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Meta-Analysis
. 2019 Oct 23;20(1):229.
doi: 10.1186/s12931-019-1198-4.

Global prevalence of asthma-COPD overlap (ACO) in the general population: a systematic review and meta-analysis

Mostafa Hosseini  1 , Amir Almasi-Hashiani  2 , Mahdi Sepidarkish  3 , Saman Maroufizadeh  4
Affiliations
Meta-Analysis

Global prevalence of asthma-COPD overlap (ACO) in the general population: a systematic review and meta-analysis

Mostafa Hosseini et al. Respir Res. .

Abstract

Background: Asthma-COPD overlap (ACO) is a term that encompasses patients with features of both asthma and COPD. To date, the global prevalence of ACO in the general population remains unknown. The objective of this study was to estimate the prevalence of ACO in the general population using a systematic review and meta-analysis.

Methods: A systematic search of ISI Web of Knowledge, MEDLINE/PubMed, and Scopus was performed up to May 2019 to identify studies reporting the prevalence of ACO. Reference lists from identified studies and relevant review articles were also searched. Eligibility criteria were studies reporting the prevalence of ACO, performed in general population, and published in English language. Pooled prevalence of ACO with 95% confidence interval (CI) was calculated using random effects Meta-analysis.

Results: A total of 27 studies were included in this meta-analysis. The Cochran Q test and I2 statistics revealed substantial heterogeneity among studies. Based on the random-effects model, the pooled prevalence of ACO was 2.0% (95% CI: 1.4-2.6%) in the general population, 26.5% (95% CI: 19.5-33.6%) among patients with asthma, and 29.6% (95% CI: 19.3-39.9%) among patients with COPD. In addition, for included studies, the global prevalence of asthma-only was 6.2% (95% CI: 5.0-7.4%) and COPD-only was 4.9% (95% CI: 4.3-5.5%).

Conclusion: We estimated the global prevalence of ACO based on population-based studies and found that 2.0% of the general population is affected. However, the prevalence of ACO depends on its diagnostic criteria. Therefore, there is a vital need to better define the ACO diagnostic criteria, management and treatment. It is worth noting that the limitations of the present study include lack of studies in some region of the world and small number of studies included in the subgroup analyses.

Keywords: Asthma; Asthma- COPD overlap; COPD; Meta-Analysis; Prevalence; Systematic Review.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram showing search strategy
Fig. 2
Fig. 2
Forest plot showing prevalence of ACO in the general population. Note. Squares represent study-specific prevalence estimates (size of the square denotes the study-specific statistical weight); Horizontal lines represent 95% confidence intervals (CIs); Diamond represents summary estimate of Prevalence with corresponding 95% CI.
Fig. 3
Fig. 3
Funnel plot for assessing publication bias in meta-analysis for ACO in general population
Fig. 4
Fig. 4
Forest plot showing prevalence of ACO in patients with asthma. Note. Squares represent study-specific prevalence estimates (size of the square denotes the study-specific statistical weight); Horizontal lines represent 95% confidence intervals (CIs); Diamond represents summary estimate of Prevalence with corresponding 95% CI.
Fig. 5
Fig. 5
Forest plot showing prevalence of ACO in patients with COPD. Note. Squares represent study-specific prevalence estimates (size of the square denotes the study-specific statistical weight); Horizontal lines represent 95% confidence intervals (CIs); Diamond represents summary estimate of Prevalence with corresponding 95% CI.
See this image and copyright information in PMC

References

    1. James SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, Abbastabar H, Abd-Allah F, Abdela J, Abdelalim A. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the global burden of disease study 2017. Lancet. 2018;392(10159):1789–1858. doi: 10.1016/S0140-6736(18)32279-7. - DOI - PMC - PubMed
    1. Ehteshami-Afshar S, FitzGerald J, Doyle-Waters M, Sadatsafavi M. The global economic burden of asthma and chronic obstructive pulmonary disease. Int J Tuberc Lung Dis. 2016;20(1):11–23. doi: 10.5588/ijtld.15.0472. - DOI - PubMed
    1. Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, Chen R, Decramer M, Fabbri LM. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease. 2017 Report. GOLD executive summary. Am J Respir Crit Care Med. 2017;195(5):557–582. - PubMed
    1. Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention, Updated 2017. In: www ginasthma org. 2017.
    1. Andersén H, Lampela P, Nevanlinna A, Säynäjäkangas O, Keistinen T. High hospital burden in overlap syndrome of asthma and COPD. Clin Respir J. 2013;7(4):342–346. doi: 10.1111/crj.12013. - DOI - PubMed

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