overlap, after baseline (1993–1997) per 1,000 person-years overall and according to gender.
Figure 3
Figure 3
All-cause mortality rates per 1,000 person-years. Note: Rates overall and according to gender in the entire cohort (n=57,053) and for participants with COPD (n=3,375), asthma (n=1,183), and asthma–COPD overlap (n=662).
See this image and copyright information in PMC

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