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. 2023 Aug 21;9(4):00098-2023.
doi: 10.1183/23120541.00098-2023. eCollection 2023 Jul.

Clinical characteristics of adults with self-reported diagnosed asthma and/or COPD: data from the BOLD Australia Study

Yijun Zhou  1 , Maria R Ampon  2 , Michael J Abramson  3 , Alan L James  4 , Graeme P Maguire  5 , Richard Wood-Baker  6 , David P Johns  6 , Guy B Marks  1   7 , Helen K Reddel  2 , Brett G Toelle  1   8
Affiliations

Clinical characteristics of adults with self-reported diagnosed asthma and/or COPD: data from the BOLD Australia Study

Yijun Zhou et al. ERJ Open Res. .

Abstract

Background: Diagnosis of asthma and chronic obstructive pulmonary disease (COPD) in the community is variable, often without spirometry. Some studies report that adults with both diagnostic labels (asthma+COPD) have worse health outcomes than those with asthma or COPD only, but data for Australian adults are limited. We investigated the relationship between clinical characteristics and self-reported diagnoses of asthma, COPD and both.

Method: We used data from the BOLD Australia study, which included randomly selected adults aged ≥40 years from six study sites. The BOLD questionnaires and spirometry test were used in all sites. Participants were grouped by self-reported diagnosis. Demographic and clinical characteristics and lung function were compared between groups.

Results: Of the study sample (n=3522), 336 reported asthma only, 172 reported COPD only, 77 reported asthma+COPD and 2937 reported neither. Fewer than half of participants with a COPD diagnosis (with or without asthma) had airflow limitation. Participants with asthma+COPD had more respiratory symptoms and greater airflow limitation than those with either diagnosis alone. Having asthma+COPD was independently associated with a higher probability of having clinically important breathlessness (modified Medical Research Council score ≥2) than asthma only (adjusted OR 3.44, 95% CI 1.86-6.33) or COPD only (adjusted OR 3.28, 95% CI 1.69-6.39). Airflow limitation (Global Initiative for Chronic Obstructive Lung Disease 2 or higher, using post-bronchodilator forced expiratory volume in 1 s/forced vital capacity ratio <0.7) was similar between asthma only and COPD only, but twice as prevalent in asthma+COPD (adjusted OR 2.18 and 2.58, respectively).

Conclusions: Adults with diagnoses of asthma+COPD have a higher symptom and disease burden than those with diagnoses of asthma only or COPD only. These patients should receive regular comprehensive reviews because of the substantially increased burden of having both diagnoses.

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Conflict of interest statement

Conflict of interest: M.J. Abramson holds investigator-initiated grants from Pfizer, Boehringer Ingelheim, Sanofi and GSK. He has conducted an unrelated consultancy for Sanofi. He has also received a speaker's fee from GSK. R. Wood-Baker reports cohort grants from the National Health and Medical Research Council. G.B. Marks has received funding for advisory boards with AstraZeneca. H.K. Reddel holds investigator-initiated grants from AstraZeneca, GlaxoSmithKline, Novartis and Perpetual Philanthropy. She has received consulting fees from AstraZeneca and GlaxoSmithKline, and honoraria for advisory boards and independent medical education from AstraZeneca, GlaxoSmithKline, TEVA, Boehringer Ingelheim, Sanofi, Getz and Chiesi. She holds non-funded leadership roles in the Global Initiative for Asthma (GINA) and National Asthma Council (NAC). All other authors declare no competing interests.

Figures

FIGURE 1
FIGURE 1
Four key characteristics of obstructive lung disease, by self-reported diagnosis of asthma and/or chronic obstructive pulmonary disease (COPD). Data presented with 95% confidence intervals. BD: bronchodilator; FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; LLN: lower limit of normal.
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