Asthma and Chronic Obstructive Pulmonary Disease Overlap According to the Japanese Respiratory Society Diagnostic Criteria: The Prospective, Observational ACO Japan Cohort Study

Abstract

Introduction: Patients with asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) present with chronic respiratory symptoms with features of both asthma and COPD. New ACO diagnostic criteria (2018) were suggested by the Japanese Respiratory Society (JRS). This prospective, multicenter, observational cohort study was conducted to investigate the proportion of patients who meet the JRS ACO diagnostic criteria among COPD patients in clinical practice.

Methods: This 2-year ongoing study enrolled consecutive outpatients aged ≥ 40 years with COPD who visited one of 27 Japanese centers at which the medical examinations/tests required for ACO diagnosis were routinely conducted. At registration, the proportion of ACO or non-ACO patients was determined using the JRS diagnostic criteria, and the characteristics of the two groups were compared using analysis of variance and chi-square test.

Results: Of 708 COPD patients analyzed at registration, 396 (55.9%) had the data necessary for ACO diagnosis to be conducted, and 312 (44.1%) were lacking these data. Of the 396 patients who had the data necessary for ACO diagnosis, 101 (25.5%) met the diagnostic criteria for ACO, and 295 (74.5%) did not (non-ACO patients). ACO patients were younger, had a greater rate of asthma based on a physician's diagnosis, and used more medications, including inhaled corticosteroids (p < 0.05), compared with non-ACO patients.

Conclusions: We have determined the proportion of patients with the data necessary to diagnose ACO using the JRS criteria, and the proportion of these who met the ACO criteria among the COPD population at the time of registration. Patients, including those lacking necessary examination/test data at registration, will continue to undergo follow-up to explore changes in their testing and ACO diagnostic status over time. Analyses of study data over 2 years will provide relevant information on the ACO symptoms, clinical course, and real-world treatment patterns.

Trial registration: ClinicalTrials.gov identifier, NCT03577795.

Keywords: ACO; Airflow limitation; Asthma; COPD; Clinical course; Diagnostic criteria; Japan; Observational study; Respiratory symptoms; Treatment outcome.

Fig. 1

Patient flow. ACO asthma-COPD overlap, COPD chronic obstructive pulmonary disease, JRS Japanese Respiratory Society. ^aPatients who were lacking data necessary for the JRS ACO criteria to be applied and were not given an ACO diagnosis at registration. ^bPatients who had the data necessary for the JRS ACO criteria to be applied and were able to be diagnosed as ACO or non-ACO at registration. The enrollment period was from June 2018 to December 2018. Patients were categorized based on examination/test data obtained within 1 year prior to registration

Fig. 2

Proportion of patients who met Japanese Respiratory Society ACO diagnostic criteria. ACO asthma-COPD overlap, COPD chronic obstructive pulmonary disease