Details

Autor(en) / Beteiligte

• Reddel, Helen K
• Vestbo, Jørgen
• Agustí, Alvar
• Anderson, Gary P
• Bansal, Aruna T
• Beasley, Richard
• Bel, Elisabeth H
• Janson, Christer
• Make, Barry
• Pavord, Ian D
• Price, David
• Rapsomaniki, Eleni
• Karlsson, Niklas
• Finch, Donna K
• Nuevo, Javier
• de Giorgio-Miller, Alex
• Alacqua, Marianna
• Hughes, Rod
• Müllerová, Hana
• Gerhardsson de Verdier, Maria

Titel

Heterogeneity within and between physician-diagnosed asthma and/or COPD: NOVELTY cohort

Ist Teil von

• The European respiratory journal, 2021-09, Vol.58 (3), p.2003927

Ort / Verlag

England: European Respiratory Society

Erscheinungsjahr

2021

Quelle

EZB-FREE-00999 freely available EZB journals

Beschreibungen/Notizen

• Studies of asthma and chronic obstructive pulmonary disease (COPD) typically focus on these diagnoses separately, limiting understanding of disease mechanisms and treatment options. NOVELTY is a global, 3-year, prospective observational study of patients with asthma and/or COPD from real-world clinical practice. We investigated heterogeneity and overlap by diagnosis and severity in this cohort. Patients with physician-assigned asthma, COPD or both (asthma+COPD) were enrolled, stratified by diagnosis and severity. Baseline characteristics were reported descriptively by physician-assigned diagnosis and/or severity. Factors associated with physician-assessed severity were evaluated using ordinal logistic regression analysis. Of 11 243 patients, 5940 (52.8%) had physician-assigned asthma, 1396 (12.4%) had asthma+COPD and 3907 (34.8%) had COPD; almost half were from primary care. Symptoms, health-related quality of life and spirometry showed substantial heterogeneity and overlap between asthma, asthma+COPD and COPD, with 23%, 62% and 64% of patients, respectively, having post-bronchodilator FEV /FVC <lower limit of normal.Symptoms and exacerbations increased with greater physician-assessed severity, and were higher in asthma+COPD, but 24.3% with mild asthma and 20.4% with mild COPD had experienced ≥1 exacerbation in the past 12 months. Medication records suggested both under-treatment and over-treatment relative to severity. Blood eosinophil counts varied little across diagnosis/severity groups, but blood neutrophil counts increased with severity across all diagnoses. This analysis demonstrates marked heterogeneity within, and overlap between, physician-assigned diagnosis and severity groups in patients with asthma and/or COPD. Current diagnostic and severity classifications in clinical practice poorly differentiate between clinical phenotypes that may have specific risks and treatment implications.