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Heterogeneity of asthma and COPD overlap

BACKGROUND: Asthma and COPD are heterogeneous diseases. Patients with both disease features (asthma–COPD overlap [ACO]) are common. However, clinical characteristics and socio-economic burden of ACO are still controversial. The aim of this study was to identify the heterogeneity of ACO and to find o...

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Autores principales: Kim, Min-Hye, Rhee, Chin Kook, Kim, Kyungjoo, Kim, Sang Hyun, Lee, Jung Yeon, Kim, Yee Hyung, Yoo, Kwang Ha, Cho, Young-Joo, Jung, Ki-Suck, Lee, Jin Hwa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2018
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5909798/
https://www.ncbi.nlm.nih.gov/pubmed/29713158
http://dx.doi.org/10.2147/COPD.S152916
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author Kim, Min-Hye
Rhee, Chin Kook
Kim, Kyungjoo
Kim, Sang Hyun
Lee, Jung Yeon
Kim, Yee Hyung
Yoo, Kwang Ha
Cho, Young-Joo
Jung, Ki-Suck
Lee, Jin Hwa
author_facet Kim, Min-Hye
Rhee, Chin Kook
Kim, Kyungjoo
Kim, Sang Hyun
Lee, Jung Yeon
Kim, Yee Hyung
Yoo, Kwang Ha
Cho, Young-Joo
Jung, Ki-Suck
Lee, Jin Hwa
author_sort Kim, Min-Hye
collection PubMed
description BACKGROUND: Asthma and COPD are heterogeneous diseases. Patients with both disease features (asthma–COPD overlap [ACO]) are common. However, clinical characteristics and socio-economic burden of ACO are still controversial. The aim of this study was to identify the heterogeneity of ACO and to find out the subtypes with clinical impact among ACO subtypes. METHODS: In the Korean National Health and Nutrition Examination Survey (KNHANES) conducted between 2007 and 2012, subjects who were ≥40 years and had prebronchodilator FEV(1)/FVC <0.7 and FEV(1) ≥50% predicted were included. The presence or absence of self-reported wheezing was indicated by W+ or W− and used as an index of airway hyper-responsiveness. S+/S− was defined as subjects who were smokers/never smokers. The subjects were divided into the following four groups: W−S−, W−S+, W+S−, and W+S+. W+S− and W+S+ were asthma-predominant ACO and COPD-predominant ACO, respectively. KNHANES and linked National Health Insurance data were analyzed. RESULTS: The asthma-predominant ACO group showed the lowest socioeconomic status, FEV(1), FVC% predicted, and quality of life (QoL) levels. The COPD-predominant ACO group showed the highest hospitalization rate, outpatient medical cost, and total and outpatient health care utilization. COPD-predominant ACO was associated with exacerbations compared to the W−S− group (adjusted odds ratio [aOR], 1.79; 95% confidence interval [CI], 1.12–2.85; P=0.015) and W−S+ group (OR 2.11; 95% CI 1.43–3.10; P<0.001). COPD-predominant ACO was associated with increased medical cost. CONCLUSION: Asthma-predominant ACO individuals displayed poorer socioeconomic status and QoL compared to the COPD-predominant ACO group. The COPD-predominant ACO group displayed more frequent exacerbations and greater medical costs. Considering the heterogeneity of ACO, it is desirable to identify subtypes of ACO patients and appropriately allocate limited medical resources.
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spelling pubmed-59097982018-04-30 Heterogeneity of asthma and COPD overlap Kim, Min-Hye Rhee, Chin Kook Kim, Kyungjoo Kim, Sang Hyun Lee, Jung Yeon Kim, Yee Hyung Yoo, Kwang Ha Cho, Young-Joo Jung, Ki-Suck Lee, Jin Hwa Int J Chron Obstruct Pulmon Dis Original Research BACKGROUND: Asthma and COPD are heterogeneous diseases. Patients with both disease features (asthma–COPD overlap [ACO]) are common. However, clinical characteristics and socio-economic burden of ACO are still controversial. The aim of this study was to identify the heterogeneity of ACO and to find out the subtypes with clinical impact among ACO subtypes. METHODS: In the Korean National Health and Nutrition Examination Survey (KNHANES) conducted between 2007 and 2012, subjects who were ≥40 years and had prebronchodilator FEV(1)/FVC <0.7 and FEV(1) ≥50% predicted were included. The presence or absence of self-reported wheezing was indicated by W+ or W− and used as an index of airway hyper-responsiveness. S+/S− was defined as subjects who were smokers/never smokers. The subjects were divided into the following four groups: W−S−, W−S+, W+S−, and W+S+. W+S− and W+S+ were asthma-predominant ACO and COPD-predominant ACO, respectively. KNHANES and linked National Health Insurance data were analyzed. RESULTS: The asthma-predominant ACO group showed the lowest socioeconomic status, FEV(1), FVC% predicted, and quality of life (QoL) levels. The COPD-predominant ACO group showed the highest hospitalization rate, outpatient medical cost, and total and outpatient health care utilization. COPD-predominant ACO was associated with exacerbations compared to the W−S− group (adjusted odds ratio [aOR], 1.79; 95% confidence interval [CI], 1.12–2.85; P=0.015) and W−S+ group (OR 2.11; 95% CI 1.43–3.10; P<0.001). COPD-predominant ACO was associated with increased medical cost. CONCLUSION: Asthma-predominant ACO individuals displayed poorer socioeconomic status and QoL compared to the COPD-predominant ACO group. The COPD-predominant ACO group displayed more frequent exacerbations and greater medical costs. Considering the heterogeneity of ACO, it is desirable to identify subtypes of ACO patients and appropriately allocate limited medical resources. Dove Medical Press 2018-04-17 /pmc/articles/PMC5909798/ /pubmed/29713158 http://dx.doi.org/10.2147/COPD.S152916 Text en © 2018 Kim et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Original Research
Kim, Min-Hye
Rhee, Chin Kook
Kim, Kyungjoo
Kim, Sang Hyun
Lee, Jung Yeon
Kim, Yee Hyung
Yoo, Kwang Ha
Cho, Young-Joo
Jung, Ki-Suck
Lee, Jin Hwa
Heterogeneity of asthma and COPD overlap
title Heterogeneity of asthma and COPD overlap
title_full Heterogeneity of asthma and COPD overlap
title_fullStr Heterogeneity of asthma and COPD overlap
title_full_unstemmed Heterogeneity of asthma and COPD overlap
title_short Heterogeneity of asthma and COPD overlap
title_sort heterogeneity of asthma and copd overlap
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5909798/
https://www.ncbi.nlm.nih.gov/pubmed/29713158
http://dx.doi.org/10.2147/COPD.S152916
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