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Comparative Study
. 2019 Feb 27:14:493-498.
doi: 10.2147/COPD.S192003. eCollection 2019.

Longitudinal comparison of outcomes in patients with smoking-related asthma-COPD overlap and in non-smoking asthmatics with incomplete reversibility of airway obstruction

Louis-Philippe Boulet  1 , Marie-Eve Boulay  1 , Joanne Milot  1 , Johane Lepage  1 , Lara Bilodeau  1 , François Maltais  1
Affiliations
Comparative Study

Longitudinal comparison of outcomes in patients with smoking-related asthma-COPD overlap and in non-smoking asthmatics with incomplete reversibility of airway obstruction

Louis-Philippe Boulet et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Background: There is a need to characterize the impact of the smoking status on the clinical course of asthmatics with incomplete reversibility of airway obstruction (IRAO).

Objective: To compare longitudinal health care use, symptom control, and medication needs between smoking and non-smoking asthmatics with IRAO.

Materials and methods: This was a 12-month follow-up of a cross-sectional study comparing asthmatics with IRAO according to their tobacco exposure. One group had a tobacco exposure ≥20 pack-years and was considered to have asthma-COPD overlap (ACO) and the second with a past tobacco exposure <5 pack-years was considered as non-smokers with IRAO (NS-IRAO). Study participants were contacted by telephone every 3 months to document exacerbation events and symptom control.

Results: A total of 111 patients completed all follow-up telephone calls: 71 ACO and 40 NS-IRAO. The number of exacerbations per patient over the 12-month follow-up was similar in both groups. However, ACO reported worse symptom control throughout the follow-up as compared to NS-IRAO, although no significant variations within a group were observed over the study period.

Conclusion: Although asthma control scores were poorer in ACO patients over 1 year compared to NS-IRAO, exacerbation rate was similar and low in both groups of asthmatics. These observations suggest that poorer asthma control in ACO was not driven by the number of exacerbations but may reflect the influence of chronic airway changes related to the COPD component.

Keywords: asthma-COPD overlap; exacerbations; fixed airflow limitation; smoking history; symptoms.

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Conflict of interest statement

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

Figures

Figure 1
Figure 1
Comparison of symptom control at baseline and over the follow-up period of 12 months between ACO and NS-IRAO. Notes: (A) ACQ-6 scores were higher in ACO as compared to NS-IRAO at baseline and throughout the follow-up period (P=0.016) with no significant variations between time points. (B) ACSS clinical scores were significantly lower in ACO as compared to NS-IRAO at baseline and throughout the follow-up period (P=0.004) with no significant variations between time points. Abbreviations: ACO, asthma-COPD overlap; NS-IRAO, non-smokers with incomplete reversibility of airway obstruction; ACQ-6, asthma control questionnaire-6; ACSS, asthma control scoring system.
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